Philosophiae Doctor - PhD (Nursing)

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Development of a protocol for nurses to reduce stigma towards mental health care users at primary health care services in the Western Cape
(2023) John James Musafiri; Bimerew, Million
Background: Nearly one in eight individuals across the world lives with a mental disorder. Mental disorders contribute to the global burden of disease, and are the third largest contributor to the overall disease burden in South Africa. The availability of mental health services at primary health care level should reduce the burden of mental disorders. It was found that several studies have revealed that stigma prevents people from seeking mental health care which contributes to delays in their recovery. Consequently, it deprives them of their basic human rights and excludes them from society. Mental health stigma has been reported among nurses and other health care providers.
Development of a model for support of emotional labour of nurses in tertiary hospitals in Nigeria
(University of the Western Cape, 2022) Ibraheem, Mulikat Ayoade; Martin, Penelope
Experience of emotional labour by nurses reflects a stressful work environment where services are guarded by organization and professional display rules and rendered with “a-smile-on-the-face” to shield the negative effect. Poor working conditions, the nature of the nursing job, lack of (or inadequate) resources, lack of role clarity, recognition and autonomy, time constraints, long working hours; a poor referral system are some of the causes of emotional labour for nurses. To regulate their emotions, service sector workers, including nurses use surface acting and deep acting strategies to cope with emotional labour at the workplace.
Intervention strategy to improve pmtct programme implementation for HIV-exposed children in a rural sub-district in North West province
(University of the Western Cape, 2022) Buthelezi, Sibusiso; Phetlhu, Deliwe
Despite the remarkable general decrease of mother-to-child transmission in the global HIV response, a high number, 84%, of child HIV infections are occurring in Sub-Saharan Africa, particularly in rural areas. Mother-to-child transmission in rural areas persists owing to several factors including inadequate implementation of prevention of mother-to-child transmission programmes. In order to achieve a target of zero new HIV infection in children born from women living with HIV, the involvement of professional nurses and mothers of children exposed to HIV in developing new intervention strategies that would improve the implementation of the prevention of mother-to-child transmission programme is undeniable.
Development of a model for nursing management of postpartum depression in Edo state, Nigeria
(University of the Western Cape, 2022) Amiegheme, Felicia Ehobhayi; Daniels, Felicity
Postpartum depression (PPD) is a disease that has been increasingly plaguing women in recent times. The incidence of PPD is high in Edo state, Nigeria. The researcher’s per-sonal clinical experience was that women who had episodes of PPD are usually provided conven-tional postnatal care with other women going through puerperium. A review of the policy statement of the Nigerian Federal Ministry of Health Sentinel records (2011) shows that there are no national nursing care guidelines for PPD. Consequently, this re-search study developed a model based on the findings of this study.
Development of an intervention strategy to provide emotional support for nurses caring for violent patients in acute wards in psychiatric hospitals in the Western Cape
(University of the Western Cape, 2022) Bekelepi, Ntombiyakhe; Martin, Penelope
Globally, workplace violence in healthcare is a major public concern, especially in the nursing profession. Nurses have higher risk of experiencing workplace violence they spend more time with patients. The violence has an impact on nurses’ day-to-day work as it negatively affects their physical and mental health, job satisfaction, productivity, and quality of patient care. Several interventions such as critical incident debriefing, group intervention approach, clinical supervision, and mindfulness-based stress reduction interventions have been developed to support nurses from workplace violence. Despite these interventions, the response to satisfaction with accessibility and utilisation have varied in areas in the workplace.
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.
A training programme for nurses on the management of preoperative anxiety and information needs of patients in Ashanti region, Ghana
(University of the Western Cape, 2022) Dankyi, Sawan; Bimerew, Million
Studies reveal that preoperative information hastens recovery, reduces postoperative complications and improves patients’ satisfaction. It is expedient to explore the preoperative information needs of patients as assumptions cannot be employed to identify said preoperative information patient needs. It was discovered in a study in the Ashanti Region of Ghana that few of the nurses follow steps to explore the anxiety and information needs of patients. The study investigated how preoperative anxiety and information needs of patients are explored and managed by nurses at district hospitals in the Ashanti Region of Ghana.
Development of a user centered mobile phone diabetes self-management intervention for people with type-2 diabetes in the ho municipality of Ghana
(University of the Western Cape, 2022) Johnson, Beatrice Bella; Chipps, Jennifer
Self-management remains a key goal for people living with Type-2 diabetes but globally has been an ongoing challenge. The inefficiencies of traditional health education approaches to diabetes care, concerns about the skills deficit and the technological explosion of mobile phone use have provided an opportunity for technologically driven innovations to facilitate selfmanagement of diabetes. Mobile phones are emerging as a tool for healthcare delivery and access to mobile phones is on the increase in the Low- and Middle-Income Countries (LMICs). The related low cost of mobile technology, especially text and voice messaging, has been reported to offer effective options for managing non-communicable diseases and highlighted the need to test this in the self-management of Type-2 diabetes.
