Research Articles (School of Nursing)

Permanent URI for this collectionhttps://hdl.handle.net/10566/13

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Preferences of South African adolescents living with HIV in the Western Cape Province regarding the use of digital technology for self-management
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Weyers, Leonie; Crowley, Talitha; Tokwe, Lwandile
Adolescents living with HIV (ALHIV) face significant challenges in self-managing their chronic condition. Digital health technology (DHT) has become increasingly common and understanding ALHIVs’ preferences is essential for developing interventions tailored to this unique population. This study aimed to explore the preferences of ALHIV regarding the use of DHT for self-management. A qualitative research approach with an exploratory and descriptive design was used. Participants were recruited using a purposive sampling method. Data were gathered through six nominal focus groups with 29 participants at two Community Health Centers in the Western Cape Province, South Africa. The participants were ALHIV aged 15–24 years. Discussions focused on current technology usage and the ranking of desired DHT features. The transcripts were analyzed using thematic analysis. Three main themes emerged: (1) everyday usage of digital technology where participants frequently used digital devices for communication, social media, and finding information; (2) the role of digital technology in self-management; a strong interest in digital technology that provides medication reminders, health education, and peer support; and (3) factors influencing digital technology, including the cost of data, limited connectivity, and issues of privacy related to participants’ HIV status. The ALHIV showed a strong willingness to use digital platforms for health information, reminders, and peer support, although concerns about connectivity, data cost, and privacy remain. These findings underscore the need for flexible, user-centered approaches when designing DHT interventions for self-management in South Africa.
Midwives’ competence and confidence in Kenya: a sequential explanatory study design
(BioMed Central Ltd, 2026) Kaura, Doreen; Tallam, Edna; Mash, Bob
Background: The competence and confidence of midwives are pivotal in delivering essential care during pre-pregnancy, pregnancy, childbirth, and postpartum for women and their newborns. This study explored midwifery competency gaps in Kenya to recommend evidence-based policies, aiming to enhance maternal and neonatal health outcomes and inform future interventions. Methods: This study utilised a sequential explanatory study design which includes integrating quantitative and qualitative approaches of data collection, analysis, and synthesis. The quantitative phase involved a cross-sectional survey assessing midwives’ competence and confidence based on the International Confederation of Midwives (ICM) domains. 2019. The qualitative phase consisted of interviews with midwives and stakeholders to further explore and elucidate the quantitative findings. Sampling, interpretation, and reporting were integrated throughout the design. Data collection occurred in two distinct phases: an initial quantitative survey followed by qualitative interviews using a qualitative descriptive explanatory design with selected midwives and stakeholders. Qualitative data was coded and analyzed using Atlas ti 9 software. Thematic analysis, based on the Colaizzi framework, was conducted to capture emerging meanings while preserving the essence presented by the informants. Quantitative data were analyzed using SPSS, with descriptive statistics and statistical significance tested using Pearson’s Chi-square and Kruskal-Wallis tests. Both qualitative and quantitative data were analyzed separately and then connected to explain the results, ensuring triangulation and complementarity for comprehensive insights. Results: Direct-entry diploma midwives (KRM) and those working in tertiary hospitals reported higher competence and confidence (P = 0.019, p < 0.001, Kruskal-Wallis). KRMs were more confident in the ICM labour and birth domain (p = 0.017). Qualitative analysis revealed four themes: qualifications, enabling environment, work experience, and optimizing midwifery. Findings suggest that direct entry midwifery programs’ duration and education significantly impact midwives’ skill development. Mentorship and clinical supervision enhanced midwives’ confidence in labour and delivery domains.
