Research Articles (School of Nursing)

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Digital health readiness – insights from healthcare leaders in operational management: a cross-sectional survey
(BioMed Central Ltd, 2025) Steenkamp, Ilze; Chipps, Jennifer; Peltonen, Laura Maria
Background: Developing countries’ public health systems struggle with digital health implementation, and reports of low digital health readiness exist within the workforce. This study investigates the perceived digital health readiness of healthcare leaders in operational management to implement digital health tools. Methods: A cross-sectional survey using the E-Ready 2.0 scale was used to measure digital health readiness (n = 329) in 11 hospitals in the Western Cape, South Africa (September 2023 – March 2024). Descriptive statistics summarised respondent characteristics and the E-Ready 2.0 subscales: conditions for change at the workplace and among individuals, support and engagement from management, colleagues’ readiness, consequences for the status quo and workplace attitudes. Statements scoring 60% or more were considered to have higher readiness. Chi-square and Mann–Whitney U tests were used to examine associations between demographic variables and subscale statements. Results: A total of 143 healthcare leaders responded (56.1% response rate) (n = 114 nurses [79.7%], n = 29 medical doctors [20.3%]). The average age was 46.4 ± 10.0 years. Overall, higher levels of readiness (above 70%) were observed with statements related to workplace attitudes, whereas conditions for change at the workplace and among individuals showed lower readiness (below 50%). Conclusion: Despite significant investment in digital health tools, there remains limited digital health readiness among those responsible for leading these implementations. © The Author(s) 2025.
HIV policy implementation challenges: experiences of HIV managers in primary healthcare facilities in the Western Cape
(AOSIS (pty) Ltd, 2026) Akimanimpaye, Furaha; Crowley, Talitha; Titus, Verinia
Background: Implementing HIV policy involves translating policy goals into practical action. In the Western Cape, South Africa, the lack of clear guidelines has challenged the consistent implementation of HIV policies at primary healthcare (PHC) facilities. Objectives: This study aimed to explore HIV managers’ experiences regarding the challenges of HIV policy implementation at PHC facilities within the Northern Tygerberg sub-district, Cape Metropole, Western Cape. Method: An exploratory, descriptive, qualitative design was employed. Purposive sampling was applied to select HIV managers (n = 10) with experience in policy implementation. Data were collected through semi-structured interviews and analysed using thematic analysis. Results: Four themes emerged from the study, reflecting the challenges experienced by HIV managers during the implementation of HIV policies at PHC facilities, including human resource challenges, staff knowledge and attitudes, system readiness, and training. Conclusion: Effective implementation of HIV policy remains essential to the national HIV response. While significant targets have been achieved, ongoing systemic challenges continue to hinder optimal policy execution and the delivery of services. Contribution: The study highlights the critical need for stronger human resource systems, improved training platforms, and enhanced facility infrastructure to ensure effective HIV policy implementation and better health outcomes for individuals living with HIV.
