A Survey of the quality of nursing care in several health districts in South Africa.

BACKGROUND: South Africa is currently focusing strongly on human resource development. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. To identify deficiencies which could be addressed by education and training, it might be useful to measure the quality of care given by nurses. METHODS: From March to August 2002 a survey was done in six hospitals and six clinics in three health districts of the KwaZulu-Natal province of South Africa. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires. RESULTS: The average scores on the different aspects varied from 11% (for nursing records) to 73% (for management of chronic diseases). Specific problems became evident. In one district three out of four hand-overs between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%). While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts. CONCLUSION: The quality of care measurements identified specific training needs, but other management strategies are probably also indicated

Introducing a new cadre into Uganda’s health care system: lessons learnt from the implementation process

Uganda introduced Registered Comprehensive Nursing (RCN) and Enrolled Comprehensive Nursing (ECN) training programs in 1994 and 2003 respectively, to create certificate and diploma level cadre of nurses with competencies in general nursing, midwifery, public health, psychiatry, paediatrics and management. This paper is based on an evaluation study undertaken to assess how the programs were implemented including stakeholders’ perceptions about the graduates. Despite being relevant, the implementation process of both programs failed to meet acceptable standards. We conclude that introducing a new cadre of nurses without proper preparation hinders realization of their full potential including their contribution to the healthcare system

Social support and health behaviour in women living with HIV in KwaZulu-Natal

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV.The sample size was 262 women, 165 from urban area and 97 from rural area. Data were collected using 3 instruments, namely a demographic questionnaire, the health behaviour schedule and the Medical Outcomes Study (MOS) Social Support Survey. Significant findings indicate that in the urban area 71% of women had disclosed their HIV status to someone, while in the rural area 49% had done so.A total of 77% of the women indicated that they were sexually active – 21% had 2 partners and 20% indicated that they had at least one episode of a sexually transmitted disease since finding out their HIV status. A total of 16% said that they currently received counselling, which was significantly more frequent in the rural sample (27%) than the urban (11%).The membership of support groups is at 12% among the participating women, and social support as well as membership of a support group was higher in the rural group than the urban group. Good social support showed an association with condom use, support group attendance and taking vitamins. However, receiving counselling as well as membership of a support group showed stronger association with positive health behaviour than social support on its own.The higher social support was not associated with increased disclosure. Keywords: HIV, health behaviour, social support, rural/urban, women. Résumé Cet article va à la découverte de la relation entre le soutien social et le comportement sanitaire des femmes rurales et urbaines qui vivent avec le VIH en Afrique du Sud. Notre étude était une enquête descriptive d'un groupe de femmes enceintes et non enceintes vivant avec le VIH. L'échantillon était de 262 femmes, 165 originaires d'un milieu urbain et 97 d'un milieu rural. Les données ont été recueillies par le biais de trois utiles, notamment un questionnaire démographique, un barème du comportement sanitaire et l'Enquête du Soutien Social de l'Étude Médicale de Résultats. Les résultats significatifs de recherche démontrent que dans le milieu urbain 71% de femmes avaient révélé leur statut séropositif à quelqu'un alors que seulement 49% du milieu rural l'ont fait. 77% de femmes ont signalé qu'elles avaient des rapports sexuels – 21% avaient deux partenaires et 20% ont signalé qu'elles ont eu au moins une épisode de maladies sexuellement transmises depuis qu'elles ont découvert leur statut séropositif. 16% de ces femmes ont dit qu'elles sont actuellement en consultation psychologique. Les consultations se sont passées plus fréquemment auprès de l'échantillon rural (27%) par rapport à l'échantillon urbain (11%). 12% de femmes participantes fait partie des groupes de soutien. Le soutien social ainsi qu'appartenir à un groupe de soutien étaient plus importants dans le groupe rural que dans le groupe urbain. Un bon soutien social a démontré un lien avec l'utilisation de préservatifs, l'assister au groupe de soutien et la prise des vitamines. Cependant, être en consultation psychologique et appartenir à un groupe de soutien ont démontré une association forte à un comportement sanitaire positif beaucoup plus que le soutien social en tant que tel. Le soutien social plus élevé n'a pas été associé aux révélations augmentées. Mots clés:VIH, comportement sanitaire, soutien social, rural/urbain, femmes

The evaluation of public psychiatric services in three provinces of South Africa

Objectives. To describe the quality of care in communityand hospital-based care in three provinces in terms of 13 standards of care and the criteria associated with each; and to explore the similarities and differences between provinces.Design. A descriptive study in the form of a survey using interviews, observation and questionnaires.Setting. Three provinces of South Africa, namely Gauteng, KwaZulu-Natal and the Eastern Cape. In each of the provinces hospitals and clinics were the focus of the study.Subjects. The person heading the mental health service in each province completed a questionnaire about the services in the province. Consumers (both direct consumers and family) received questionnaires or were interviewed if illiterate. In each province a sample of hospital units and clinics was visited and interview and observation schedules were completed.Outcome measures. Thirteen previously tested standards of care were addressed covering a comprehensive array of indicators of care. Management, research and development, structural and process standards were included.Results. All three provinces fared wen for three standards (staff attitudes, process of hospital admission and availability of forensic care). On another three all the provinces fared poorly (management, regular review and/or evaluation of services, and research activity). In terms of clinic services all three provinces scored low for the availability of weekend and emergency services and psychosocial rehabilitation. In terms of hospital care the criteria referring to human rights of patients produced the lowest scores.Conclusions. The paucity of management information on some aspe<;ts makes planning and evaluation difficult. However, the report does indicate specific areas that need improvement in each province

Primary health care nurses’ management practices of common mental health conditions in KwaZulu-Natal, South Africa

Background: Psychiatric conditions contribute to 13%of the global burden of diseases and account for one third of years lost because of disability (YLD). Despite the high prevalence of mental health problems, primary health care (PHC) services remain ineffective in managing patients with mental health conditions. Objectives: The aim of the study was to determine the practices of PHC nurses in the management of psychiatric patients in primary health care clinics in one of the rural districts in South Africa. Method: A survey was conducted amongst nurses working in several PHC clinics in KwaZulu-Natal (KZN) in order to determine their practices in the management of psychiatric patients. Mixed methods were used to determine the PHC nurses practices in the management of psychiatric patients. Results: The findings revealed that in five sites (83.3%) treatments are not reviewed every six months, there were no local protocols on the administration of psychiatric emergency drugs, and none of the study sites provided psychiatric patients with education on their medication and its possible side effects. Conclusion: Based on the results of this study it is evident that psychiatric patients at PHC clinics in the district where the study was conducted do not receive quality treatment according to institutional mental health guidelines

The quality of nursing documentation in some private and provincial hospitals in the Cape Peninsula and the PWV-area

An investigation was undertaken with the aim o f establishing standards for the documentation o f nursing care. Nursing care records in the medical and surgical units o f private and general hospitals in the PWV-area and the Cape Peninsula were audited. A considerable number o f deficiencies were identified in the daily record keeping o f nursing care