Dorah U. Ramathuba

Factors contributing to the low uptake of medical male circumcision in Mutare Rural District, Zimbabwe

Background Medical male circumcision (MMC) has become a significant dimension of HIV prevention interventions, after the results of three randomised controlled trials in Uganda, South Africa and Kenya demonstrated that circumcision has a protective effect against contracting HIV of up to 60%. Following recommendations by the World Health Organization, Zimbabwe in 2009 adopted voluntary MMC as an additional HIV prevention strategy to the existing ABC behaviour change model. Purpose The purpose of this study is thus to investigate the factors contributing to the low uptake of MMC. Methods The study was a quantitative cross-sectional survey conducted in Mutare rural district, Zimbabwe. Questionnaires with open- and closed-ended questions were administered to the eligible respondents. The target population were male participants aged 15–29 who met the inclusion criteria. The households were systematically selected with a sample size of 234. Statistical Package for the Social Sciences was used to analyse the data. Results Socioculturally, circumcised men are viewed as worthless (37%), shameful (30%) and are tainted as promiscuous (20%), psychological factors reported were infection and delayed healing (39%), being ashamed and dehumanised (58%), stigmatised and discriminated (40.2%) and fear of having an erection during treatment period (89.7%) whilst socio-economic factors were not having time, as it will take their time from work (58%) and complications may arise leading to spending money on treatment (84%). Conclusion Knowledge deficits regarding male medical circumcision lead to low uptake, education on male medical circumcision and its benefits. Comprehensive sexual health education should target men and dispel negative attitudes related to the use of health services.

Knowledge, attitudes and practices regarding cervical cancer prevention at Thulamela Municipality of Vhembe District in Limpopo Province

Background Cervical cancer is a widespread and often fatal disease that affected 1 million women globally in 2005. Not only is it the second most common cancer in women but it was also the second leading cause of cancer deaths, accounting for over 250 000 in 2006. Purpose The purpose of the study was to assess the knowledge, attitudes and practices regarding cervical cancer prevention among rural women in Vhembe District in Limpopo Province. Methodology A quantitative descriptive approach was adopted. The quantitative design enabled the discovery of more information by means of direct questioning of a sample of women aged 30 years and older. A convenience sampling was used to select the respondents. Data were analysed using the Statistical Package for Social Sciences. Measures to ensure ethical issues were adhered to. Results The findings revealed that women lacked knowledge about cervical cancer and preventive methods, and displayed positive attitudes to the use of services if made available as health workers did not adequately inform them about the availability of the services. Conclusion The awareness of cervical cancer among women in Vhembe District is limited. There is a need to educate and promote awareness of cervical cancer among women to reduce the burden of morbidity and mortality.

Experiencing Uncertainty: Lived Experience of Having Cancer among Patients in Vhembe District of Limpopo, South Africa

Abstract The purpose of this study was to explore and describe the experiences of patients diagnosed with cancer in Vhembe district, Limpopo Province. A qualitative, exploratory, descriptive and phenomenological design was used. A purposive theoretical sample of patients who were diagnosed with different cancers within 2-5 years in a regional hospital in Vhembe district of Limpopo Province was obtained. Data was collected through in-depth interviews with participants who were in remission phase or undergoing treatment and. data saturation occurred after in-depth interviews with eight participants. Field notes were also used during data collection to capture nonverbal communication from participants. The findings revealed that cancer patients experienced a sense of uncertainty, withdrawal and isolation, lack of proper communication and attitudes and adjusting to the existential body changes. Recommendations that are described focused on understanding what it is like to have cancer and filling the gaps of patient’s expectations and addressing emotional and physical needs.

Support in Caring for People Living with HIV and AIDS: A Concept Analysis

Abstract The purpose of this paper is to examine the concept of support to nurses’ caring for people living with HIV/AIDS in health care institutions using evolutionary approach. This paper describes the antecedents, attributes, and consequences of nurses’ support in the context of HIV/AIDS caring. The concept “support” was undertaken because of its frequent use in nursing literature in connection with of support of patients and families to enable them to restore their health. The aim of the investigation was to inductively develop a definition of support, specifically for nurses who are overburdened by caring for People Living with HIV and AIDS (PLWHA). The study followed an evolutionary method of concept analysis. Data were sourced from scientific journals, dictionaries, the thesaurus and encyclopedias, and they were analysed using reasoning strategies such as analysis, synthesis, inductive and deductive strategies, retroduction, inferences and derivation. These essential attributes were then organised into categories and sub-categories that would meaningfully define the support of nurses in health care services which care for PLWHA. The definition of support was derived from clarifying the empirical meaning of support. Synthesis was used to collate the theoretical and empirical meaning of support.