Development of a training programme for professional nurses to promote the use of postpartum family planning in Epe local government area, Lagos state, Nigeria
(University of the Western Cape, 2022) Igbinoghodua, Omo-Ojo Betty; Julie, Hester
Postpartum family planning (PPFP) is the initiation of family planning methods among postpartum women, within 12 months after delivery. During this period, the women are a vulnerable group of people with high unmet need for family planning. They are exposed to the risks of unwanted pregnancy, which potentially, could increase maternal mortality, due to the consequences of too frequent pregnancies. Studies have revealed a consistent low use of family planning during the postpartum period. Additionally, it has been documented that the low use of postpartum family planning, most likely, was attributed to inadequate services that had been rendered at healthcare centres, as well as poor motivation by those providing family planning services. A training programme for nurses, to improve health services, was identified as the most appropriate for quality healthcare services, to influence the behavioural skill and good decision making of the PP women, regarding the use of PPFP.
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.
Development of a safe conception training programme for healthcare workers in antiretroviral therapy units in the Volta region, Ghana
(University of Western Cape, 2021) Klutsey, Ellen Eyi; Phetlhu, Deliwe R.
Women living with HIV (WLHIV) desire to bear children. Safe conception (SC) education for informed decision-making to prevent peri-conception HIV infection is needed but not routinely available. Poor SC knowledge, attitude, skills in addition to the absence of a standardised training programme were challenges that limited delivery. This study therefore aimed at developing a training programme for healthcare workers to facilitate SC education among WLHIV. The study adopted the intervention research approach. Both qualitative and quantitative methods were employed.
Development of a mindfulness-based unit management training programme for professional nurses in Ondo State, Nigeria
(2021) Ogundele, Alice Igbekele; Julie, Hester
Professional nurses constitute the highest number of health manpower all over the world. The nature of their work make them prone to physical and emotional trauma which sometimes affect the care they render. Therefore, nursing requires that professionals demonstrate acceptable levels of self-awareness and self-control which is congruent with the key principles of mindfulness contributing to a standard of nursing practices that do not always reach by providers as expected. Likewise, Nurse Managers are expected to utilise mindfulness principles in the planning, organising, staffing, directing and controlling activities of their units. Therefore, the aim of this study was to develop a mindfulness-based unit management training programme for professional nurses in Ondo State, Nigeria. The objectives of this study were to: (a) determine the level of individual mindfulness of professional nurses. (b) measure the extent to which individual mindfulness impacts professional nurses’ mindfulness. (c) determine the effect of professional nurses’ mindfulness on unit management performance of professional nurses. (d) design mindfulness-based unit management programme for professional nurses. (e) verify the developed mindfulness-based unit management training programme for professional nurses.
Development of a safe conception training programme for healthcare workers in antiretroviral therapy units in the Volta region, Ghana
(University of Western Cape, 2021) Klutsey, Ellen Eyi; Phetlhu, Deliwe R.
Women living with HIV (WLHIV) desire to bear children. Safe conception (SC) education for informed decision-making to prevent peri-conception HIV infection is needed but not routinely available. Poor SC knowledge, attitude, skills in addition to the absence of a standardised training programme were challenges that limited delivery. This study therefore aimed at developing a training programme for healthcare workers to facilitate SC education among WLHIV. The study adopted the intervention research approach. Both qualitative and quantitative methods were employed.
A model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression
(University of the Western Cape, 2010) Pearce, Shelltunyan; Kortenbout, W.
The purpose of this research study is to develop and describe a model to enhance the empowerment professional nurses to promote the recovery of people who have been diagnosed with depression. Depression is a prevalent psychiatric disorder that despite its increase worldwide, often goes undetected or inadequately treated. The biomedical model's reductionist and dualistic approach proves to be inadequate for nursing practice to address depression and calls for the examination of a multifaceted holistic approach. A multifaceted holistic approach views disease as having multiple causes that are amenable to multiple therapeutic interventions. Despite research evidence about the effectiveness of such an approach, an in-dept literature search did not reveal the availability of such a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. The research question that emerged was: • How can professional nurses in the Western Cape be empowered to promote the recovery of people who have been diagnosed with depression? The assumption is that this question was necessary to address. To realise the purpose of this research study, the following objectives were formulated: • To explore and describe the self reported attributes needed by professional nurses to promote the recovery of people who have been diagnosed with depression. • To explore and describe how these self reported attributes can be facilitated in the work environment. • To propose a model to enhance the empowerment of professional nurses to promote the recovery of people who have been diagnosed with depression. • To develop guidelines for the operationalisation of the model. The theoretical framework for this research study was adopted from the Critical Social Theory. The research design and method used was qualitative, explorative, descriptive and contextual in nature. The research was done in two phases. In phase one the researcher did semi- structured interviews with a purposive and convenient sample of fourteen (14) professional nurses who were working in the Cape Town Metropolitan area and the West Coast.
