Evaluation of self-efficacy in clinical performance of nurses initiate and management of anti-retroviral therapy by South African professional nurses
- Authors: Mangi, Nozuko Glenrose
- Date: 2017
- Subjects: Nursing assessment -- South Africa -- Eastern Cape Self-efficacy Nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/4492 , vital:28344
- Description: Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.
- Full Text:
- Authors: Mangi, Nozuko Glenrose
- Date: 2017
- Subjects: Nursing assessment -- South Africa -- Eastern Cape Self-efficacy Nursing -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10353/4492 , vital:28344
- Description: Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.
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Perceptions of adolescents regarding induced abortion in two public hospitals in East London, South Africa
- Authors: Sidloyi, Nozitulele
- Date: 2017
- Subjects: Abortion -- South Africa -- Eastern Cape , Teenage pregnancy -- South Africa -- Eastern Cape , Teenagers -- Sexual behavior
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/4428 , vital:28339
- Description: Adolescent pregnancy is a concern worldwide and has risen at an alarming rate in South African societies. Many teenage pregnancies end up being aborted. Despite the availability of contraceptives free of charge in public institutions, unintended pregnancies among adolescents still persist. These unintended pregnancies result in a high rate of induced abortion, both safe and unsafe. The study was conducted to explore and describe the perceptions of adolescents regarding induced abortion in two public hospitals in East London, South Africa. This was a qualitative, phenomenological research study to explore the perceptions of adolescents regarding the induced abortion. Participants were purposively selected to participate in the study. Data were collected by means of individual interviews using interview guide in order to allow the participants to express their perceptions freely because of the sensitivity of the issue. Data were collected until saturation was reached. Saturation was reached after 24 participants were interviewed by the researcher. Data analysis used Tech’s (1990) steps as outlined by Creswell (2014:198). Themes, categories, and subcategories were identified following the data analysis. All adolescents admitted having consensual unprotected sex. Engagement in early sexual behaviour by the adolescents was evident as their sexual debut was between the ages of fifteen and sixteen years. Adolescents emphasised that they had abortions because they had no choice. Adolescents cited poor-socio economic status as their main reason for having abortions. Some findings were that adolescent men were against abortion and they had to be persuaded by their female counter parts. A recurrent factor in the results was the infrequent use of contraceptives, including condoms by the adolescents. This indicated that adolescents practised unsafe sex, with little or no regard for sexual transmitted diseases including Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS). The results also indicated poor treatment by the nursing staff at the family planning clinics. This poor treatment resulted in adolescents not attending family planning clinics. This led to adolescents using abortion as the only method of contraception. Shortage of staff was a contributing factor to the poor treatment of adolescents in the family planning clinics. Adolescents cited that contraception at the clinics is not prioritised. The participants suggested that they should be reminded when to come to the clinic for family planning. Perceptions of reasons for adolescents choosing induced abortion ranges from psychosocial to socio-economic reasons. The knowledge of participants of what was happening to them and what they were doing seemed adequate. The perceptions of the adolescents regarding induced abortion were that abortion is wrong, against their morals as they are Christians; they use abortion because they have no choice due to their poor socio-economic status. The strategies to reduce the unintended pregnancy through the proper management of the contraception programmes, including the change in negative attitudes of health care providers in the family planning clinics could yield positive results.
