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Perceptions, knowledge and attitudes of women towards maternal deaths at Qaukeni Sub-district in OR Tambo Health District in Eastern Cape Province, South Africa

  • Authors: Mayekiso, Nomahlubi Dorcas
  • Date: 2018
  • Subjects: Maternal health services--South Africa--Eastern Cape Mothers--Mortality
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/11194 , vital:37203
  • Description: BACKGROUND AND AIM: Maternal mortality is a global problem, with the risk of deathever present during pregnancy, labour and postnatal, particularly in developing countries. The purpose of the study was to explore the perceptions, knowledge and attitudes of women of child-bearing age concerning maternal deaths in Qaukeni Sub-District, Eastern Cape Province, South Africa. METHODS: A descriptive, contextual, exploratory research design was used to explore the perceptions, knowledge and attitudes of child-bearing-age women. Interviews were conducted with 21 purposively selected multiparous pregnant women. FINDINGS: Some of the participants knew signs and symptoms of pregnancy as well as danger signs during pregnancy such as haemorrhage, sepsis, high blood pressure and complications of unsupervised home deliveries; while others had little knowledge about these signs and symptoms. Some participants knew about the causes of maternal deaths and a number of them had beliefs that can be construed as myths. The use of herbal medications in pregnancy, such as gwarugwaru and mbelekisane, were highlighted as a problem in maternal health, with serious complications that can lead to maternal deaths. The participants have negative attitudes towards the clinics and hospitals due to the ill treatment they received from health professionals in labour wards, which may have led to the loss of lives of women and children. Lack of resources, unskilled traditional birth attendants, lack of accountability and responsibility by health professionals were contributory factors towards maternal deaths. CONCLUSIONS: Lack of resources, unskilled traditional birth attendants, lack of accountability and the irresponsibility of professional nurses and doctors were all pointed out by participants as either direct or indirect causes of maternal deaths. The recommendations include frequent in-service training for unskilled birth attendants, and the provisions of more professional nurses and doctors. Campaigns also need to be held to highlight the risks that women are exposed to during pregnancy, and the importance of early interventions.
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Physiological traits, anthropometric characteristics and motor development of rural children in Nkonkobe Municipality, South Africa

  • Authors: Idamokoro, Mere
  • Date: 2018
  • Subjects: Motor learning Children -- Physiology Children -- Anthropometry -- South Africa
  • Language: English
  • Type: Thesis , Masters , Human Movement Science
  • Identifier: http://hdl.handle.net/10353/10061 , vital:35314
  • Description: Aim: The purpose of this study was to examine the physiological, anthropometric and motor development characteristics of rural children between the ages of 5 – 7 years old. Methods: The study involved 305 school children (159 boys and 146 girls) randomly selected from primary schools in Alice sub-district, Nkonkobe Municipality. Body weight, height, skinfold thickness and girth measurements were measured using standard procedures. Overweight and obesity were defined using body mass index (BMI) for age and gender. Derived variables were: fat mass, fat-free mass, fat mass index, fat-free mass index, waist-to-hip ratio, waist-to-height ratio and subscapular-to-triceps ratio. Motor development levels were measured and assessed using Test of Gross Motor Development –Second Edition (TGMD-2). Blood pressure was measured using aneroid sphygmomanometer. Results: Boys had higher mean values of blood pressure (69.19 ± 7.30 and 38.15 ± 5.91) compared to girls (68.39 ± 7.97 and 37.11 ± 7.53). The proportion of overweight among girls (15.75 percent) was higher compared to boys (10.69 percent). Likewise, the percentage of obesity among boys (16.35 percent) was higher compared to girls (10.27 percent). The motor development results showed that girls (40.9 ± 6.54) performed better than boys (39.7 ± 6.64) in locomotor skills test. Conversely, boys (39.8 ± 7.62) performed better than girls (38.6 ± 7.29) in object control. Conclusion: The prevalence of overweight and obesity among the children is alarmingly high and concerning for the health. At all ages, girls had higher body fat percentage and fat mass than the boys. However, FFMI and WHR were higher in boys compared to the girls. There is no gender difference in the waist-to-height ratio and STR of both boys and girls. The locomotor raw score is higher in girls than in boys; however, the object control raw score is higher in boys compared to girls. The non-correlation of BMI with TGMD-2 tests suggests an equal potential of motor development among the children, regardless of their body fatness. There is need for obesity prevention programme in schools, which should involve all the stakeholders (teachers, parents/guardians, government, NGOs). The programme should focus on creating awareness concerning child body weight, healthy dietary intake and regular BMI screening in schools.
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Reasons for late booking of pregnant women at antenatal care clinics in King Sabata Dalindyebo Sub-district in the Eastern Cape, South Africa