Knowledge, attitudes and practices toward breast cancer screening in a rural South African community

Objectives The study assessed the knowledge, attitudes and breast cancer screening practices amongst women aged 30–65 years residing in a rural South African community. Method A quantitative, descriptive cross-sectional design was used and a systematic sampling technique was employed to select 150 participants. The questionnaire was pretested for validity and consistency. Ethical considerations were adhered to in protecting the rights of participants. Thereafter, data were collected and analysed descriptively using the Predictive Analytics Software program. Results Findings revealed that the level of knowledge about breast cancer of women in Makwarani Community was relatively low. The attitude toward breast cancer was negative whereas the majority of women had never performed breast cancer diagnostic methods. Conclusion Health education on breast cancer screening practices is lacking and the knowledge deficit can contribute negatively to early detection of breast cancer and compound late detection. Based on the findings, community-based intervention was recommended in order to bridge the knowledge gap.

Home-based carers' perceptions of health promotion on sexual health communication in Vhembe District

Background The introduction of home-based care in rural communities in the 1980s contributed immensely toward the upliftment of the personal and environmental health of communities. Women’s groups provided health promotion skills and health education to communities and made a difference in health-related behaviour change. Objective The purpose of the study was to explore and describe the home-based carers’ perception regarding health promotion concerning sexual health communication in Vhembe district, in the context of HIV, amongst communities still rooted in their culture. Method A qualitative, explorative and descriptive design was used in order to understand home-based carers’ perceptions regarding health promotion on sexual health communication amongst rural communities which may adversely impact on health promotion practices. The population were home-based organisations in Vhembe. The sample was purposive and randomly selected and data were gathered through semi-structured face-to-face interviews and focus groups which determined data saturation. Open coding was used for analysis of data. Results The results indicated that sexual communication was absent in most relationships and was not seen as necessary amongst married couples. Socioeconomic conditions, power inequity and emotional dependence had a negative impact on decision making and sexual communication. Conclusion This study, therefore, recommends that educational and outreach efforts should focus on motivating change by improving the knowledge base of home-based carers. Since they are health promoters, they should be able to change the perceptions of the communities toward sexually-transmitted infections and HIV by promoting sexual health communication.

Menstrual knowledge and practices of female adolescents in Vhembe district, Limpopo Province, South Africa

Background Although sexual issues are openly discussed in the media, sexuality and reproductive functions are treated as taboo. Menstruation is a normal physiologic process, but carries various meanings within cultures and is rarely discussed amongst families and communities. Purpose This study sought to assess the knowledge and practices of secondary school girls towards menstruation in the Thulamela municipality of Limpopo Province, South Africa. Methods A quantitative descriptive study design was used and respondents were selected by means of convenience sampling from a population of secondary school girls. The sample consisted of 273 secondary school girls doing Grades 10–12. A self-administered questionnaire was used to collect data, which was analysed by computing frequencies and percentages using the Statistical Package for Social Sciences (SPSS version 12). Findings The findings revealed that respondents experienced menarche at 13 years and that menstruation is a monthly bleeding (80%) that happens to every female; it is a sign of adulthood (91%). 15% reported that it is the removal of dirt from the stomach and abdomen, 67% indicated the source of menstruation being the uterus, 65% the vagina and 13% from the abdomen. 73% reported having fear and anxiety at the first experience of bleeding and that they could not maintain adequate hygienic practices due to a lack of privacy and sanitary towels. Conclusion Interventions are needed to increase girls’ opportunities to discuss menstruation and access information from adults including mothers, parents and guardians. School-based sexuality education should be comprehensive, begin early and be regularly repeated.

Patients Perspective Of Cancer Treatment And Care In Vhembe District Of Limpopo Province

Objective: The study explored and described the experiences of patients diagnosed with cancer in Vhembe district, Limpopo Province. A qualitative research design which was phenomenological, exploratory, descriptive was used. The aim of the study was to add to the knowledge and understanding of the complex human phenomena. Methods: A purposive theoretical sample of twelve patients who were diagnosed with different cancers within 2-5 years in a regional hospital in Vhembe district of Limpopo Province was obtained. Data was collected through in-depth interviews with eight participants who were in remission phase or undergoing treatment. Data saturation occurred after in-depth interviews with eight participants, field notes were also used during data collection. Results: The findings revealed that cancer patients experienced poor communication and attitudes, experienced body changes, sense of withdrawal and depression and problems with follow-up care. Conclusions: Understanding the cultural perspective of what it is like to have cancer and filling the gaps of patient’s expectations and addressing emotional and physical needs.