Nurse educators’ competence and use of digital education technology at selected nursing education institutions in Nigeria
(Elsevier Ltd, 2025) Owoeye, Isaiah Dada; Chipps, Jennifer-Anne; Daniels, Felicity
The use of digital education technology has permeated educational settings and its use has become compelling for educators in nurse training. The competence of educators is however paramount for the appropriate use of the technology in the teaching and learning process. The study aimed to explore the pedagogical competence and use of digital education technology among nurse educators in Nigerian nursing education institutions. Qualitative methods were followed and in-depth interviews using one broad question and probing questions. Twelve nurse educators were purposively sampled across five nursing education institutions. Interviews were recorded, transcribed, and imported into Atlas.ti version 23 software for data analysis. Ethical clearance was obtained from the Research Ethics Committee of the University of the Western Cape. Most participants were female. Participants’ average age was approximately 41 years and their experience approximately 11 years. The data generated seven themes and twenty two categories related to pedagogical, digital and ethical competence as follows: Characteristics, qualities, and or roles of nurse educators; student roles and responsibilities in the learning process; educators’ understanding, philosophy, use and experience, and learning needs related to digital education technology; use of digital education technology in clinical education and administration in the current and future digital era; digital education technology utility; educators and students’ competence and use of digital education technology; and promotors and inhibitors of ethical competence. Students and educators used digital education technology in the teaching and learning process, but educators are lagging with an urgent need for digital literacy, provision of devices, and skills to address ethical issues for users in education
Infection prevention knowledge related to central line infections and ventilator-associated pneumonias: A survey of Finnish intensive care units
(Elsevier Inc., 2025) Salanterä, Sanna; Terho, Kirsi; Löyttyniemi, Eliisa Susanna
Background: Health care-associated infections pose a significant risk for the patients in intensive care due to the use of medical instrumentation required for care. Methods: We conducted a cross-sectional, nationwide survey on awareness of recommended infection prevention practices involving central venous catheters and invasive ventilators in intensive care units. Results: A total of 810 (50% of those surveyed) nurses and physicians participated in the survey. We found that 8% of the respondents had good knowledge of infection prevention in central venous care, while 24% had good knowledge of ventilator-associated pneumonia prevention practices. Discussion: The overall level of knowledge measured with this nationwide survey was suboptimal. The level varied between units, and depending on individual questions for particular professions. The displayed knowledge may have partially been based on tradition rather than on up-to-date evidence-based guidelines. Conclusions: Educational training in evidence-based infection prevention is needed for practical implementation to be improved. © 2025 Association for Professionals in Infection Control and Epidemiology, Inc.
Understanding self-management in teaching and learning: a concept analysis for nursing education
(Elsevier Ltd, 2026) Crowley, Talitha; Kokuro, Mercy; van der Merwe, Anita S
Background The concept of self-management has been examined in healthcare and other sectors such as education, but its definition and uses in nursing education remain unclear. Aim To explore the concept ‘self-management’ in healthcare and teaching and learning literature and apply these insights to nursing education. Design Concept analysis. Methods The eight steps of concept analysis according to Walker and Avant were used. PubMed, EBSCOhost, Medline, Google Scholar, Science Direct and PsycINFO were searched up to 2022 with an updated search in 2024. Content-rich articles on self-management were included if they: (a) discussed the theoretical or conceptual foundation of self-management, (b) were healthcare or education related, (c) were written in English and (d) had the full-text available. Data on attributes, antecedents and consequences were extracted and analysed using thematic analysis. Results Thirty-three articles were included with nine attributes, categorised as personal (self-motivation, self-regulation, self-evaluation, self-efficacy, individual action and skills, self-monitoring, environmental management, continuous task) and combined (partnership). Antecedents were the individual capacity to learn, external motivation, access to learning resources, teaching and learning strategies, and support from educators, family and friends. Consequences were improved quality of life, enhanced coping abilities, empowerment, engagement in self-management behaviours, increased self-efficacy, self-control, satisfaction, independence, self-directedness, and accountability. Negative outcomes may arise from avoiding help due to overconfidence in self-management abilities. Conclusion In combining all nine attributes, a clear definition and understanding of self-management in the teaching and learning context are formulated which can assist nursing students in becoming effective self-managers.
Alcohol and substance use and associated risk factors in nursing undergraduates at a South African university
(AOSIS (pty) Ltd, 2025) Kovane, Gaotswake Patience; Mayers, Pat M
Background: The use of substances by university nursing students is a significant public health challenge and may impact their professional conduct and compromise the quality of patient care. Aim: The study aimed to investigate alcohol and substance use by undergraduate nursing students, and the associated risk factors, at a university in the Western Cape province, South Africa. Setting: The study was conducted at a university in the Western Cape province, South Africa. Methods: A quantitative, descriptive survey design was used. A convenience sample of second-, third-and fourth-year nursing students completed a self-report online questionnaire. Descriptive statistics, Chi-square tests and multivariate linear regression were used to analyse the data. Results: A total of 212 questionnaires were completed. Most respondents (81%; n = 171) were female. The substances most used were tobacco (24.1%), alcohol (64.6%) and cannabis (marijuana) (23.7%). Few students had used ‘hard’ recreational drugs. Female students were more likely to have used alcohol and drugs over the 12 months preceding the study. Conclusion: To limit alcohol and drug use of nursing students, nursing education institutions need to increase efforts to raise awareness, include relevant curriculum content and provide appropriate support. Contribution: This study highlights the substance use risks and behaviours of undergraduate nursing students. Nursing students, as future health professionals, need to be empowered to make informed choices about the use of alcohol and other substances and need to be supported by university policies, appropriate education and counselling services.
