Health challenges of elderly people caring for children orphaned by AIDS in a community setting in South Africa

The HIV epidemic has resulted in the death of many people in their reproductive years, leaving behind orphans who are sometimes cared for by their elderly relatives despite the feebleness of their aging bodies. The purpose of the study was to explore and describe the health challenges of elderly people caring for children orphaned by AIDS. This research was conducted as a qualitative phenomenological exploratory, descriptive, and contextual study, conducted in the Mafikeng Municipality of North-West province in South Africa. Data were collected from December 2011 to February 2012 through individual face-to-face interviews and field notes. Elderly people’s health challenges in caring for children orphaned by AIDS centred on physical, psycho-emotional, economic and, psychosocial constraints, linked to re-parenting at an old age or because of losing their own children and relatives to AIDS. They experienced physical exhaustion as a challenge of caring for the children orphaned by AIDS as the capacity of their bodies was now reduced and they also had to meet the physical, emotion and spiritual needs of the orphans as well as providing them with food, clothing and shelter. Lack of sleep, dizziness, elevated blood pressure, low glucose levels and asthmatic attacks were also aggravated by contemplating how to fend for these children or owing to the fact that the orphans were very stubborn and took the elderly for granted. This study afforded an understanding of the health challenges elderly people experience in caring for children orphaned by AIDS. The study also recommended some of the interventions that can assist elderly people in this role they play of caring. Based on the findings, it can be deduced that on top of health challenges they face, they are obliged to deal with the added burden of caring for orphaned children by AIDS.Department of HE and Training approved lis

An ethnographic exploration of postoperative pain experiences among Ghanaian surgical patients

The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. Purpose: This study focused on patients’ experiences of postoperative pain (POP) and factors that affect POP. Design: The study employed qualitative ethnographic principles. Method: Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana. Findings: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. Implications for Future Research and Practice: Health professionals need to understand the sociocultural effects of pain in order to give effective care. Conclusion: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.Department of HE and Training approved lis

An insight into the preoperative experiences of Ghanaian general surgical patients

The unknown outcome of surgery has always been a source of anxiety for patients and their relatives. However, the experiences of Ghanaian surgical patients have not been adequately explored. This study sought to have an in-depth exploration of the preoperative experiences of Ghanaian general surgical patients to inform effective preoperative care. The study employed an ethnographic design and was conducted at two hospitals in Accra. Thirteen general surgical patients were purposively recruited and interviewed. Data analysis occurred concurrently and themes that emerged included reaction to impending surgery with subthemes of inappropriate disclosure, fear of death, readiness for surgery, and effect of waiting in the theatre. Also, the theme information gap had subthemes of preoperative care, expectations at the theatre, and undue delays. The study emphasized the need for health professionals to provide effective education to the public and patients, on surgery and its effects, to curb negative perceptions about surgery.Web of Scienc

Psychosocial factors influencing Ghanaian family caregivers in the post -operative care of their hospitalised patients

This study explored the psychosocial factors influencing family caregivers during the care of patients who had undergone surgery and were in pain. Family caregivers play key roles in the care of post-surgical patients in different cultures. However, research has not adequately explored family caregivers’ experiences within the post-operative context in Ghana. An exploratory qualitative design was employed. Data collection involved individual interviews. Concurrent content analysis was undertaken and saturation of data was achieved with 12 family caregivers and 1 key informant. The participants were recruited from the surgical department of a tertiary health facility in Accra, the capital city of Ghana. The study revealed six themes that influenced family caregivers in the care of post-surgical patients: faith, fear, feeling of relief, empathy, commitment and inadequate knowledge. Health professionals should meaningfully integrate and educate family caregivers on patient care and pain management within the post surgical context.Department of HE and Training approved lis

The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight

This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients’ POP. It also identified the factors that influenced nurses’ pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients’ pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses’ response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.Web of Scienc

Determinants of nurses’ knowledge gap on pain management in Ghana

There are concerns about adequacy of nurses’ knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses’ inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses’ inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.Web of Scienc

Perspectives of the surgeons, anaesthetists, and pharmacists on post-operative pain management roles in the Ghanaian context

Post-operative pain is best managed by a multi-disciplinary team approach. An extensive review of the literature indicated that little is known about the roles of surgeons, anaesthetists, and pharmacists regarding post-operative pain management in Ghana. Therefore, this study was undertaken in order to fully understand how health professionals perceive their roles and the challenges that influence their decisions about post-operative pain management. A qualitative approach with a focused ethnographic design was employed involving eleven in-depth individual interviews. Purposive sampling approach was employed. The study was conducted at a tertiary hospital in Accra, Ghana. The study revealed that surgeons and anaesthetists practised pre-emptive analgesia by administering intra-operative analgesia, giving nerve blocks, and infiltrating surgical wounds. Sometimes, epidural analgesia and perfusers were used for patients who could afford them, particularly if they were expected to experience severe post-operative pain. Challenges reported by all the participants related to inadequate personnel, opioid effect and availability, inadequate training and collaboration, and effects of organisational culture were identified. It was concluded that effective collaboration among health professionals could enhance post-operative pain management. There is a need for enhanced commitment, in order to provide more effective post-operative pain management.Department of HE and Training approved lis