  • Authors: Ntshanga, Nomvume Signoria
  • Date: 2018
  • Subjects: Pregnant women -- South Africa -- Eastern Cape Prenatal Care Late antenatal care booking
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/10520 , vital:35592
  • Description: Background: The initiation of ante-natal care booking is universally recommended in the first trimester of pregnancy. While working in the Oliver Reginald Tambo district in the Eastern Cape Department of Health, the researcher noticed that late booking was the norm in all sub-districts, especially in the King Sabata Dalindyebo (KSD) sub-district, resulting in impaired antenatal care and an increased potential for adverse outcomes such as maternal mortalities. Purpose of the study: The purpose of the study was to explore and describe the reasons for late booking for antenatal care by pregnant women in the KSD sub-district. Objectives: The objective of the study was to determine reasons why women were booking late for antenatal in KSD sub district. Methods: Thirteen in-depth, unstructured interviews were conducted with late bookers (i.e., those who sought antenatal care (ANC) after twenty weeks of pregnancy) between July and August 2015. The interviews were recorded and, subsequently, transcribed by a reputable linguist from Walter Sisulu University (WSU) and analysed using Creswell’s thematic analysis model. Findings: The average gestational age of booking was 22 weeks (ranging from 22 to 28 weeks). Most women were teenagers and young unmarried women, most of whom were still attending school. All were unemployed. Most had experienced previous pregnancies. All these women delayed attending clinic early due to their ignorance of the exact gestational period for one to start the clinic. Although most of the women did not have direct reasons, the bulk of their reasons for delays were linked to long distances being travelled, leading to the payment of expensive taxi fees. This may also be attributed to cultural factors that seem to promote a veil of secrecy regarding pregnancy, the desire for visual evidence of pregnancy first and the practice of married women having to care for sick relatives. Conclusion: Poor access to clinics is a fundamental systemic failure and a major contributor and one of the reasons why women delayed in attending antenatal care clinics. Low socio economic status and cultural beliefs, coupled with long distance and expensive taxi fare, are other reasons for late booking.
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Relationship between alcohol use patterns and knowledge of alcohol-attributable health conditions among undergraduate students' at a university in the Eastern Cape

  • Authors: Mandeya, Andrew
  • Date: 2018
  • Subjects: Drinking of alcoholic beverages College students--Alcohol use
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/11128 , vital:37173
  • Description: Background: Alcohol use prevalence has been found to be higher than 50 percent at some universities in South Africa. It is against this background that this study aimed to establish the relationship between alcohol use, knowledge of alcohol-attributable health conditions and biographical characteristics. Literature review: The study was based on a review of literature on prevalence and patterns of alcohol use among university students, knowledge of alcohol-attributable chronic diseases, foetal alcohol syndrome, sexual and reproductive health and alcohol use measurement. Methodology: Data were collected from 213 undergraduate students enrolled for the Statistics service courses on two campuses of the same university. The Mann-Whitney normal approximation and the Kruskal-Wallis tests were used to compare health knowledge across levels of alcohol use and biographical characteristics. The chi-squared test and multiple logistic regression analysis were used to determine the significance and patterns of associations between alcohol use and health knowledge and biographical characteristics. Results: The prevalence rates of alcohol use and risky alcohol use were found to be 58.2 percent and 42.7 percent, respectively. The mean health knowledge was 42.9 percent, which, is rather low. Males [OR=0.3; 95 percentCI (0.18; 0.68)], returning students [OR=0.5; 95 percentCI (0.25; 0.94)] and those with employed fathers [OR=2.3; 95 percentCI (1.19; 4.47)] were found to be at a higher risk of alcohol use. Health knowledge was significantly higher among alcohol users (Z=-2.7; p=0.0074) and those whose fathers had a post matric education (𝜒2=6.4; p=0.0410) and/or employment (Z=-2.7; p=0.0064). Conclusion: While prevalence rates of alcohol use and risky alcohol were high, health knowledge was disappointingly low. This suggests need for interventions designed to minimise alcohol use while at the same time increasing health knowledge.
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Risk factors of cardio-metabolic diseases among student nurses at Lilitha College of Nursing, East London, South Africa