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.
Health practices of pregnant women attending antenatal clinics in the Western Cape, South Africa: a cross-sectional survey
(Unisa Press, 2025) Noncungu, Thabani Mishack; Chipps, Jennifer; Crowley, Talitha
Background: Health practices are the decisions and actions pregnant women take to manage pregnancy and health issues, reflecting self-care behaviours that influence maternal and neonatal outcomes. Aim: To investigate the health practices of pregnant women attending antenatal clinics. Setting: Selected antenatal clinics in primary healthcare facilities in the Western Cape. Methods: A sample size of 267 pregnant women was drawn from three intentionally selected primary healthcare facilities in the Western Cape, chosen for their high antenatal attendance rates in the sub-district. The sample size was calculated using a sample size calculator, and respondents were selected using a systematic sampling method. A validated scale, Health Practices in Pregnancy Questionnaire-II, was used to collect data. Data were analysed per scale instructions using the Statistical Package for Social Sciences (SPSS) version 30 for descriptive and inferential statistics. Results: The study achieved a response rate of 248 respondents. The respondents were on average 27.4 years old (sd=7.53), with 193 (77.8%) reporting that they attended secondary school. Just over half of the respondents (n=126, 50.8%) did not know the gestational age of their current pregnancy. Respondents had low health practices scores (108.11/170 (sd=9.17) [CI=95%: 106.96-109.26, range 83.80 to 138.80]. Positive health practices were rated higher than abstaining from harmful practices. No significant predictors of health practices were found. Conclusion: Health practices should receive specific focus in health education activities. Contribution: The authors recommend that nurses at antenatal clinics should educate pregnant women about the importance of health practices as part of self-care promotion.
Health practices of pregnant women attending antenatal clinics in the Western Cape, South Africa: a cross-sectional survey
(Unisa Press, 2025) Noncungu, Thabani Mishack; Chipps, Jennifer; Crowley, Talitha
Background: Health practices are the decisions and actions pregnant women take to manage pregnancy and health issues, reflecting self-care behaviours that influence maternal and neonatal outcomes. Aim: To investigate the health practices of pregnant women attending antenatal clinics. Setting: Selected antenatal clinics in primary healthcare facilities in the Western Cape. Methods: A sample size of 267 pregnant women was drawn from three intentionally selected primary healthcare facilities in the Western Cape, chosen for their high antenatal attendance rates in the sub-district. The sample size was calculated using a sample size calculator, and respondents were selected using a systematic sampling method. A validated scale, Health Practices in Pregnancy Questionnaire-II, was used to collect data. Data were analysed per scale instructions using the Statistical Package for Social Sciences (SPSS) version 30 for descriptive and inferential statistics. Results: The study achieved a response rate of 248 respondents. The respondents were on average 27.4 years old (sd=7.53), with 193 (77.8%) reporting that they attended secondary school. Just over half of the respondents (n=126, 50.8%) did not know the gestational age of their current pregnancy. Respondents had low health practices scores (108.11/170 (sd=9.17) [CI=95%: 106.96-109.26, range 83.80 to 138.80]. Positive health practices were rated higher than abstaining from harmful practices. No significant predictors of health practices were found. Conclusion: Health practices should receive specific focus in health education activities. Contribution: The authors recommend that nurses at antenatal clinics should educate pregnant women about the importance of health practices as part of self-care promotion.