Assessing the psychological distress and coping strategies among academic staff of a university during COVID-19
(AOSIS (Pty) Ltd, 2025) Owoeye, Isaiah; Akimanimpaye, Furaha; Adebiyi, Babatope
Background: The coronavirus disease 2019 (COVID-19) pandemic has been associated with stress because of its disruption to normal lifestyle. While the resilience of people was challenged, some coping strategies were adopted to maintain balance in the face of the pandemic. Aim: To assess psychological distress and coping strategies among the academic staff. Setting: Afe Babalola University located in the Southwest, Nigeria. Methods: A descriptive-cross-sectional design was used on the population of 512 academics where a sample size of 248 was drawn using Taro Yamane with a 10% non-response rate. The instruments used were a modified Kessler Psychological Distress Scale (K10) and an adapted COPE inventory for coping strategies. The scale reliability of K10 was 0.866 while that of coping strategy was 0.610. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 28. The results were presented in simple percentages, means and standard deviations. Results: Most respondents had severe psychological distress (185, 98.9%) with the most rated report ‘Feel worthless’ 4.8 ± 0.59. The most rated coping strategy was ‘I try to lose myself for a while by drinking alcohol or taking drugs’3.8 ± 0.60 with overall coping scale mean, 2.3 ± 1.02. Conclusion: There was severe distress and substance used among academics. The study recommends teaching on effective coping styles and institution probable preparation for future pandemic. Contribution: The study provides insight into the psychological state of the academic staff during the COVID-19 pandemic and unveils the adaptive strategies used. The results of the study are useful for the development of appropriate coping skills for the staff.
Strengthening theoretical assessment design in nursing education: advancing SDG 4
(AOSIS (pty) Ltd, 2025) Donough, Gabieba; Mthimunye, Katlego D.T.; Daniels, Felicity Megan
Background: Quality theoretical assessments in nursing education are essential for achieving Sustainable Development Goal 4 (ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all). However, misalignment with National Qualification Framework (NQF) standards, an overreliance on recall-based questions and inadequate educator training undermine the fairness of assessments and students’ ability to demonstrate clinical competence. Aim: This study explores theoretical assessment design in nursing education, evaluating its alignment with NQF standards, competency-based assessments and Sustainable Development Goal 4. Setting: Conducted at a South African nursing school offering undergraduate nursing programmes. Methods: A multimethod approach integrated educator interviews, document reviews of moderation reports, a scoping review and a student survey to investigate assessment practices. Results: While educators valued Bloom’s Taxonomy, over-reliance on recall-based questions limited critical thinking, clinical decision-making and competency development. Misalignment with NQF standards caused inconsistencies in cognitive demand, while gaps in moderation processes impacted assessment validity and fairness. Educators faced challenges because of limited training and support, and students struggled with ambiguous and linguistically complex assessments that hindered their ability to demonstrate competency. Conclusion: Strengthening assessment design, moderation and educator training is essential to improving competency-based assessment practices in nursing education. Policy reforms promoting fair, transparent, and competency-driven assessments will enhance graduate preparedness, ensure alignment with NQF standards and support SDG 4’s goal of quality education. Contribution: This study provides empirical evidence supporting assessment policy improvements, promoting structured, competency-based assessments that enhance fairness, deepen learning and align with nursing education standards.
Challenges and opportunities in digital learning technologies for nursing education in low-resource settings: a scoping review
(Unisa Press, 2025) Owoeye, Isaiah Dada; Daniels, Felicity; Chipps, Jennifer-Anne
The use of digital learning technologies is becoming increasingly popular worldwide. However, there is a lack of published evidence regarding their application in nursing education, particularly in low-resource settings. To inform the development of digital learning guidelines for use in such contexts, a scoping review was conducted to examine the use of these technologies and the associated challenges. The review question was: What are the challenges and opportunities associated with the use of digital learning technologies in nursing education in low-resource settings? The Joanna Briggs Institute (JBI) scoping review methodology was followed. The databases Scopus, Academic Search Complete, PubMed, and CINAHL were searched using the following criteria: student nurses and nurse educators in nursing education institutions; low-resource settings, defined as low- and middle-income countries; and the use of digital learning technologies. Studies involving non-nursing health professions were excluded. Retrieved papers were screened by title and abstract, with full text reviews conducted as needed. Data were analysed thematically using the digital competence framework. Few studies have been conducted in African countries. Key themes included the use of digital learning technologies in general, their application in clinical teaching and theoretical instruction, and the emergence of artificial intelligence in nursing education. Most reported uses were related to students’ online learning experiences. The main challenges were linked to pedagogical competence, along with the need for administrative and technical competencies, thus extending the existing digital competence framework.
Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review
(BMC Pregnancy and Childbirth, 2024) Lunda, Petronellah; Minnie, Catharina Susanna; Lubbe, Welma
Background: This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was ‘What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?’ Methods: A detailed search was done on electronic databases: ebscohost: Medline, oalster, Scopus, scielo, Science Direct, pubmed, Psych INFO, and socindex. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. Results: Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women’s knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. Conclusion: Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care. © The Author(s) 2024.