  • Authors: Mkanzi, Noluthando
  • Date: 2018
  • Subjects: Risk assessment Cardiovascular system -- Diseases Human physiology
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/12924 , vital:39404
  • Description: Background: Non-communicable diseases are a growing public health concern and its prevalence is escalating exponentially, with a high frequency of morbidity, premature mortality, disability and loss of productivity. Since health education has become an important part of medical care, student nurses are potentially well suited to assist with the combat of these diseases. Early identification and treatment of modifiable risk factors among young adults would reduce the risk of developing cardio-metabolic diseases, thus, promoting health, prolonging life as well as saving costs related to healthcare. Objective: This study aimed to investigate the prevalence of cardio-metabolic risk factors among student nurses. Method: This was a descriptive cross sectional study, involving a convenience sample of 228 students during the educational year of 2017-2018 at Lilitha Collegeof Nursing in East London, South Africa. The WHO STEPwise standardized questionnaire was used to collect information on socio-demographic data (age, gender, year of study) and behavioural characteristics (smoking, alcohol consumption, physical inactivity, and dietary intake) of the participants. Anthropometric screening included measurement of height, weight and waist circumference. The biochemical screening included measurement of blood pressure and determination of fasting blood glucose concentration. Only students with complete data set were included in the data analysis. Statistical Package for Social Science (SPSS) version 23.0 was employed for descriptive and inferential analysis. Results: About half (41.7 percent) of the study participants were between the ages of 21 to 25 years and majority were females (67.5 percent).The prevalence of overweight and obesity were found to be 33 percent and 44 percent respectively. The prevalence of overweight was higher in males (44.6 percent), while females (53.9 percent) had higher prevalence of obesity. Female gender and increasing age are the only independent predictors of obesity. Results on blood pressure measurement showed that 25 percent of the participants had elevated blood pressure, and 22 percent were on stage 1 of hypertension while 2 percent were on stage 2. According to Joint National Committee on hypertension (JNC)’s criteria for defining hypertension, 44 percent of the participants had pre hypertension and 11percent had hypertension, diabetes and vegetables consumption were statistically associated with hypertension. The prevalence of pre-diabetes and diabetes was 6 percent and 7 percent respectively. Only abdominal obesity measured by waistto- hip ratio had a significant relationship with diabetes. Just 4.8 percent of the participants smoked daily and 33.3 percent consumed alcohol. Regarding physical activity, males were more active (60.8 percent) compared to females (54.8 percent). Conclusion: A high burden of overweight, obesity, and physical inactivity was observed among student nurses in East London. Screening for cardio-metabolic risk factors (CMRFs) among nursing students and implementation of intervention programs are recommended. Programs to raise awareness about CMRFs, encourage young adult students to adopt a healthy dietary behaviour and promote physical exercise should be initiated.
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Screening for cardiometabolic risk factors among commercial drivers in Buffalo City Metropolitan Municipality, Eastern Cape, South Africa

