A comprehensive support programme for professional nurses performing HIV counselling and testing at primary health care clinics in the rural Eastern Cape
- Authors: Madolo, Agrinette Nomboniso
- Date: 2019
- Subjects: HIV-positive persons -- Counseling of , AIDS (Disease) -- Patients -- Counseling of , Primary health care -- South Africa -- Eastern Cape , Community health nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/40746 , vital:36232
- Description: The increase in global rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has had far reaching effects on healthcare services around the world. According to the 2017 statistics released by UNAIDS, South Africa has the largest HIV epidemic in the world. The South African Department of Health provides an HIV counselling and testing (HCT) service to patients in order that they may know their HIV status and endeavours to educate patients so that they may adapt their behaviours and lifestyles. The goal of this study is to develop a support programme for nurses to assist them in coping emotionally with their day-to-day activities when providing HCT services to patients attending primary healthcare clinics. The paradigm used as a lens to view the phenomenon is Kinlaw’s cyclical growth of empowerment theory. The researcher used a qualitative,explorative, descriptive and contextual design. The study involves three phases: (a) empirical research that explores nurses’ experiences of performing HCT in primary healthcare rural clinics, (b) the development of a conceptual framework for a support programme using the survey list of Dickoff et al. (1968:427). (c) the formalisation of the Comprehensive Support Programme to help nurses to cope emotionally with working with HCT on a long-term basis. Chinn and Kramer (2005118) were used to evaluate the programme. . The empirical findings revealed registered nurses experienced HCT both positively and negatively. They felt overwhelmed by the expectation that all patients attending primary healthcare clinics should be offered HCT routinely and the time constraints involved. They described how the emotional trauma attached to HCT affected their work patterns, leading to low productivity, and affected them outside work, leading to stress and sleep disturbances. They feltl disturbed that even when informed, people choose not to adopt safer sex practices and that how patients responded to a positive diagnosis cannot be predicted. Participants showed signs of stress, frustration, despair and sadness because most tested clients show positive test results and the number of clients testing positive is increasing. While participants felt helpless to improve the situation, at the same time, HCT was experienced as rewarding because it enabled diagnosis of medical conditions of which people weree not aware. The goal of the study was achieved with the development and formalisation of an extensive, relevant and applicable Comprehensive Support Programme for implementation for registered nurses to enable them cope emotionally when conducting HCT based on the empirical findings.
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- Date Issued: 2019
Perspectives of South African women and midwives on clinical practice in public maternity units: facilitating the scaling-up of such clinical practices
- Authors: Wibbelink, Margreet
- Date: 2019
- Subjects: Physician practice patterns , Midwives -- South Africa -- Attitudes Pregnant women -- South Africa -- Attitudes Midwifery -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/44422 , vital:37168
- Description: Despite a steady drop globally in maternal and newborn deaths since 1990, thousands of women and newborns still die each year during pregnancy and childbirth. South Africa, together with other countries, failed to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015. This is despite the positive efforts made in the country towards achieving these goals. However, much more still needs to be done. For that reason, proper and safe care of labouring women remains the identified major focus to prevent these deaths. The current study was the culmination of an investigation into the problem of poor performance regarding maternal and perinatal outcomes as identified by the researcher. The aim of this research study was to understand the experiences and perceptions of the women and the midwives regarding the clinical practices in public maternity units in South Africa in order to facilitate the scaling-up of the midwifery practice. A mixed-methods (sequential exploratory) design was used to answer the research question and objectives, and the study was conducted in three phases. In Phase One, a qualitative research design was implemented. The population were all the midwives in the Eastern Cape who had been working in public maternity units and women who had delivered in those settings. Non-probability purposive sampling with inclusion criteria assisted in selecting a suitable sample. Data collection was done using semi-structured audio-recorded interviews from eleven public sector midwives and eleven women receiving care from the midwives in the Eastern Cape, a province of South Africa. On data analysis, three themes emerged, namely participants had diverse experiences of the midwifery practice, midwives highlighted the burden with regard to the shortage of skilled midwives, and midwives identified managerial issues that affect their performance. Phase Two of the study comprised the quantitative research. The population was the midwives in South Africa who were working in public maternity units and nonprobability purposive sampling criteria were used to select participants. Data collection was done by means of a survey that used a tool adapted from the Hennessy-Hicks Training Needs Analysis Questionnaire. Questions for the survey tool were based on the results of Phase One. A total number of 314 questionnaires were completed, returned and analysed. Phase Three of the study comprised the integration of the results of the first two phases. The study found that midwives were committed to provide quality care but major factors needed to be addressed to facilitate scaling-up of clinical midwifery practices. The midwifery profession needed to be strengthened and an enabling working environment provided. Based on the results of the study as well as the theoretical, conceptual and contextual framework, two strategies were developed: Strategy 1: Empowering midwives to deliver woman-centred care in public sector maternity units Strategy 2: Creating an enabling work environment in order to deliver womancentred care in public sector maternity units.
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- Date Issued: 2019