Use of artificial intelligence in healthcare in South Africa: a scoping review
(AOSIS (pty) Ltd, 2025) Chipps, Jennifer; Sibindi, Thandazile; Cromhout, Amanda; Bagula, Antoine
Background: Artificial intelligence (AI) transformed healthcare worldwide and has the potential to address challenges faced in the South African healthcare sector, such as limited public institutional capacity, staff shortages, and variability in skills levels that exacerbate the demand on the healthcare system that can lead to compromised care and patient safety. Aim: This study aimed to describe how AI, especially machine learning is used in healthcare in South Africa over the last 5 years. Method: The Joanna Briggs Institute (JBI) methodology for scoping reviews was used. Peer-reviewed articles in English, which were published from 2020 to date were sourced and reviewed using the Population, Concept, Context (PCC) framework. Results: A total of 35 articles were selected. The results showed a focus on conventional machine learning, a health focus on HIV and/or tuberculosis (TB) and cancer, and a lack of big data in fields other than cancer. Conclusion: There has been an increase in the use of machine learning in the analysis of health data, but access to big data appears to be a challenge. Contribution: There is a need to have access to high-quality big data, inclusive policies that promote access to the benefits of using machine learning in healthcare, and AI literacy in the health sector to understand and address ethical implications
Nurse prescribing and dispensing in South Africa: gaps in the current legislative framework
(AOSIS (Pty) Ltd, 2024) Crowley, Talitha; Gray, Andy Lofts; Geyer, Nelouise
Nurse prescribing and dispensing are central to ensuring universal health access in South Africa. To describe the historical development of the legal enablements of nurse prescribing and dispensing in South Africa and highlight gaps in the current legislative framework We emphasise significant deficiencies in the current legislative landscape that pose challenges to these vital nursing practices and call for urgent revisions of the legislative framework, particularly the revision of Section 56 of the Nursing Act (33 of 2005) and its related regulations, to formalise authorisation of specialist nurse prescribers in public and private practice. This will also entail an application to the South African Health Products Regulatory Authority (SAPHRA) for the scheduling of substances by authorised nurse prescribers in the defined professional nurse and specialist nurse categories by the Minister of Health There is a necessity for prompt legislative revisions to address identified deficiencies
Perceptions of incivility in a nursing school at a university in south africa – cross-sectional study. “incivility in nursing education – is it a problem?”
(Elsevier Ltd, 2024) Fürst, Laetitia; Heradien, Zenobia; Abubu, Janiere
Respectful civil behaviour of nurses is key to nursing practice and can directly affect quality of patient care. Reports of international studies on incivility in nursing schools is well documented, however little is known about incivility in nursing schools in South Africa. This study aimed to describe the nursing students’ perception of the level and occurrence of incivility in nursing students and faculty at a nursing school at a university in South Africa. A quantitative descriptive cross-sectional survey was conducted. A self-administered questionnaire was used to determine the student nurses’ perceptions of levels and occurrence of incivility among nursing students and faculty. The questionnaire included the Incivility in Nursing Education-Revised (INE-R) scale. A sample of 277 was calculated, and an all-inclusive sampling method was used to target all undergraduate nursing students. Data was analysed using IBM Statistical Package for Social Sciences (SPSS) version 27 and descriptive statistics, 95% confidence intervals were used to describe the data and Independent Samples Mann-Whitney U tests were used to compare gender differences. The questionnaire was completed by 540 (77 %) undergraduate nursing student respondents, between 12 March 2021 and 20 April 2021. Respondents reported low levels of perceived student incivility behaviours (2.07 ± 0.7 [95 %CI 2.0–2.1]), with using a computer, phone, or other media device during class, meetings, activities for unrelated purposes being the highest rated perceived low-level student incivility behaviour (2.52 [95 %CI 2.43–2.62]. Low levels of perceived levels and occurrence of low faculty incivility were reported with respondents rating arriving late for class or other scheduled activities as the highest rated perceived level of low incivility behaviour (1.91 [95 %CI 1.82–1.99]). The highest perceived occurrence for low faculty incivility was being unavailable outside of class (not returning calls or emails, not maintaining office hours) (1.82 [95 %CI 1.74–1.9]. Though some perceived incivility amongst students and faculty in the selected nursing school exist, the occurrence is perceived to be low. Further investigations should explore the impact of uncivil behaviours in academic theory environments, and the impact on individuals in practice.