Using machine learning to improve readmission risk in surgical patients in South Africa
(Multidisciplinary Digital Publishing Institute (MDPI), 2025) Chipps, Jennifer; Tokac, Umit; Brysiewicz, Petra
Unplanned readmission within 30 days is a major challenge both globally and in South Africa. The aim of this study was to develop a machine learning model to predict unplanned surgical and trauma readmission to a public hospital in South Africa from unstructured text data. A retrospective cohort of records of patients was subjected to random forest analysis, using natural language processing and sentiment analysis to deal with data in free text in an electronic registry. Our findings were within the range of global studies, with reported AUC values between 0.54 and 0.92. For trauma unplanned readmissions, the discharge plan score was the most important predictor in the model, and for surgical unplanned readmissions, the problem score was the most important predictor in the model. The use of machine learning and natural language processing improved the accuracy of predicting readmissions.
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.
Self-management knowledge, attitudes and practices among persons with type 2 diabetes in Ghana
(AOSIS (pty) Ltd, 2025) Johnson, Beatrice; Chipps, Jennifer; Jarvis, Mary
Diabetes is one of the major non-communicable diseases. Diabetes self-management has been identified as a key strategy to reduce complications and to improve health outcomes. Aim: This study aimed to investigate the diabetes self-management knowledge, attitude and practices among people with type-2 diabetes in Ghana. Setting: Two clinics for diabetes patients in the Ho municipality of Ghana were selected to conduct the study. Methods: An outpatient cross-sectional survey was conducted using a 57-item researcher-administered questionnaire based on the Information, Motivation, Behaviours Model adopted for Diabetes. A total of 321 patients with type 2 diabetes were randomly selected from the two outpatient clinics for diabetes in Ho, Ghana. Data were analysed using descriptive statistics and multiple linear regression modules were conducted to determine the predictors of self-management practices. Significance was set at p < 0.05. Results: The average score for knowledge was 11.37/24 ± 3.40 or 47%, indicating poor levels of diabetes self-management knowledge. Moderately positive attitudes were found (2.83/5 ± 1.57) [95% CI –1.86 to –3.80] with poor self-management practices with a median of 3.00 per week (maximum 5.20, minimum 0.60 per week). Knowledge explained 20% of variation in self-management practice. Conclusion: The findings from this study show an overall deficit in knowledge of diabetes with related low self-management practice. This suggests the need for robust self-management education programmes to improve access to diabetes self-management-related information. Contribution: This study highlights the important knowledge of diabetes in self-management.
Knowledge of mental disorders in primary healthcare nurses in the Western Cape, South Africa
(AOSIS (Pty) Ltd, 2025) Musafiri, John J.; Bimerew, Million S.; Chipps, Jennifer Anne
Background: Mental disorders remain a global health burden. The integration of mental health services into primary healthcare (PHC) can contribute to reduction of this burden. However, studies have reported PHC nurses’ lack of knowledge of mental disorders, which leads to their negative attitudes towards people with mental disorders preventing them from seeking help. Objectives: The objective of this study is to assess the knowledge levels of PHC nurses regarding mental disorders in the Western Cape, South Africa. Method: A quantitative descriptive survey was conducted. A self-administered questionnaire was used to collect data from a sample of 246 PHC nurses in the Cape Town metropole. Data were analysed using descriptive statistics, Chi-square tests and independent sample tests. A cut-off value of ≥ 80% was used to determine the sufficient levels of knowledge. Results: The average knowledge score (15.6; 78.0%) was below the cut-off value of ≥ 80%, indicating insufficient levels of knowledge. Sufficient levels of knowledge were found for over half of the respondents (139, 59.4%). Most of the respondents were knowledgeable about the symptoms of depression (221, 94.4 %), bipolar (217, 92.7%), schizophrenia (213, 91.0%) and anxiety disorders (209, 89.3%). Conclusion: Over half of the PHC nurses could identify the signs and symptoms of common mental disorders. However, the knowledge of dysthymia and psychosis requires more attention. Contribution: This study contributes to the existing body of knowledge in nursing practice and education related to mental disorders.