- Full Text:
- Authors: Sidloyi, Nozitulele
- Date: 2017
- Subjects: Abortion -- South Africa -- Eastern Cape , Teenage pregnancy -- South Africa -- Eastern Cape , Teenagers -- Sexual behavior
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/4428 , vital:28339
- Description: Adolescent pregnancy is a concern worldwide and has risen at an alarming rate in South African societies. Many teenage pregnancies end up being aborted. Despite the availability of contraceptives free of charge in public institutions, unintended pregnancies among adolescents still persist. These unintended pregnancies result in a high rate of induced abortion, both safe and unsafe. The study was conducted to explore and describe the perceptions of adolescents regarding induced abortion in two public hospitals in East London, South Africa. This was a qualitative, phenomenological research study to explore the perceptions of adolescents regarding the induced abortion. Participants were purposively selected to participate in the study. Data were collected by means of individual interviews using interview guide in order to allow the participants to express their perceptions freely because of the sensitivity of the issue. Data were collected until saturation was reached. Saturation was reached after 24 participants were interviewed by the researcher. Data analysis used Tech’s (1990) steps as outlined by Creswell (2014:198). Themes, categories, and subcategories were identified following the data analysis. All adolescents admitted having consensual unprotected sex. Engagement in early sexual behaviour by the adolescents was evident as their sexual debut was between the ages of fifteen and sixteen years. Adolescents emphasised that they had abortions because they had no choice. Adolescents cited poor-socio economic status as their main reason for having abortions. Some findings were that adolescent men were against abortion and they had to be persuaded by their female counter parts. A recurrent factor in the results was the infrequent use of contraceptives, including condoms by the adolescents. This indicated that adolescents practised unsafe sex, with little or no regard for sexual transmitted diseases including Human Immune Deficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS). The results also indicated poor treatment by the nursing staff at the family planning clinics. This poor treatment resulted in adolescents not attending family planning clinics. This led to adolescents using abortion as the only method of contraception. Shortage of staff was a contributing factor to the poor treatment of adolescents in the family planning clinics. Adolescents cited that contraception at the clinics is not prioritised. The participants suggested that they should be reminded when to come to the clinic for family planning. Perceptions of reasons for adolescents choosing induced abortion ranges from psychosocial to socio-economic reasons. The knowledge of participants of what was happening to them and what they were doing seemed adequate. The perceptions of the adolescents regarding induced abortion were that abortion is wrong, against their morals as they are Christians; they use abortion because they have no choice due to their poor socio-economic status. The strategies to reduce the unintended pregnancy through the proper management of the contraception programmes, including the change in negative attitudes of health care providers in the family planning clinics could yield positive results.
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The effectiveness of medium-fidelity simulation on the clinical readiness of student midwives
- Authors: Ntlokonkulu, Zukiswa Brenda
- Date: 2017
- Subjects: Obstetrics Midwifery Emergency medical services , Simulated patients
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/4503 , vital:28345
- Description: Simulation affords the student a safe and supportive environment in which to practise skills repeatedly without causing any harm to a real patient. The Department of Nursing Sciences at the University of Fort Hare has a laboratory that offers lowto medium-fidelity simulation in the form of task trainers and mannequins. These task trainers and mannequins are used in general nursing, and in community and midwifery nursing sciences, for the demonstration of skills, the practising of skills by students and for formative assessments. In midwifery, task trainers are used for vaginal examinations, abdominal palpation breech and vaginal deliveries and the management of post-partum haemorrhage (PPH). Given that in a real-life clinical environment limited opportunities exist for students to practise during an obstetrical emergency, medium-fidelity simulation (MFS) in midwifery ideally positions the student in a practical environment without risking the patient’s safety. Despite the availability of MFS at UFH, its benefit on the clinical readiness of student midwives is not known. The present study was designed to assess the effectiveness of MFS in enhancing the clinical readiness of student midwives at the University of Fort Hare. The main research objective of the study was to explore, describe and analyse the effect of medium-fidelity simulation on student midwives’ confidence, critical thinking ability, communication, satisfaction and team work in an obstetrical clinical emergency environment. This was a qualitative, interpretive, phenomenological analysis designed to explore the student midwives’ lived experiences regarding the effectiveness of mediumfidelity simulation and the effect of these experiences on clinical readiness. The target population was fourth-year Bachelor of nursing student midwives at the University of Fort Hare. Purposive sampling was used to select five student midwives who were team leaders during the management of PPH using MFS. Ethical approval was granted by the University of Fort Hare Ethics Committee. Informed consent was obtained from the participants prior to data collection. Trustworthiness was ensured by observing the principles of transferability, credibility, confirmability and dependability. Data was collected through individual face-to-face interviews and a semi-structured interview guide. All fourth-year student midwives had viewed an on-line video entitled Essential Steps in Management of Obstetrical Emergency(ESMOE) Postpartum Haemorrhage, in which the procedure was demonstrated. The video, sent via Backboard, was presented in such a way that student midwives had the opportunity to watch it repeatedly in order to thoroughly comprehend the demonstrated skill. A semi-structured interview guide was used for data collection. Interviews were conducted in the simulation laboratory. A Samsung smartphone was used to record interviews and a notepad was used to make notes of gestures, such as smiles or other facial expressions. Data was analysed using thematic content analysis applicable to interpretative phenomenological analysis (IPA) studies using the six steps: reading and re-reading; initial noting taking; developing emergent themes; searching for connections across the emergent themes; moving to the next case and lastly, looking for patterns across cases. The major findings indicated that the participants had differing views regarding the concept of clinical readiness; some held that clinical readiness meant being ready or prepared to handle any eventuality in the course of work, others opined that it was a state of being conversant with the policies and procedures in the clinical ward. Participants believed that clinical readiness was parallel to being competent and that midwives should always be ready to anticipate complications that might arise with the patient, endeavouring to analyse and interpret such conditions clinically. Participants expressed the need to see the simulation skill demonstrated repeatedly for thorough understanding of the technique, so that they could work independently in an obstetrical emergency situation. During simulation, participants were confident in delegating duties to team members, affirming that in order to ensure that tasks were carried out, team leaders should receive regular updates from team members.