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.
A service learning pedagogy for an undergraduate bachelor of nursing curriculum
(University of Western Cape, 2021) Hoffman, Jeffrey Cornè; Hester, Julie
Globally, healthcare curricula are being transformed to serve societal needs and strengthen the provision of healthcare services towards ensuring Primary Health Care. Community Engagement and its typology were deemed significant to redress the nature of healthcare services, as well as the nature of the nursing curriculum, in order to develop socially accountable graduates. SL is known as a philosophy and an approach to community development and pedagogy. In this current study, the primary focus of SL was viewed as pedagogy, with the intention of fostering skills and values associated with accountability.
Roots and constructs of incivility in professional nursing education: Refocusing solutions and actions
(University of Western Cape, 2020) Vink, Hildeguard Jo-Anne; Frant, José; Julie, Hester
Incivility is rudeness, disrespect, disregard for others or their opinions, and a barrier to social interaction that could be associated with stress. The lack of regard for others creates a disrespectful, conflicting, and stressful environment, which could be perceived as an attack on the individual‟s dignity, or sense of self-worth. According to reports, such behaviour could be increasing and affecting the welfare of educators, students, and the overall educational process. Nursing education has not been exempted from this behaviour. Therefore, incivility is a nursing problem, which affects all those involved, from the academics, students, clinicians, patients and families.
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.
An intervention towards the improvement of academic performance, success and retention among bachelor of nursing students at a higher education institution in the Western Cape
(University of the Western Cape, 2019) Mthimunye, Katlego Dumisani Trevor; Daniels, Felicity
Academic success, which is measured by continuous assessment and examination results, is one of the major goals of higher education. However, Higher Education institutions worldwide are faced with a challenge on how to improve the academic performance, success and ultimately the retention of students during their studies. Aim: The aim of this study was to develop an intervention towards the improvement of academic performance, success and retention among undergraduate nursing students at a university in the Western Cape, South Africa. Methods: A multi-method research approach was employed to meet the study aim and objectives. The study was conducted in three phases that were guided by the adapted phases of the Design and Development (D&D) model by Rothman and Thomas (2013). Phase one (Study 1– 4) was the problem analysis and information gathering phase. Phase two was the design and early development during which designing observational elements and specifying procedural elements were applied. Phase three (Study 5) was the validation phase. Results: This thesis comprised of five interdependent studies. Study 1: A systematic review of literature was conducted encompassing previous literature from 2006 to 2016 regarding the predictors of academic performance and success among undergraduate nursing students. It was found that satisfactory academic performance among nursing students is associated with older age, female gender, English language proficiency, majority ethnic status, pre-admission academic achievements, selecting nursing as first choice for study, participating in organised music programmes, active academic engagement, as well as psychological and emotional factors. Study 2: Undergraduate nursing students’ (n =232) perceptions regarding their educational environment were explored. This study showed that generally the nursing students were positive about their educational environment. However, the findings indicated that enhancements are required to improve the conditions of the educational environment. Study 3: The study explored the challenges experienced by undergraduate nursing students (6 - focus group discussions) regarding their academic performance and success and the measures implemented to overcome these challenges. The findings revealed that students’ academic performance is influenced by the students’ economic background, place of residence, inadequate theoretical and clinical support and the unfavorable educational environment. However, the findings also indicated that students employ a surface approach to learning, maintain a positive attitude and remain academically engaged in response to these challenges. Study 4: The study explored the challenges experienced by nurse educators (n = 8) regarding the academic performance, success and retention of undergraduate nursing students and the measures implemented to overcome these challenges. The findings revealed that students’ academic performance is influenced by poor class attendance, lack of academic readiness, socioeconomic backgrounds, English language proficiency, structure of the programme, the educational environment and the working conditions for nurse educators. Study 5: A three round Delphi study was conducted to validate an intervention towards improving the academic performance, success and retention among nursing students. The intervention was structured into eleven categories that emerged from phase 2: (1) Select high quality prospective nursing students; (2) Provide English language support; (3) Promote class attendance; 4) providing financial support to deserving students; (5) Provide university residence to undergraduate nursing students; (6) Encourage family support and involvement; (7) Make the undergraduate nursing programme student-friendly; (8) Ensure a conducive teaching and learning environment; (9) Enhance theoretical and clinical support to undergraduate nursing students at all times; (10) Ensure uniformity and consistency in the process of teaching and learning as well as; (11) Provide support to nurse educators and clinical supervisors. Conclusion: The findings of this study have several implications for the education of nursing students. The developed intervention may help promote better understanding of the academic performance, success and retention of nursing students.