  • Authors: Adedokun, Aanuoluwa Odunayo
  • Date: 2018
  • Subjects: Diabetes -- South Africa -- Eastern Cape Obesity -- South Africa -- Eastern Cape Commercial vehicles
  • Language: English
  • Type: Thesis , Masters , Nursing Science
  • Identifier: http://hdl.handle.net/10353/10431 , vital:35463
  • Description: Cardio-metabolic risk factors are the aggregates of conditions that increase the susceptibility of developing cardio-metabolic diseases such as cardiovascular diseases (CVD) and diabetes. This includes insulin resistance, obesity, hyperglyceamia, dyslipoproteinemia, hyperinsulinemia and hypertension. This condition are worsen by smoking and physical inactivity as they mostlyare not easily detected. This was a cross-sectional survey of 403 commercial taxi drivers at ten different taxi ranks in BCMM. The study utilized a convenient sampling technique for the participants of the study. The WHO STEPwise approach was used for data collection. The WHO STEPwise questionnaire was used for a face-to-face interview. Socio-demographic (sex, age, marital status, driving experience, income) and behavioural characteristics (smoking, alcohol consumption, consumption of sweet drinks, physical activity, and dietary intake) of participants were obtained. Also, objective reports concerning anthropometric measurements (weight, height, waist and hip circumference), blood pressure and biochemical measurement that is the blood glucose measurement. All anthropometric measurements were taken following a standard procedure using a Lufkin nonextensible flexible anthropometric tape (W606PM), Rosscraft, Canada and a SECA weighing scale and stadiometer (Hamburg, Germany). Blood pressure was checked also in accordance with standard protocols using a Medic+ Digital Blood Pressure Monitor Model 1219 (Hamburg, Germany). A validated ACCU-CHEK glucose monitoring apparatus (Mannheim, Germany) wasused for blood glucose measurement. Overweight and obesity was defined as a body mass index (BMI) of 25.0 kg/m2 –29.9 kg/m2 and≥ 30 kg/m2, respectively. Pre-hypertension was defined according JNC-8 criteria a systolic blood pressure of 120- 139 mmHg and diastolic of BP 80-89 mmHg while hypertension was defined as an average of two systolic BP ≥140mmHg and/or diastolic BP of ≥90mmHg or a history of hypertension or anti hypertensive medication use. Diabetes status was determined using the fasting blood glucose (FBG) test and defined as a FBG ≥ 7.0mmol/L or self-reports of history or current diabetes medication use (treatment), while pre-diabetes was defined as a FBG of 5.6-6.9mmol/L. Awareness of diabetes was defined as self-reported history of diabetes among the people with diabetes. Metabolic syndrome status was determined according to the National agreement among makers of abdominal obesity. Statistical Package for Social Sciences (SPSS) was used for data analysis. The mean age of the participants was 43.3 (SD12.5) years. The prevalence of overweight and obesity was 34.0 percent and 38.0 percent, respectively. Age, marital status, period of driving, not-smoking, hypertension and diabetes were significantly associated with obesity. In logistic regression analysis, after adjusting for confounding factors, only age (OR 1.6, CI 1.0-2.7), hypertension (OR 3.6, CI 2.3-5.7) and non-smoking (OR 2.0, CI 1.3-3.1) were the independent and significant determinants of obesity. The prevalence rates of abdominal obesity by waist circumference (WC), waist-hip-ratio (WHR), waist-to-height ratio (WHtR) and neck circumference (NC) were 61.5 percent, 67.5 percent, 80.1 percent and 65.3 percent, respectively. A strong correlations exists between WHR and WC (>0.64); and WHtR and WC (>0.62). There exists a good agreement between WC and WHR. Also, a moderate agreement exists between WC and WHtR, WC and NC, WHR and WHtR, and WHtR and NC. The prevalence of above normal body composition for participants with hypertension was 71.0 percent, 65.9 percent, 63.2 percent and 66.5 percent by WC, WHR, WHtR and NC, respectively. For diabetes, the prevalence was 20.6 percent, 19.4 percent, 17.0 percent and 18.6 percent by WC, WHR, WHtR and NC, respectively. Waist circumference was a stronger predictor of hypertension and diabetics, with odds ratio of 3.7 (95 percent CI: 2.3-6.1 and 3.1 (95 percent CI: 1.6-6.0), compared to NC, with odds ratio of 1.7 (95 percent CI: 1.1-2.8). The prevalence of pre-hypertension was 33.7 percent and hypertension was 57.0 percent. Age, marital status, level of education, period of driving, obesity, alcohol, sweet drinks consumption and diabetes were significantly associated with hypertension. After adjusting for confounders, age >35 years (P=0.004), obesity and alcohol use (P<0.001), period of driving >5years (p=0.028) and diabetes (P=0.003) were significant predictors of hypertension. Prevalence of pre-diabetes and diabetes was 17 percent and 16 percent, respectively. Of those who were diabetic (n=63), the majority were aware of their diabetes status (n=43) and were on treatment (n=30). Age, marital status, level of education, period of driving, obesity, sweet drinks consumption, physical activities and hypertension were significantly associated with diabetes. Only age >35 (AOR= 3.6, CI 1.2-11.1), ever married (AOR= 3.3, CI 1.5-7.0) and hypertension (AOR= 3.4, CI 1.7-6.8) were the independent predictors of diabetes after adjusting for confounders. The prevalence of metabolic syndrome was 22 percent. Age, marital status, level of education, physical inactivity and period of driving were significantly associated with metabolic syndrome. After adjusting for confounders, only age above 35 years (Adjusted Odd Ratio [AOR] =3.8, CI=1.4- 9.5), ever married (AOR=3.0, CI=1.6-5.3) and period of driving above five years (AOR= 2.4, CI=1.2-4.7) were the significant and independent predictors of metabolic syndrome. About 30 percent of the participants were daily smokers, 37 percent consume alcohol regularly and only 18 percent were physically active, while 82 percent were physically inactive. In conclusion, there was a high prevalence of obesity, hypertension and diabetes among the commercial drivers in this setting, which is associated with unhealthy lifestyles (smoking, excessive alcohol consumption, physical inactivity). Interventions aimed at promoting cardiovascular health of commercial drivers such as health education and workplace screening, should prioritize weight reduction, healthy eating and physical activity in this population.
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Secrets that kill : reflections on violation of cultural rights enshrined in the constitution and human rights through traditional circumcision

  • Authors: Mlisa, Lily Rose Nomfundo
  • Date: 2018
  • Subjects: Human rights--South Africa Circumcision Circumcision--Law and legislation
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/11150 , vital:37176
  • Description: The study was based on four research objectives: (1) to identify philosophy, psychology, cultural reasons behind the harsh and traumatic experiences of young Xhosa boys and their mothers during ukwaluka (male circumcision) as a mark for transition to manhood; (2) to review perceptions concerning the role of mothers during the male circumcision (MC) process (3) identify cultural and psycho-social construction and meaning of MC and (4) to explore recommended possible strategies on managing MC-related traumas and deaths in the Sub-Saharan region and Eastern Cape Province in particular. Desktop literature review methodology was followed. An in depth literature review was conducted on diverse website search engines using a set of inclusion criteria. Published articles from 1995 to 2015 were selected. Thematic content analysis was used to categorise and interpret emerging themes from the reviewed articles as aligned to set research objectives. Results revealed diverse philosophical and cultural perceptions around MC, its construction and meaning among different cultures whether circumcising or non-circumcising cultures. In addition, various reasons are laid out for the harsh treatment given to initiates in different settings. Results also indicated that the MC is no longer a secret due to social media profuse publications about it. The impact of education and health care benefits around medical male circumcision (MMC) has influenced women from both non-circumcising and circumcising cultures to accept it. It is recommended that MC should continue under strict observation of prescribed protocols to lessen or prevent malpractices in the process. MMC is also highly recommended. In addition, the government and traditional leaders have to continue to conduct capacity building of traditional surgeons, prospective initiates and initiates including nurses and family members about crucial protocols and health matters around MC. Finally, results recommend best practices that could be learnt from other circumcising cultures to restore the respect of MC in the Eastern Cape, as well as inclusion of women in the MC process management.
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The effectiveness of employee assistance programme and its contribution in the improvement of employee productivity in the Department of Health, OR Tambo District : a case study of forensic pathology laboratory