- Full Text:
- Authors: Ntlokonkulu, Zukiswa Brenda
- Date: 2017
- Subjects: Obstetrics Midwifery Emergency medical services , Simulated patients
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10353/4503 , vital:28345
- Description: Simulation affords the student a safe and supportive environment in which to practise skills repeatedly without causing any harm to a real patient. The Department of Nursing Sciences at the University of Fort Hare has a laboratory that offers lowto medium-fidelity simulation in the form of task trainers and mannequins. These task trainers and mannequins are used in general nursing, and in community and midwifery nursing sciences, for the demonstration of skills, the practising of skills by students and for formative assessments. In midwifery, task trainers are used for vaginal examinations, abdominal palpation breech and vaginal deliveries and the management of post-partum haemorrhage (PPH). Given that in a real-life clinical environment limited opportunities exist for students to practise during an obstetrical emergency, medium-fidelity simulation (MFS) in midwifery ideally positions the student in a practical environment without risking the patient’s safety. Despite the availability of MFS at UFH, its benefit on the clinical readiness of student midwives is not known. The present study was designed to assess the effectiveness of MFS in enhancing the clinical readiness of student midwives at the University of Fort Hare. The main research objective of the study was to explore, describe and analyse the effect of medium-fidelity simulation on student midwives’ confidence, critical thinking ability, communication, satisfaction and team work in an obstetrical clinical emergency environment. This was a qualitative, interpretive, phenomenological analysis designed to explore the student midwives’ lived experiences regarding the effectiveness of mediumfidelity simulation and the effect of these experiences on clinical readiness. The target population was fourth-year Bachelor of nursing student midwives at the University of Fort Hare. Purposive sampling was used to select five student midwives who were team leaders during the management of PPH using MFS. Ethical approval was granted by the University of Fort Hare Ethics Committee. Informed consent was obtained from the participants prior to data collection. Trustworthiness was ensured by observing the principles of transferability, credibility, confirmability and dependability. Data was collected through individual face-to-face interviews and a semi-structured interview guide. All fourth-year student midwives had viewed an on-line video entitled Essential Steps in Management of Obstetrical Emergency(ESMOE) Postpartum Haemorrhage, in which the procedure was demonstrated. The video, sent via Backboard, was presented in such a way that student midwives had the opportunity to watch it repeatedly in order to thoroughly comprehend the demonstrated skill. A semi-structured interview guide was used for data collection. Interviews were conducted in the simulation laboratory. A Samsung smartphone was used to record interviews and a notepad was used to make notes of gestures, such as smiles or other facial expressions. Data was analysed using thematic content analysis applicable to interpretative phenomenological analysis (IPA) studies using the six steps: reading and re-reading; initial noting taking; developing emergent themes; searching for connections across the emergent themes; moving to the next case and lastly, looking for patterns across cases. The major findings indicated that the participants had differing views regarding the concept of clinical readiness; some held that clinical readiness meant being ready or prepared to handle any eventuality in the course of work, others opined that it was a state of being conversant with the policies and procedures in the clinical ward. Participants believed that clinical readiness was parallel to being competent and that midwives should always be ready to anticipate complications that might arise with the patient, endeavouring to analyse and interpret such conditions clinically. Participants expressed the need to see the simulation skill demonstrated repeatedly for thorough understanding of the technique, so that they could work independently in an obstetrical emergency situation. During simulation, participants were confident in delegating duties to team members, affirming that in order to ensure that tasks were carried out, team leaders should receive regular updates from team members.
- Full Text:
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