A practice framework for the cooperative treatment of cancer between traditional health practitioners and radiation oncologists in KwaZulu-Natal province, South Africa

Background: Cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) is crucial for the continuity of care in the treatment of patients with cancer. However, scant information exists on how to co-ordinate cooperation between these health practitioners without interrupting the treatment of the patients. Aim: The study aimed to explore the practices of THPs and ROs in cancer treatment and ultimately derive a workable practice framework between these health practitioners in the KwaZulu-Natal (KZN) province. Setting: The study was conducted in selected districts, namely eThekwini, uThukela, Amajuba, uMkhanyakude, iLembe, uMzinyathi and uMgungundlovu, in KZN. Methods: A qualitative study by using a descriptive phenomenological approach was conducted to collect data from 28 THPs involved in the treatment of cancer and four ROs from public oncology hospitals. Focus groups and one-on-one semi-structured interviews by using open-ended questions were conducted to collect data from THPs and ROs, respectively. Framework analysis was used for data analysis to identify themes. Results: The study found that in KZN, THPs and ROs are working in parallel and that there are problems when patients seek cancer treatment from both health practitioners. Furthermore, the THPs and ROs work in an environment where there is no relationship, respect and trust, open communication and referral of patients by ROs to THPs. Both teams indicated that patients consult both traditional medicine (TM) and allopathic medicine (AM) by moving between the two health practitioners, resulting in interruptions in treatment. In addition, the study found that cooperation between THPs and ROs is understood as the provision of continuity care, where the parties work independently but share certain information of the patient on treatment, or as already being treated by each of them. The focus was on the type of relationship, enablers and common grounds for cooperation. Conclusion: The workable cooperative practice framework could be an inclusive health system where the parties work in parallel, with the patient being the main actor in the collaboration

Frequency and reasons for missed appointments of outpatient mental health care users in the uMgungundlovu District

Background: Over the years, there has been a rapid growth in the use of mobile technology which has been proven to increase treatment adherence. Short message services may improve service delivery through appointment reminders and improve communication between health care workers and patients. Missed appointments are becoming common amongst mental health care users, and this has a significant economic burden on mental health symptoms. Objectives: The aim of the study was to determine the frequency and reasons for missed appointments of outpatient mental health care users for their follow-up care in the uMgungundlovu District. Method: This study used a quantitative survey. A non-probability convenient sampling method was used to select 182 participants at the psychiatric clinics. Results: Of the 182 participants, results of the study indicated that n = 84 (46.2%) respondents had missed their appointment at some stage. Of the n = 84 (46.2%) respondents who had missed appointments, n = 28 (33.3%) had missed their appointment once, and n = 45 (53.6%) had missed their appointment 2–3 times. Most common reasons for missed appointments included mental health care users forgetting (n = 58; 69%), work commitments (n = 14; 16.7%), no transportation (n = 4; 4.8%) and financial constraints (n = 5; 6%). Conclusion: The main reasons for missed appointments that were identified included forgetfulness, work commitments, lack of transportation and financial constraints. A significant number of participants (53.6%) had missed their appointments 2–3 times

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

Background: Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. Aim: This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). Setting: The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. Methods: A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin’s approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. Results: This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. Conclusion: The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science

Experiences of facilitators regarding the extended curriculum programme offered at a higher education institution in the province of KwaZulu-Natal in South Africa