  • Authors: Siyangaphi, Thembinkosi
  • Date: 2018
  • Subjects: Employee assistance programs -- South Africa -- Eastern Cape Labor productivity Employee motivation -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/10542 , vital:35603
  • Description: The Employee Assistance Programme (EAP) is a programme used by organizations to address problems related to drug addiction, stress and family problems, aimed at enhancing both work productivity and promoting high morale among the workers. The employees in the Department of Health (DoH) are faced with many challenges which affect them, personally, and their output at work. The OR Tambo District is currently faced with high levels of absenteeism, stress, low morale amongst health staff members, resulting in most employees resigning from the service. Others die due to ill health caused by high levels of stress and depression. Some employees are being dismissed for unethical behaviour, which include, among other things, alcohol and drug abuse and abuse of state resources, non-performance and absenteeism. Furthermore, due to the shortage of staff which results in a very high workload for the incumbents, some employees experience burnout, stress, depression and exhaustion. The main objective of the study was to assess the effectiveness of the Employee Assistance Programme among OR Tambo health workers in order to improve their work productivity and performance. The study applied a descriptive, quantitative design. The target population were all employees in the Forensic Pathology Laboratory in OR Tambo District and the sample included Managers, FPOs, Supervisors and General Assistants. The questionnaire was used to collect data. The major findings of the study demonstrated that most workers are dissatisfied with their personal growth and development in the organization. Furthermore, the results indicate that respondents are not satisfied with the decision space in their job functions, salary and benefits. The findings of this study demonstrated that most employees of the Department of Health experienced health, emotional and financial problems relating to alcohol and drug abuse, stress and work overload in their workplace. The study shows that the managers referred their employees for cases related to poor performance, absenteeism, alcohol and drug abuse, tiredness, employee and health problems; changes which were noticeable after referral. One of the major conclusions and recommendations that have been drawn in this study is that EAP is a good programme in terms of its contribution to work productivity of employees, however, it needs to be marketed and services should be utilized effectively.
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The factors that affect the low uptake of medical male circumcision among adult males 20-39 years of age in Gauteng Province, South Africa

  • Authors: Palmer, Eurica Laetitia
  • Date: 2018
  • Subjects: Circumcision Circumcision -- South Africa -- Gauteng Initiation rites -- South Africa -- Gauteng
  • Language: English
  • Type: Thesis , Masters , Public Health
  • Identifier: http://hdl.handle.net/10353/10553 , vital:35606
  • Description: The objective of this study is to determine the factors that contribute to low MMC uptake with the aim of proposing strategies to improve MMC demand creation for older adult males (20-39 years). By employing a qualitative research methodology, the study explores the factors and barriers that contribute to the low MMC uptake of adult males aged between 20 to 39 years in order to understand the situation from the perspective of the participants. A purposive sampling method was used to select 24 participants. Individual in-depth interviews were conducted with four Provincial Programme Managers from the National and the Gauteng Provincial Department of Health. Two focus-group discussions were also conducted with 20 adult males aged 20 to 39 years. The data collected were analysed, categorised, synthesised and decoded. The results of the research were explained well comprising the narratives of the participants. The main findings show that there are various contextual, individual and community factors contributing to the low MMC uptake. The study also found that the MMC programme does not review MMC communication messages consistently and continuously and demand creation strategies for adult males in the age group 20 to 39 years.
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The perceptions of professional nurses about the introduction of the National Health Insurance in a private hospital in Gauteng

  • Authors: Molokomme, Victoria Khabonina
  • Date: 2018
  • Subjects: Health insurance Hospitals Primary health care
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/13057 , vital:39444
  • Description: The National Health Insurance is a relatively new concept in South Africa currently being piloted to ensure that all citizens have access to quality and affordable health care regardless of their socio-economic status. This study was prompted by concerns regarding the introduction of the NHI and its implications on the South African health system. Therefore it seeks to determine the professional nurses concerns about the introduction of the NHI in a private hospital in Gauteng and to describe recommendations based on these perceptions. This study used a qualitative, exploratory and descriptive design. Data was collected using a semi-structured individual interview schedule. The sample was purposive consisting of professional nurses employed in a private hospital in Gauteng. Thematic data saturation determined the number of professional nurses interviewed. Data analysis was done with the aid of Creswell’s theory (2014:1996). Ethical considerations were observed and trustworthiness maintained. The results of the study outlined that professional nurse’s perception about the NHI is centred on equal distribution of health services to benefit all South Africans. However, concerns were based on its financial implications for those mandated to pay towards the fund. The feasibility of its implementation in the midst of staff shortage, inadequate resources and its impact on the public health sector was seen as a major challenge. The notion of a joint effort between public and private health sector in creating one health system was anticipated by most participants. The NHI implementation raised concerns about the impact it will have on the private sectors viability in the future. Professional nurse’s non-involvement in policy making, poor communication, lack of transparency, concerns about governance and management were perceived to be stumbling blocks towards efficient and effective implementation of the NHI.
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Towards the development of a conceptual framework for hospital performance assessment of a South African public hospital in the Eastern Cape province