Quality midwifery care during childbirth at a midwife obstetric unit: a qualitative study
(AOSIS (pty) Ltd, 2025) Martin, Sedeeka; Robertson, Anneline; Filies, Gérard
Background: Globally, there is an increasing focus on enhancing the quality of midwifery care. In public institutions, primary care midwifery is provided at a midwife obstetric unit (MOU). Midwives at MOUs are the first contact that pregnant women have when accessing midwifery care. There exists a notable disparity in the perception of quality midwifery care between midwives and women. In South Africa, there has been a scarcity of research examining the perspectives of midwives and women, regarding the quality of midwifery care provided during childbirth. Objectives: The objective of this study was to explore and describe women’s and midwives’ perceptions of the quality of midwifery care during childbirth, at a MOU in Cape Town in the Western Cape, South Africa. Method: A qualitative exploratory descriptive design was utilised. Four women and five midwives were selected through purposive sampling. Semi-structured interviews were undertaken, transcribed and analysed utilising Tesch’s eight-step approach to qualitative data analysis. Results: Three themes emerged: (1) understanding of quality midwifery care, (2) experiences of women during childbirth and (3) support received by women and midwives. Conclusion: The quality of midwifery care remains compromised within the MOU setting due to various challenges encompassing limitations of both human and physical resources. It is imperative to establish a shared understanding of what constitutes quality midwifery care, as women and midwives often perceive it differently. Contribution: Midwifery care during childbirth requires the engagement of all stakeholders, including women, to enhance the quality of midwifery care provided.
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.
Using natural language processing in the LACE index scoring tool to predict unplanned trauma and surgical readmissions in South Africa
(John Wiley and Sons Inc, 2025) Chipps, Jennifer; Tokac, Umit; Brysiewicz, Petra
Background: Unplanned and potentially avoidable readmission within 30 days post discharge is a major financial burden. Aim: To use text-based electronic patient records to calculate the Charlson Comorbidity Index (CCI) score using a natural language processing technique to establish the feasibility and usefulness of the text-based electronic patient records in identifying patients at risk for unplanned readmission. Methods: A retrospective review of electronic patient records for general and trauma surgery in a hospital in South Africa (2012–2022) was conducted using the LACE score. Validated sentiment analysis analyzed free text components of electronic patient records to compute the CCI score and to establish the feasibility and usefulness of the LACE score in identifying patients at risk for unplanned readmission. Results: Trauma surgery patients had a mean LACE score of 5.91 (SD = 2.41), with 8.44% scoring 10 or higher and a specificity and sensitivity of 91.63% and 13.81%, respectively. The general surgery patients had a mean LACE score of 7.75 (SD = 3.04), with 10.63% scoring 10 or higher and a specificity of 71.47% and a sensitivity of 44.80%, respectively. Logistic regression analysis revealed that LACE scores significantly predicted unplanned readmissions in both trauma (β = 0.11, p < 0.001; OR = 1.112, 95% CI [1.082, 1.143]) and general surgery (β = 0.15, p < 0.001; OR = 1.162, 95% CI [1.130, 1.162]) patients. Conclusion: The LACE score demonstrated the predictive value for readmission in trauma and general surgery patients. The LACE score was relatively effective in identifying patients who were less likely to be readmitted but showed limitations in identifying patients at higher risk of readmission. However, the successful use of natural language processing for data extraction of comorbidities shows promise on addressing the challenges around text-based medical records.
Experiences of simulated patients in clinical skills laboratory: a qualitative study
(AOSIS (pty) Ltd, 2025) Shange-Goba, Mbalenhle P.; Willemse, Juliana J.
Background: Nursing simulations with simulated patients (SPs) have proven effective in creating realistic opportunities to enhance the students’ clinical competence within a safe learning environment. This setting helps to reduce anxiety and increases self-confidence among health sciences students. This study aimed to explore experiences of SPs in clinical skills laboratory of a Department of Nursing at a university in Western Cape. Objectives: Objectives were set to explore the contextual elements of SPs’ experiences during clinical skills sessions, identify educational design aspects from those experiences and assess their views on student outcomes. Method: A qualitative descriptive, exploratory and contextual design was used. Data were collected through semi-structured interviews with eight SPs. The data were coded to develop emerging themes and sub-themes, following Braun and Clark’s systematic analysis process. An independent coder reviewed findings, and themes were confirmed during a consensus meeting. Results: This study found that SPs engaged in multiple role-play consultations, improving their understanding of healthcare consultation structures and rules. They recognised their roles in achieving the outcomes needed for students. Conclusion: This study confirmed existing literature on SPs in a clinical skills laboratory within a Department of Nursing. Participant interviews provided verbatim quotations that enriched findings. Contribution: The study aimed to recommend ways for a Department of Nursing to support SPs in improving their laboratory skills and enhancing student learning.