Consumer satisfaction with community mental health care in Durban: research

This study presents a consumer evaluation of the delivery and aspects of services provided at three communityrun mental health centres with the aim of using this information to improve the services in future for quality assurance. One hundred and eleven clients attending the psychiatric community health clinics responded to a self-report questionnaire that elicited information on their satisfaction with several aspects of their clinical care in community mental health services. Items on the questionnaire included clientsํ level of overall satisfaction and degree of acceptability of the services to the clients, the effectiveness of health care service delivery, clientsํ views of the quality and outcome of therapy, the clinicํs effectiveness, future behaviour in similar situations, and recommendations of the clinic to others. Analysis of findings indicated that participants were generally satisfied with the mental health service provided, with suggestions for some areas of care needing attention. Recommendations were made for improving certain aspects of follow up care and for additional studies in other settings to include appropriate proportions of all racial groups in South Africa. Hierdie studie handel oor ๋n verbruikersevaluering van die lewering van dienste en aspekte daarvan wat aan die drie gemeenskapsonderhoudende geestesgesondheidsentra gelewer is met die doel om hierdie inligting te gebruik om die dienste in die toekoms vir kwaliteitsversekering te verbeter. Eenhonderd-en-elf kliฮnte wat die klinieke vir psigiatriese gemeenskapsgesondheid besoek het, het op ๋n selfverslag-vraelys gereageer wat hulle tevredenheid met verskillende aspekte van hulle kliniese sorg in die gemeenskapsgeestesgesondheidsdienste aan die lig gebring het. Items in die vraelys het kliฮnte se vlak van algehele tevredenheid en graad van aanvaarbaarheid van die dienste aan die kliฮnte, die effektiwiteit van gesondheidsorglewering, kliฮnte se menings oor die kwaliteit en uitkomste van terapie, die kliniek se effektiwiteit, toekomstige gedrag in soortgelyke situasies, en aanbevelings van die kliniek aan ander ingesluit. ๋n Analise van die bevindinge het aangedui dat deelnemers oor die algemeen tevrede was met die geestesgesondheidsdienste wat gelewer is, met voorstelle vir sekere aspekte van sorg wat aandag nodig het. Aanbevelings is gemaak om sekere aspekte van opvolgsorg te verbeter en vir verdere studies in ander omstandighede om toepaslike verhoudings van alle rassegroepe in Suid-Afrika in te sluit. Key Words: Consumer satisfaction, Psychiatric community health clinic, Mental health service delivery, Durban, South Africa Health SA Gesondheid Vol.9(1) 2004: 3-

Critical success factors for institutionalising service-learning in a nursing programme at the University of the Western Cape, South Africa

Scholars in the fields of community engagement contend that the service-learning (SL) policy implementation in higher education is more likely to be successful when there is a strong institutional commitment and the policy implementation is well conceptualised. Research indicates that most higher education institutions in South Africa failed to operationalise the national SL policy, which mandates the incorporation of social responsiveness in their academic programmes. This quantitative study investigated whether a university in the Western Cape had created an enabling environment for a school of nursing to institutionalise service learning in the nursing programme. A cross-sectional survey was conducted using total sampling (n=48) to collect data on the operationalisation of the critical success factors and the stage of SL institutionalisation for each of Furco’s five dimensions. Furco’s self-assessment tool for service-learning institutionalisation was modified. A descriptive analysis was done using SPSS version 19. The results indicated that all of the success factors were present in the institutional structures and policies. However, the institution is perceived to be performing best in the dimensions of student support, philosophy and mission, and institutional support for SL. It can thus be concluded that the institution has created an enabling environment for mainstreaming SL in the nursing programmes.Department of HE and Training approved lis

Effects of uterine fundal massage on number of postpartum haemorrhage cases at a level 2 maternity hospital in the Western Cape, South Africa

Globally, as well as in South Africa, postpartum haemorrhage (PPH) due to uterine atony is the number one direct cause of maternal mortality associated with the postpartum period. Active management of the third stage of labour has been thought to prevent PPH in women. This study assesses uterine fundal massage in the postpartum period as part of active management of the third stage of labour (AMTSL) and its outcome on the number of PPH cases at a level 2 maternity hospital. A quasi-experimental approach was used to determine the effect of continuous uterine fundal massage, every 15 minutes for the first 2 hours after birth, on the number of PPH cases at a level 2 maternity hospital in the Western Cape. It was found that the number of PPH cases reduced from 33/426 cases in the comparison group to 23/431 cases in the experimental group, although this was not statistically significant (Chi-square test, p=0.14). There was also a reduction in the mean postpartum blood loss (not statistically significant). Potential risk factors were considered in a logistic regression model but did not change the final conclusion that the effect of the intervention did not result in a statistically significant decrease in occurrence of PPH (p=0.1039).There was insufficient evidence to reject the null hypothesis of the study. It was concluded that more studies may be necessary to add to the outcome of AMTSL intervention in the maternity setting. A number of other recommendations were made for later implementation within the clinical setting for this study.Department of HE and Training approved lis