  • Authors: Wagner, Rolene Margaret
  • Date: 2018
  • Subjects: Public hospitals Hospital care Hospitals -- Administration
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/12249 , vital:39223
  • Description: An integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals, is not available. The aim of this study was therefore to contribute to the development of a conceptual framework for assessing the performance of a SA public hospital in the Eastern Cape Province. The systematic literature review included all black and grey literature that relate to one of the two main themes- the purpose of measuring hospital performance and the methodology of assessing hospital performance. Relevant studies were identified through a Google search using the following descriptors: “Hospital Performance”, and “Hospital Performance Assessment”. There were 369 scholarly articles with the exact descriptors anywhere in the article with 59 articles released during the period 2012 to 2016. Ultimately, 7 articles met all the inclusionary criteria and described enterprise wide assessments of hospital performance. Other relevant articles, inclusive of grey literature, are included. Two of the studies in Morocco and Costa Rica were systematic reviews of hospital performance and covered the period 2000-2011. The Botswana case study assessed the use of the WHO PATH tool to measure the performance of its public hospitals. The Iranian, United States and Malaysian studies reflected on single aspect measures of hospital performance such as efficiency; the effect of weighting hospital performance indicators for patient harm on hospital profiles and payment; and Bed Occupancy rates, respectively. The review of the challenges associated with developing a hospital performance assessment framework was not found to be as useful as the other articles. The WHO PATH tool provides a high level integrated conceptual framework for measuring and comparing the performance of a South African teaching hospital in the Eastern Cape Province with other hospitals. This, however, needs to be adapted to the South African context with specific indicators being selected by local stakeholders that will promote best possible patient outcomes and a positive experience of patient-centred care at effective and efficient public health facilities. Lessons can be drawn from other countries’ experiences that have implemented hospital performance assessments and tested specific performance indicators.
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Women's knowledge and attitudes towards discontinuation of the Long-acting reversible contraceptive (Implanon) in Buffalo City Municipality, South Africa

  • Authors: Mrwebi, Khungelwa Patricia
  • Date: 2018
  • Subjects: Contraceptives Birth control Women's health services
  • Language: English
  • Type: Thesis , Masters , MPH
  • Identifier: http://hdl.handle.net/10353/11206 , vital:37231
  • Description: Unintended pregnancy remains a public health concern worldwide despite the availability of many contraceptives options. The South Africa Government introduced Implanon —a Long-acting Reversible Device— with aim to cost effectively prevent unplanned pregnancy. There are concerns that the implementation of this contraceptive option was without prior piloting to test for level of acceptance and attitude towards this contraception. Also, there is paucity of evidence on knowledge of women and their attitude to implanon as well as duration of use and reasons for discontinuation of implanon in South Africa. The present study address this gap by assessing the women’s knowledge of and attitude to implanon as well as reasons for implanon discontinuation in Buffalo City Municipality in South Africa. This prospective observational study administered a pre-validated questionnaire to 189 women who had removed implanon in the reproductive health clinic in one regional hospital and a primary health centre in Buffalo City Municipality. Descriptive statistics were used to analysis the study data. The average duration for implanon use among the participants was 11.2 months. Most participants had poor knowledge of implanon and implanon knowledge was significantly associated was with age. Most participants opined that implanon use is associated with heavy bleeding (60.7), irregular frequent bleeding (84.3percent), and weight gain (67percent). The main reason for implanon discontinuation was its side effects (71.3 percent). Other reasons for discontinuation of implanon are poor or wrong positioning (3.2percent), want to become pregnant (4.3percent). Some participants discontinued implanon because they were on treatment; 24 participants on ARV drug, one on antipsychotic drugs, and one on TB drugs. Experience of heavy bleeding (39.9percent) was the most stated side of implanon leading to implanon discontinuation. The study concluded that women, even though adopted implanon, lack knowledge of implanon mechanism of action and side effects. Poor knowledge of implanon side effects could explain its early discontinuation among women in South Africa. Provider should prioritise comprehensive counselling of clients on implanon side effects and mechanism of action in order to realise the benefit of implanon in this population.
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Attitutes of professional nurses towards the dimensions of quality care in the community health centres of the King Sabatha Dalindyebo sub-district, Eastern Cape