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.
Human sperm as an in vitro toxicity model: a versatile tool for assessing the risk of environmental contaminants
(Springer Science and Business Media Deutschland GmbH, 2025) Keyser, Shannen; Davidse, Morgan; Bennett, Monique; Maree, Liana; Petrik, Leslie
Contaminants of emerging concern (CECs) pose a significant threat to human and ecosystem health due to their persistence, bioaccumulation in higher trophic levels, and potential toxicity. While in vivo models are commonly used for toxicity screening, developing alternative in vitro techniques for rapid environmental risk assessment is essential. Spermatozoa, with their compartmentalized structure, measurable characteristics and sensitivity to environmental changes, offer potential as an in vitro model for toxicity screening. We evaluated the impact of selected CECs, including pharmaceuticals and pesticides, on sperm function in highly motile sperm subpopulations selected from donor semen. Standardised protocols were applied to assess various sperm functional parameters after 1–4 h of exposure to either individual or a mixture of chemicals. Our findings revealed that total motility is insufficient to detect subtle toxic effect. More responsive measures, such as sperm kinematics, induced hyperactivation, viability, mitochondrial membrane potential (MMP) and presence of reactive oxygen species (ROS) should be assessed to elucidate the effect of a toxic environment on sperm function. Most chemicals exerted a dose–response effect on sperm parameters, with the higher concentrations resulting in the most negative effects. The inherent sensitivity of human spermatozoa to oxidative stress, mitochondrial damage and energy metabolism, makes them a robust model for assessing toxicity. These features highlight their utility as an alternative cellular model for evaluating CECs and advancing risk assessment methodologies.
Experiences of skilled birth attendants with dissemination strategies and use of maternal clinical guidelines: a qualitative synthesis
(Elsevier Ltd, 2025) Kaura, Doreen; Atsali, Eunice Nyasiri; Tomlinson, Mark
Despite several evidence-based clinical guidelines aimed at improving the quality of maternal care as well as avert maternal mortality, guidelines frequently fail to reach the intended users. This qualitative synthesis explored experiences of Skilled Birth Attendants (SBAs) dissemination strategies and use of Maternal Clinical Guidelines (MCGs) by SBAs within the primary health care settings. Studies focusing on experiences of dissemination and use of evidence-based MCGs by SBAs were included. Further, it included studies published in English and those conducted between 2010–2023. A search was conducted using search terms “Maternal clinical guidelines “Dissemination” “Use” “Implementation” “Skilled birth attendants” “experiences or perceptions or attitudes or views or feelings or qualitative or perspective”. The search was done via Hinari and EBSCOhost in; Medline, PubMed, CINAHL. Additionally, searches were conducted using reference lists of the selected papers. Grey literature was searched from library repository and google scholar for further information. Search articles were uploaded in Mendeley, and duplicates removed. We included qualitative studies (10), mixed methods studies (5) and two (2) qualitative systematic syntheses because of paucity in qualitative only articles. Johanna Briggs Institute (JBI) Sumari appraisal tool was used to conduct the appraisal. All the articles included in this study were all imported to ATLAS ti for data management. The articles were code, grouped and themes developed. Three themes emerged: Dissemination strategies of MCGs, Use of MCGs (SBAs health systems factors), Improved utilization of maternal clinical guidelines. The findings of this study show experience in terms of facilitators and barriers to dissemination and use of guidelines. The study found Guidelines factors, Health systems factors, Skilled birth attendants’ factors and Community factors as the main facilitators and barriers for dissemination and use of guidelines. Future primary research may focus on, dissemination methods, actual use, and the outcomes of use. Additionally, the importance of appropriate use of maternal clinical guidelines needs to be emphasized early in midwifery competency education and more emphasis during in-service education.

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