Background: Much like the rest of the world, student access and success are primary concerns of the South African higher education institutions, especially in the face of data that suggest that up to 50% of students do not successfully complete their course of study. Despite compulsory and free basic education for all South Africans, and increased government funding for education, there has been little impact on learner performance and the majority of primary schools remain poor. To improve access and success and in keeping with international practice, the Department of Nursing at the selected university of technology in 2013 offered for the first time the extended curriculum programme (ECP). To date, the impact of the programme has never been evaluated. Objectives: The aim of the study was to explore the experiences of the facilitators regarding ECP in the undergraduate nursing programme. Method: Guided by this, the current article describes a qualitative exploration of the experiences of six purposively selected facilitators regarding ECP in the Department of Nursing. In-depth interviews were conducted with the ECP facilitators. Tesch’s method was used to analyse the data. Results: Four main themes emerged from the data: stigmatisation and lack of confidence, lack of self-will, additional workload of facilitators and gradual improvement of students’ performance. The participants reported that although students displayed and verbalised negative attitude towards the ECP, the performance of students showed gradual improvement and thus a need to continue to offer the programme to increase access and success in higher education institutions. Conclusion: It was concluded that ECP should continue to increase access and success in higher education institutions; however, there is a need for additional resources to support ECP students

Allopathic medicine practitioners’ experiences with non-disclosure of traditional medicine use

Background: A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. Aim: This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. Setting: This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. Methods: An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Results: Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients’ disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Conclusion: Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. Contribution: The study highlighted that patients do not disclose their TM use because of AMPs’ attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women.Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes).Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks’ gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant.Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy.Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies.Keywords: sFlt-1, PlGF, sEng, pregnancy, HIV

Circulating soluble fms-like tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa

Background: Based on the increased pre-eclampsia and HIV antenatal incidence in South Africa, we determined the angiogenic profiles due to its mechanistic link in preeclampsia development, throughout uncomplicated pregnancies in HIV positive and negative women. Objective: To determine the angiogenic profiles throughout uncomplicated pregnancies in HIV positive and HIV negative women. We explored possible correlations between angiogenic serum levels and selected maternal characteristics (HIV status, gestational age, maternal factors, and pregnancy outcomes). Method: This study was conducted at a primary health care facility in Durban, South Africa. Forty-six pregnant women aged 18-45 years, were enrolled at 10-20, 22-30 and 32-38 weeks\u2019 gestation, respectively through convenient sampling. Serum samples were collected and quantitatively evaluated using ELISAs. Clinical and epidemiological data were analysed using STATA (version 14). A probability level of p < 0.05 was considered statistically significant. Results: Of those enrolled, 28.3% were nulliparous, 82% were HIV positive and none developed pre-eclampsia. Systolic and diastolic blood pressure increased slightly throughout pregnancy. Fluctuating angiogenic and anti-angiogenic levels were demonstrated during pregnancy. Conclusion: This study contributes to the current angiogenic knowledge in normotensive pregnancies, and may assist as a reference range against which these factors may be compared in HIV complicated pregnancies. DOI: https://dx.doi.org/10.4314/ahs.v19i2.4 Cite as: Ogunlola M, Reddy P, Sibiya MN, O\u2019Connor L, Borg D, Haffejee F, Ghuman S, Ngxongo T, Govender N. Circulating soluble fmslike tyrosine kinase-1, soluble endoglin and placental growth factor during pregnancy in normotensive women in KwaZulu-Natal, South Africa. Afri Health Sci.2019;19(2): 1821-1832. https://dx.doi.org/10.4314/ahs.v19i2.

Perceptions of student nurses on the writing of reflective journals as a means for personal, professional and clinical learning development