  • Authors: Ntuku, Nonzukiso Sheila
  • Date: 2017
  • Subjects: Community health services -- South Africa -- Eastern Cape Nursing services -- South Africa-- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/13989 , vital:39737
  • Description: The study focused on attitudes of professional nurses towards the dimensions of quality care. Quality care is the main focus of the Department of Health in the Republic of South Africa. The researcher believes that professional nurses form the backbone of the whole health care fraternity; hence they are central to the study of quality care dimensions. The aim of the study was to determine and describe the attitudes of professional nurses towards the dimensions of quality care in the community health centres of the KingSabatha Dalindyebo sub-district. A quantitative descriptive design was employed to meet the objectives of the study. The non-probability purposive sampling method was used to select participants to provide information on the attitudes of professional nurses towards the dimensions of quality care in the community health centres of the King Sabatha Dalindyebo sub-district, Eastern Cape. From the target of 84 professional nurses who were employed at the five community health centres of King Sabatha Dalindyebo sub-district of the O.R. Tambo District, Eastern Cape Province, 70 (83,3percent) professional nursesresponded to the questionnaires. A self-administered questionnaire written in simple English was used to collect data from the professional nurses regarding their attitudes towards dimensions of quality care. The researcher adhered to the ethical standards of nursing research as described by the Democratic Nursing Organisationof South Africa regarding anonymity, confidentiality, privacy and quality research, according to which the names of professional nurses were not recorded on the questionnaires. The data were analysed using the Statistical Package for the Social Sciences (SPSS) computer software. The distribution of the results has been presented in tables and a bar graph. The results of the study revealed that the professional nurses of these community health centres had positive attitudes towards the dimensions of quality care.
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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: 20122013201120142010. 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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Factors affecting experiential learning for midwifery students at the public college of nursing in the Eastern Cape

  • Authors: Pama, Nomzekelo
  • Date: 2017
  • Subjects: Midwifery -- Study and teaching -- South Africa -- Eastern Cape Midwives -- Training of -- South Africa -- Eastern Cape Nursing -- Study and teaching -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/4524 , vital:28375
  • Description: In nursing education, experiential learning is an important part of the curriculum and accounts for almost half of the requirements for the nursing programmes. A positive relationship with and collaboration between the training institutions and clinical placement facilities are vital for student achievement. Nurse educators are also expected to involve themselves in clinical accompaniment to bridge the theory-practice gap. Student nurses placed in midwifery clinical learning environments experience difficulty in meeting their experiential learning outcomes and programme requirements. Due to the overcrowded clinical facilities, they compete for the limited learning opportunities and resources which make the integration of theory and practice difficult. Therefore, this leads to delay in the commencement of community service by some of the nursing students as they do not graduate because of not achieving midwifery clinical outcomes and programme requirements. The purpose of the study is to assess factors affecting experiential learning for midwifery students at the public college of nursing in the Eastern Cape and the main objectives of the study were to: • Identify the challenges affecting the quality of learning in the clinical learning environment. • Determine the nature of supervision for experiential learning of midwifery students. • Determine the role of a nurse educator in the experiential learning of student nurses in midwifery clinical learning environment. Methods and analysis A quantitative, descriptive survey was conducted by making use of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 115 student nurses within the selected sites. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the learning environment (2) the supervisory relationship and (3) the role of the nurse teacher (lecturer).
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Factors influencing adherence to folic acid and ferrous sulphate nutritional supplement intake among pregnant teenagers in Buffalo City Municipality, Eastern Cape

  • Authors: Kalipa, Zamazizi
  • Date: 2017
  • Subjects: Pregnancy -- Nutritional aspects Pregnant women -- Attitudes Folic acid -- Pregnant women
  • Language: English
  • Type: Thesis , Masters , Nursing
  • Identifier: http://hdl.handle.net/10353/10017 , vital:35286
  • Description: Aim: The purpose of this study was to determine the factors influencing folic acid/ferrous sulphate nutritional supplement intake among pregnant teenagers in Buffalo City Metropolitan Municipality (BCMM), Eastern Cape in South Africa.Methodology: This was a cross-sectional, descriptive study involving 300 purposively selected pregnant teenagers aged between 13 to 19 years, who were attending antennal clinic in BCMM. A self-designed questionnaire was used for data collection. Results: The majority (97.0 percent) of the respondents obtained their supplements from the clinic; took other medications (87.2 percent); the respondents regularly used nutritional supplements (71.7 percent); agreed that folic acid and ferrous sulphate were important for pregnancy outcomes (96 percent); should be taken before pregnancy and after birth (68.2 percent); and nurses had explained the possible pregnancy complications (71.7 percent). About 84.1 percent agreed that the medication containers were clearly labelled; and nurses had explained the side effects of folic acid/ ferrous folate (60.7 percent), and the likely action in case side effects occurred (56 percent). The majority of the participants also agreed that folic acid and ferrous sulphate are good for the unborn baby (88 percent); and are harmless to the unborn baby (75.3 percent). The majority (49.2 percent) of the participants did not consume dark leafy vegetables, cabbage (35.0 percent), liver (47.1 percent), beef/lamb (42.0 percent), fish (43.3 percent) and beans/legumes (36.4 percent). Participants indicated that folic acid and ferrous sulphate made them feel nauseous, inclined to vomit and also caused stomach pain.Conclusion: The majority of pregnant teenagers received their nutritional supplements from the health facilities over the counter. The study indicated that nausea, vomiting, forgetting to take the supplements due to busy schedules, non-availability of folic acid and ferrous sulphate in health facilities were the major reasons influencing the intake of folic acid and ferrous sulphate by pregnant teenagers. Also, there is low consumption of iron and folate rich foods by pregnant teenagers in this setting. Health practitioners including doctors, nurses and community health care workers needed to improve health education by including information on nutritional supplements and the importance an use of folic acid and ferrous sulphate during pregnancy.
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Needs assessment in the development of a problem-based learning for paediatric nurse specialist programme at the University of Fort Hare Eastern Cape