Community service nurses in primary healthcare clinics: Experiences of supervision and support from professional nurses
(AOSIS, 2022) Zambodla, Ayanda; Williams, Margaret; Ricks, Esmeralda
Background: Newly qualified nurses in South Africa are required to undertake a compulsory 1-year community service (CS) in a public healthcare facility. They are not yet competent to work alone and require supervision and support from senior professional nurses. Aim: This study aimed to explore and describe the experiences of community service nurses (CSNs) regarding supervision and support from professional nurses at primary healthcare clinics (PHC). Setting: The study was conducted with CSNs who were working in PHC clinics in Nelson Mandela Bay (NMB). Methods: A qualitative, explorative, descriptive and contextual study was conducted using semi-structured interviews with 10 CSNs. Purposive sampling was used. Data were analysed using Tesch’s coding method of content analysis.
Nursing students’ experiences of clinical assessment at a university in South Africa
(AOSIS, 2023) Donough, Gabieba
Nursing education includes both classroom and clinical teaching. The clinical teaching was explored through this research. The successful training of the undergraduate nursing students can be attributed to effective clinical teaching and supervision and is determined by both training requirements and services provided. Although there have been several researches on clinical supervision, there is still a dearth of information of the realities of supervision regarding assessment of undergraduate nursing students. The authors’ original thesis formed the foundation of this manuscript. This study aimed to explore and describe nursing students at the undergraduate level experiences regarding clinical supervision.
Effectiveness, acceptability and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle-income countries: A systematic review
(MDPI, 2023) Crowley, Talitha; Petinger, Charné; Nchendia, Azia Ivo
Adolescents living with HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology-enabled interventions can be used to optimize healthcare delivery to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa. This review synthesized the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar were searched to identify studies in LMIC published from 2010 to 2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10–19 years) were included. The review was performed, and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols.
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.
Nursing education reform in South Africa: Implications for postgraduate nursing programmes
(Elsevier, 2023) Crowley, Talitha; Daniels, Felicity
Training of Specialist Nurses is of critical importance for the continued delivery of quality health services globally and in South Africa. In accordance with international trends, nursing education in South Africa has undergone significant educational reforms in the past few years. The aim of this paper is to critically reflect on current nursing education reform in South Africa and the implications for the postgraduate diploma in nursing programmes. The paper highlights some of the challenges encountered with the development, accreditation and implementation of the new nursing postgraduate diploma programmes. Successful nursing education reform requires collaborative and proactive conversations between all stakeholders before changes are made to existing nursing categories and skills mix, during the development of new programme frameworks, during programme development and after implementation of the reform strategies.
Designing theoretical assessments at nursing higher education institutions: A scoping review
(Stellenbosch University, 2022) Donough, Gabieba
Assessment in higher education remains one of the most reliable forms of assessing the effectiveness of the learning and teaching (L&T) process. Excellence in theory assessment design is, therefore, a pivotal element of the success of many Higher Education Institutions (HEIs) around the world. This scoping review aimed to establish current assessment best practices in nursing at HEIs. The five steps of Arksey and O’Malley’s framework guided this scoping review. Following a systematic search of various databases, including Academic Search Complete, CINAHL, ERIC, MEDLINE, PubMed, Sage Online Journals, SCOPUS, and Wiley Online Library for the period from 2010 to 2020, a rigorous screening process was undertaken by three independent reviewers. The search terms included assessment best practice and nursing education institution. Of the 652 articles screened, 12 studies met the inclusion criteria.
Acceptability and feasibility of a screening protocol for antenatal depression (SPADe) in Blantyre District, Malawi
(BMC, 2022) Chorwe‑Sungani, Genesis; Mwagomba, Modesta; Chipps, Jennifer
Depression is one of the most common perinatal mental health problems that afect pregnant women. Antenatal depression can adversely afect the well-being of the pregnant woman and her foetus. Depression is rarely detected by midwives due to the unavailability of relevant screening instruments in Malawi. A Screening Pro‑ tocol for Antenatal Depression (SPADe) was developed and recommended for possible use to screen for depression in antenatal clinics in the country. The acceptability and feasibility of using the SPADe protocol to screen for depression has not been established. The aim of this study was to assess the acceptability and feasibility of screening for depres‑ sion by midwives using SPADe in antenatal clinics in Blantyre district.