A programme to facilitate quality client-centred care in Primary Health Care clinics of the rural West Coast District
(University of the Western Cape, 2018) Eygelaar, Johanna Elizabeth; Klopper, Hester C.; Jooste, Karien
Introduction: The overall aim of this study was to develop a programme to facilitate quality client-centred care in Primary Health Care clinics of the rural West Coast District. Research design and -method: Both quantitative and qualitative methods were applied for this study . Phase 1, a situational analysis collected and analysed quantitative data from the perspective of clients and clinical nurse practitioners via structured questionnaires. The population included all clients 18 years and older (N=137 991) of the fixed clinics (N=25) in the five subdistricts of the West Coast District. According to the Cochran formula a sample of (n=383) should be adequate to represent the population. Non-proportional sampling was applied to estimate the number of participants per clinic. An all-inclusive sample of (n=64) clinical nurse practitioners participated in the study. Phase 2, the qualitative part of the situational analysis, applied five focus group discussions to explore and describe the managers and allied health professionals’ perceptions about quality client-centred care. A semi-structured interview schedule was compiled to guide the focus group discussions. An all-inclusive sample was utilised to include all the managers and allied health professionals of the five subdistricts (N=43). Phase 3 included the development of the programme based on the study findings and literature. Quantitative results: The analysis revealed the following quality client-centred care challenges, namely: Patient Rights (Domain 1) were not always respected and adhered to as these were characterised by: language (statistical p<0.001 and practical significant with a large effect size d=0.74); Satisfaction and Safety (statistical p<0.001 and practical significant with a medium effect size d=0.55); Referral Procedures (statistical significant p<0.001); Waiting Times (statistical p<0.001 and practical significant with a medium effect size d=0.47) and Confidentiality difficulties (statistical p<0.001 and practical significant with a medium effect size d=0.68). The Domain 2, Clinical Governance, Care and Safety showed shortcomings as highlighted by the Client and his/her Family (statistical p<0.001 and practical significant with a large effect size d=0.77). Clinical Support Services, Domain 3, revealed inadequacies regarding the continuous availability of medication (statistical significant p<0.008) and the reporting of side-effects (statistical significant p<0.001). Furthermore, Public Health Domain 4, showed that clients identified community health promotion and disease prevention events (statistical p<0.01 and practical significant with a large effect size d=0.79), and home visits by the community healthcare workers (statistical p<0.001 and practical significant with a large effect size d=1.09) as both a “problem” and a “gap”. Leadership and Corporate Governance, Domain 5 was characterised by the lack of: visible organograms (clients mean 2.40), community communication (clients mean 2.12 & clinical nurse practitioners mean 2.36), visibility of goals, values and future plans of the Western Cape Department of Health (statistical p<0.001 and practical significant with a medium effect size d=0.59) and role and function of the clinic committees (statistical significant p<0.008). Moreover, Domain 6, Operational Management was challenged by inadequate staffing levels (statistical significant p<0.003). Lastly, Domain 7: Infrastructure was characterised by the lack of drinking water in the waiting areas (clients mean 2.08 & clinical nurse practitioners mean 2.02), inadequate clinic space (clients mean 2.10 & clinical nurse practitioners 2.23); maintenance not up-to-date (statistical significant p<0.002); physical appearance of the clinic (statistically significant p<0.001) did not have a positive effect on staff morale and evacuation plans (statistical p<0.001 and practical significant with a medium effect size d=0.54) were not visible. In addition, correlations between the domains showed that the domains are not in silos, but are interdependent on another. Qualitative results The qualitative, thematic data analysis revealed various inadequacies regarding quality client-centred care. Theme One about the Patient Rights revealed that patients were not always treated with the necessary respect and dignity. Theme Two concerning Patient Care, revealed that focus group participants were well-informed on what the concept client-centred care entailed. However, patients and or clients did not always experience their care as client-centred. Theme Three about the Clinical Support Services, indicated shortages of medication and medical equipment; long waiting time for specialists and rehabilitation referral appointments. Theme Four, referring to the Public Health confirmed that health promotion and prevention activities are limited, due to various organizational factors and community healthcare workers’ activities which are limited to home-based care activities. Theme Five, Corporate Governance and Leadership matters were characterised by too many processes or “red tape” resulting in inefficient procurement processes, inadequate staffing and inactive health committees. Theme Six, Operational Management highlighted the severe pressure under which the operational managers have to work, resulting from their twofold role of being the clinic manager and at the same time operate as a clinical nurse practitioner. Theme Seven refers to Infrastructure and Facilities and is characterised by inadequate maintenance and lack of space according to the number of clients and package of care. To summarise: The situational analysis revealed 81 problems. These problems form the evidence base for the development of the programme to facilitate quality client-centred care in primary helth care clinics of the rural West Coast District.

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