  • Authors: Melitafa, Nomntu
  • Date: 2017
  • Subjects: Nursing assessment Problem-based learning Nursing -- Study and teaching
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/8921 , vital:33966
  • Description: The study seeks to assess the need for developing a post graduate child nursing science programme with a problem based learning approach at the University of Fort Hare East London Campus. The aim is to the aim of the study was to conduct a needs assessment in preparation for development of a PBL curriculum so as to produce reflective PNSs. Literature exposed the high mortality rates of children and the competency gaps of trained PNSs. A descriptive quantitative design was used to guide the study. The data were collected by means of self-administered survey questionnaires which constituted closed and open ended questions to yield both quantitative and qualitative data. Data were obtained based on demographic information, performance and importance of the PNS activities, competences of PNSs as well as the prevalence of child health problems at the rural, semi-urban and urban hospitals in the ECP. The purposive sampling technique was used to select participants. The sample size was 70 and 38 participants responded. Quantitative and qualitative data were obtained. Quantitative data were analyzed through use of the Statistical Programme for Social Science software (SPSS) Version 9.0.1 and qualitative data were analyzed manually. Quantitative results were presented with pie graphs, tables and frequencies. Four themes emerged, revealing factors prohibiting the service delivery of PNSs, special training needs of PNSs, prevalent health problems in children and personal interventions. The results showed that in essence there is a need to develop the envisaged Problem Based Learning (PBL) curriculum.
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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.
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Perceptions of unit managers regarding competencies of newly qualified registered nurses in East London health services

  • Authors: Bengu, Phindiwe Faith
  • Date: 2017
  • Subjects: Nurses -- In-service training -- South Africa -- Eastern Cape Community health nursing -- South Africa -- Eastern Cape
  • Language: English
  • Type: Thesis , Masters , MCur
  • Identifier: http://hdl.handle.net/10353/13597 , vital:39683
  • Description: The South African Nursing Council requires registered nurses to have the necessary knowledge, skills, attitudes and values which will enable them to render an efficient service (Morolong and Chabeli, 2005:39). The South African Education and training system, through its policy of outcomes- based education and training, has tabled competency as a national priority. In support of this, the South African Nursing Council (SANC) requires that the newly qualified registered nurse possess competency on the core functions of a registered nurse. The health system also demands competent nurse practitioners to ensure quality nursing care. Due to the fact that competency is a national priority and a statutory demand, the research question that guided the study is what are the perceptions of unit managers regarding competencies of newly qualified registered nurses in East London Health Care services. The study was aimed at describing the perceptions of unit managers regarding the competencies of newly qualified registered nurses in order to propose the recommendations to improve the competencies of such newly qualified registered nurses and to provide quality patient care. A quantitative descriptive non experimental design was used to evaluate the perceptions of unit managers regarding competencies of newly qualified registered nurses from a public nursing college. The sampling method of probability convenience sampling was used in this study. Data were collected by means of a questionnaire administered to ninety unit managers and only eighty one unit managers participated in the study. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 22 software. Statistical methods enabled the researcher to reduce, summarize, organise, manipulate, evaluate, interpret and communicate quantitative data. Data were cleaned and coded and spoilt data were checked. Findings from the software were displayed in graphs or tables. Concerning the eighty one unit managers who participated in the study, age and sex matched respondents were selected according to their availability.The results showed that there is agreement that competence of the nurses affects the image, mission and staff utilisation in their units and/or institutions. There was no dominant opinion on the possible association between competency and environmental, physical and technological factors. There was unanimous agreement that newly qualified nurses need constant supervision and in-service training. There was moderate agreement on the use of acquired knowledge and skills by nurses and there was no dominant opinion about how newly qualified nurses tolerate differences and handle misunderstandings and shortcomings of other professions. In conclusion newly qualified registered nurses need coaching, mentoring, n-service training and constant supervision. Recommendations regarding strategies to be used to improve competencies of newly qualified registered nurses included exit evaluations of community service practitioners, stipulating the competency framework of newly qualified nurses and assessment criteria of competency. Mentoring and coaching of newly qualified registered nurses during community service, monthly or quarterly meetings with the community service candidate in order to identify their challenges were also recommended. Motivation strategies in order to boost their morale so that they can deliver quality patient care. The newly qualified registered nurses should hold meetings with the unit managers regarding the challenges the unit managers face when assessing competencies of newly qualified registered nurses.
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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.
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