Stress and coping – Perceptions of final year nursing students returning to clinical practice during the COVID-19 pandemic, South Africa
(AOSIS, 2021) Jarvis, Mary Ann; Martin, Penelope; Williams, Margaret
The novel nature of the coronavirus disease 2019 (COVID-19) pandemic places challenges on nursing students as they try to complete the clinical requirement of their training. Nursing faculties need to understand these challenges to support and equip nursing students to enter the workforce. To explore and describe the anticipated and subsequent perceptions of final year Bachelor of Nursing students returning to clinical practice during the COVID-19 pandemic in South Africa.The study was conducted at two universities in the Western Cape and KwaZuluNatal, South Africa. Both universities offer 4-year Bachelor of Nursing programmes accredited by the South African Nursing Council and were in ‘hot spot areas’ for SARS-CoV-2.
Nursing students' perceptions of clinical learning opportunities and competence in administration of oral medication in the Western Cape
(Democratic Nursing Organisation of South Africa, 2020) Musafiri, John J.; Daniels, Felicity Megan
Medication errors may result in patients' harm and even death. The improvement of nursing students' competence in the administration of medication through education and training can contribute to the reduction of medication errors. OBJECTIVES: This study aimed at describing the Bachelor of Nursing students' perceptions about clinical learning opportunities and competence in the administration of oral medication. METHOD: A quantitative descriptive design was employed. An all-inclusive sample of 176 nursing students registered at a university in the Western Cape, South Africa, in 2014 was considered for the study, of whom 125 students consented to participate and completed the questionnaires. Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis and descriptive statistics were conducted. RESULTS: The findings showed that a minority of students did not have opportunities to rotate in all specific types of wards.
Pathways from witnessing community violence to mental health problems among South African adolescents
(SAMA, 2020) Naidoo, Pamela P.; Donenberg, Geri R.; Kendall, Ashley D.
The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions. Objectives. To assess pathways between community violence exposure and internalising and externalising problems in SA adolescents receiving mental healthcare, and the roles of parent and peer relationships in these associations. Methods. Participants (N=120 parent-adolescent pairs) were recruited from four mental health clinics in Western Cape Province to participate in a pilot test of a family-based HIV prevention study. Adolescents reported on their exposure to community violence, parental attachment, peer support of risk behaviour, and mental health. Parents reported on adolescents' internalising and externalising mental health problems. Participants received transport money (ZAR30 = USD3) and a shopping voucher or cash (ZAR50 = USD5) for their time. Results. Adolescents were 12 - 18 years old (mean (standard deviation) 14.39 (1.82) years), 53% were male, and 67% and 33% reported black African and mixed-race ethnicity, respectively. Parents were 94% female and reported an average monthly income of ZAR3 973 (USD397).
Student midwives' knowledge, skills and competency in relation to the active management of the third stage of labour: A correlational study
(Democratic Nursing Organisation of South Africa, 2020) Muzeya, Fungai; Julie, Hester
BACKGROUND: Lesotho has been experiencing health challenges as indicated by its high maternal mortality ratio of 620 per 100 000 live births for the year 2010, which has been linked to its limited human resources. OBJECTIVES: The knowledge and skills of final-year student nurse-midwives related to the active management of the third stage of labour were determined. METHOD: A quantitative, descriptive survey design was used to conduct this study with 99 final-year midwifery students at four nursing schools in Lesotho using stratified sampling. The structured questionnaire collected data on the knowledge and self-reported competency. Subsequently, the controlled cord traction marks, extracted from the objective structured clinical examination (OSCE), were compared to the self-reported competency of these midwifery students using R software version 3.4.0. RESULTS: The mean score for knowledge and the OSCE was 73.8% (n = 99) and 77.2% (n = 99), respectively. The majority of respondents (95.2%, n = 99) rated themselves highly in terms of the active management of the third stage of labour competency.

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