Background: Reflective journals are used by the students to voice their views on the daily activities during clinical placement. Reflective journals are aimed at helping the student to observe and record as many facts about daily practice as the student finds relevant. Reflective journal writing can therefore be used as a tool to evaluate that clinical learning is actually taking place and what challenges students are experiencing which may influence their learning. Findings by Harris (2006:460–461) are encouraging that through journaling students will develop ability to identify and analyse their difficulties, make suggestions for solving problems and ask and pursue questions on their own. Some of the participants confirmed improved values clarification, self-valuing and personal growth. Bulman & Schutz (2008:172) recommends journal writing for recording processes the student observe, copy and internalize in her journey towards professional development. Objectives: This study aimed to determine student nurses' perceptions of reflective journal writing as a means for personal, professional development and clinical learning development. Method: A quantitative and descriptive survey was conducted in September 2013. Forty participants were recruited from second year student nurses of a University of Technology in uMgungundlovu District of KwaZulu-Natal. Purposive convenience sampling strategy was used. A structured questionnaire was designed by the researcher from literature reviewed. The questionnaire was piloted and modified, then used after permission had been granted by the Ethics Committee of the university concerned. The Statistical Package for Social Sciences (SPSS 17) programme was used for data analysis. Results: Results indicated that the participants generally experienced writing of reflective journals to be a valuable tool enhancing personal development, professional growth and clinical learning. A significant number (n = 24/60%) confirmed that they improved in making proactive decisions and taking on the spot corrective actions; 52% (n = 21) of the participants were empowered to examine their attitudes and perspectives to a given situation and 55% (n = 22) participants increased in active involvement and ownership of their learning. Recommendations: It is recommended that clinical staff be reminded of their responsibility as role models for student nurses so as to enhance their personal, professional development and clinical development. The writing of reflective journals must be encouraged in nurse education and students given guidance and constructive feedback

Factors influencing successful implementation of the basic antenatal care approach in primary health care facilities in eThekwini district, KwaZulu-Natal

Background: In a move to alleviate the burden of consistently high maternal and perinatal mortality rates, the South African National Department of Health (DoH) introduced Basic Antenatal Care (BANC) in all Primary Health Care facilities that were providing antenatal care services. However, not all facilities in the eThekwini district have successfully implemented the approach. The aim of the study was to identify the factors that influence successful implementation of the BANC approach. Objectives: The objectives were to identify facilities that had successfully implemented the BANC approach and the factors that influenced successful implementation of the BANC approach, in order to make recommendations on these factors. Method: A descriptive quantitative design was used. Firstly, primary health care facilities that were successful in implementing the BANC approach were identified through a retrospective record auditing. A total of 27 facilities were identified, of which 18 facilities were included in the study. This was followed by data collection from 59 midwives in order to identify the factors that influenced successful implementation of the BANC approach. The data was analysed using version 19 of the Statistical Package for the Social Sciences. Results: The positive factors that influenced successful implementation of the BANC approach included: the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary health care services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health care supervisors; supervisors’ understanding of the approach and the levels of experience of midwives involved in implementation of the BANC approach. Conclusion: The success that the facilities had achieved in implementing BANC approach was attributed to these positive factors

Factors influencing successful implementation of the basic antenatal care approach in primary health care facilities in eThekwini district, KwaZulu-Natal

Background: In a move to alleviate the burden of consistently high maternal and perinatal mortality rates, the South African National Department of Health (DoH) introduced Basic Antenatal Care (BANC) in all Primary Health Care facilities that were providing antenatal care services. However, not all facilities in the eThekwini district have successfully implemented the approach. The aim of the study was to identify the factors that influence successful implementation of the BANC approach.   Objectives: The objectives were to identify facilities that had successfully implemented the BANC approach and the factors that influenced successful implementation of the BANC approach, in order to make recommendations on these factors. Method: A descriptive quantitative design was used. Firstly, primary health care facilities that were successful in implementing the BANC approach were identified through a retrospective record auditing. A total of 27 facilities were identified, of which 18 facilities were included in the study. This was followed by data collection from 59 midwives in order to identify the factors that influenced successful implementation of the BANC approach. The data was analysed using version 19 of the Statistical Package for the Social Sciences. Results: The positive factors that influenced successful implementation of the BANC approach included: the availability and accessibility of BANC services, policies, guidelines and protocol; various means of communication; a comprehensive package of and the integration of primary health care services; training and in-service education; human and material resources; the support and supervision offered to the midwives by the primary health care supervisors; supervisors’ understanding of the approach and the levels of experience of midwives involved in implementation of the BANC approach. Conclusion: The success that the facilities had achieved in implementing BANC approach was attributed to these positive factors