Perceptions of rural women regarding sexual health communication in the era of HIV/AIDS in Vhembe district, Limpopo province: Implications for sexual health interventions

I recent years, there has been increasing evidence that stress and burnout in nurses affects their health and quality of life. The objective is to present three studies with applications for moderating the detrimental effects of stress and promoting health in nurses. Study 1 examined the role of stressgenerating factors and relief factors on experienced stress in nurses in a pediatric oncology institute. The subjects responded to questionnaires assessing sources of stress, sources of relief, perceived stress, quality of life, burnout and compassion fatigue. The results showed that stress and relief were independent factors affecting burnout, and that relief had a greater impact. The major sources of stress were family and daily issues, and of relief people and bodily activities. Study 2 examined the impact of stress vulnerability on quality of life. 100 nurses responded to questionnaires assessing stress vulnerability, perceived stress, and quality of life. The results showed that stress vulnerability correlated significantly with perceived stress and quality of life. Study 3 examined the impact of attitudes relevant for physical health. The responses to the questionnaire of the cognitive orientation of physical health by 52 nurses showed that attitudes on themes such as sharing experiences, expressing emotions, controlling perfectionism and cooperating with others contribute to mental and physical well-being. The major conclusions are that the mental and physical quality of life of nurses could be improved by promoting relief-generating activities, moderating stress vulnerability and enhancing specific attitudes that contribute positively to one’s well-being.T presentation will focus on acute kidney injury (AKI), and why our role as critical care nurses can impact outcome. AKI characteristics, its incidence and causes in sepsis, ischemia/reperfusion and nephrotoxin exposure will be reviewed. The impact of AKI on recovery and mortality as well as discussion of the use of new biomarkers which will replace BUN and Creatinine will be described. Critical care nursing assessment of the potential for AKI will include use of the most simple, accurate and useful biomarker we currently use today: urine output. Research on the usefulness of accurate urine output measurement on outcomes will also be reviewed and why we can make an impact on patient outcomes.Background: In Northern India, skewed sex ratios, female feticide and higher child mortality rates for girls have become serious concern. The female child mortality as a result of son preference have increased during the last several decades .Since families cannot know the sex of the fetus due to Indian government policies, they now ‘neglect’ girl child to ensure there are few survivors. Survival chances of second and third daughters are plunging neglecting healthcare and nutrition has become tool for death as ‘good riddance’.Introduction: When older patients are in need of care the desire for help is often related to practical duties, but they also express a preference for support with the emotional difficulties that d ...S activities performed in nursing programs can provide many learning opportunities for nursing students. Simulation gives the students a hands-on approach to perform skills learned throughout their nursing education. Real life simulated activities, allow students to put their knowledge into practice, while recognizing areas of weakness that need improvement. During the activities, students perform learned skills, medication administration, and professional communication. The environment to perform these activities is a safe learning environment to allow students to make and recognize mistakes prior to entering the career field. Faculty encourages students and assists in improving areas of weakness demonstrated by the students. The simulation activities begin with a pre-assignment to prepare for the lab, a hands-on approach to perform skills learned, followed by a debriefing session. The debriefing session consists of the student discussing a verbal self-evaluation regarding their performance, followed by a discussion with faculty. During the discussion, areas of weakness are identified and ways to improve are discussed. Students needing to improve are scheduled one-on-one time with lab personnel to improve on identified weakness area. By implementing simulation activities in the nursing program, students are more prepared to enter the workforce. In addition to hands-on, simulation labs are also utilized to enhance learning from the didactic setting. Simulation labs are scheduled according to the lecture schedule in order to enhance an understanding of the content delivered. By scheduling according to content, students can begin to connect theory and practice by learning in the classroom and demonstrating in the lab.‘First line healthcare’ is offered via telephone in many Western countries. The overall aim of this thesis is to describe Telephone Nursing (TN) from three viewpoints: telenurses, parents calling f ...A comparison of critical thinking skills of baccalaureate nursing students in north east, central and western China was conducted to measure and compare the critical thinking abilities of nursing students based on the California Critical Thinking Disposition Inventory (EETDI). A convenient sampling method was used in each area with 300 participants totally. The baccalaureate nursing student’s critical thinking scores in the three areas were compared for disposition. The findings indicated that in the total as well as the majority of sub-scale areas of critical thinking held by the nursing students of these three areas showed an ambivalence disposition towards critical thinking (mean=277.75 S.D=23.18). The ANOVA indicated that there were statistically significant differences among these three area on the total score as well as six sub-score P<0.01~0.001 with students in the central area holding the highest score (mean=288.94, S.D=21.18). The Tukey’s HSD indicated that the total mean score was statistically higher for students in central area than those for students in north eastern and in western areas (P<0.001). There was also a significance difference between students in the eastern and western area (P<0.01).T diversity and increasing number of elder migrants within the German and Austrian population is challenging the health care systems: How can they be included in an adequate (culturally sensitive) way? The ongoing academic discussions and the different approaches in practice to this question reveal how differently elder migrants and their needs are perceived within the German and Austrian society. In the talk, the author will introduce the different perceptions of a culturally sensitive elderly care upon the predominant paradigms that may vary locally the intercultural opening in German cities and a diversity management approach in Vienna (Austria), and upon the estimations and assessments of the importance of a culturally sensitive elderly care, how they varied within the last decade and among different groups of people.This study examined the validity and reliability of a Turkish version of the Modified Moral Sensitivity Questionnaire for Student Nurses (MMSQSN). After obtaining permission to adapt the MMSQSN into Turkish, the translation/back-translation method was used with expert opinions to determine content validity. Factor analysis was conducted to examine the construct validity and test–retest was performed on the questionnaire to determine reliability. Cronbach’s alpha coefficients were calculated to assess for internal consistency. Participants included 272 baccalaureate degree student nurses who took ethics lessons prior to their clinical internship. The factor analysis revealed that even though the factor structure in the original scale was the same, relevant items were categorized with similar components, and factor loads were sufficient. The correlation coefficient in the analyses of test–retest scores was .66 for the total scale (p < .05) and the Cronbach’s alpha was .73 for the total scale. The translated MMSQSN is a valid and reliable measure of ethical sensitivity in student nurses in Turkey.Due to the uncertainties of job availabilities among rural communities, poverty stricken families find it hard to supply enough food to their family members. Food insecurity refers to limited or uncertain availability of nutritionally adequate, safe foods or the inability to acquire personally acceptable foods in socially acceptable ways. The purpose of this study was to explore food insecurity among HI Sero-positive patients in rural Vhembe district of Limpopo Province. A qualitative, exploratory, descriptive and contextual design was used. A non-probability, purposive sampling method was used to select eight family members who care for HI seropositive patients at home. Permission to conduct a study was obtained from University of Venda Higher Degrees Committee, University of Venda Health, Safety Research Ethics Committee and the Provincial Department of Health. Informed consent also obtained from participants. In-depth interviews were conducted with eight family members. Data were analyzed according to Teschs open-coding method. This study revealed that debilitating nature of patient, condition, altered socio-economic status and insufficient knowledge about the importance of nutrition in human health are the determinants of food insecurity amongst HIV Seropositive patients. The study concluded that food insecurity is challenge among HI seropositive patients and thus hinders their recovery.Methodology: This is a descriptive, comparative, and correlational study. 277 male/female Haitians who were older than 18 years old and lived in rural areas were included into sample. It was a convenience sampling. The sample was collected in four different rural areas in Haiti from Jan 1 thru Jan 9th, 2014. The subjects who voluntarily walked into a free health clinic were screened with blood pressure (both systolic and diastolic blood pressure), pulse pressure, and heart rate. Descriptive analyses and t-test were used to achieve the study objectives.D is both an urgent and complex occupational health issue. Many individuals are employed at the same time as they are experiencing a major depressive episode. A large proportion of workers who experience a depression-related absence from work are women. However, little is known about the experiences of returning to work for women with depression. The goal of this study is to identify women’s experiences of returning to work after a lapse due to a depression. Grounded Theory is the method being used. At this time 31 women of the projected 40 have participated in in-depth interviews. Analysis is currently being conducted and reoccurring themes are emerging. In this presentation the focus will be on two themes. The first theme is “Battling Adversity” which includes battling depression, battling the workplace and battling the institution, all of which describe the struggle many women have experienced in returning to work. The second theme “Upholding Silence” includes concealing their depression and selective disclosure. Women speak about wearing a mask when they are in the workplace in order to conceal their depression. Many women mention triggers and use particular language while explaining their absence from work, such as burnout, stress, and fatigue. These words are thought to be helpful in concealing the depression. Women described their journey back to work and back to wellness.Five out of eight Liguria Region public health care facilities participated: San Martino Hospital (SMH), Galliera Hospital (GH), Azienda Sanitaria locale 1(ASL 1), Azienda Sanitaria locale 4(ASL 4), Azienda Sanitaria locale (ASL 5).Information about introduction to SCDs was collected through regular meetings with the staff of the Health Protection and Prevention Department or the occupational health physicians of the participating companies.Background: Acute lymphoblastic leukemia (ALL) is the highest incidence malignancy among children under the age of 15 years old. For the limited cognitive ability of the children with ALL, family caregivers especially for the children’s parents are essential partners in the delivery of complex health care services and are mainly response for taking care of children in and out of the hospital. Thus, caregivers have huge care burden and urgently need professional and available support which can be satisfied by the technique of mobile health.Clinical trial rating scale based outcome measures have been criticized of lacking relevance and meaning to end-users, particularly patients. This is concerning since inferences regarding the usefu ...W in the patient narrative has become a familiar term, used as part of the common language in the context of caring for patients. To do so encompasses sharing conversation that allows exploration of the entire patient experience as it relates to health and illness. However, the complexity of engaging in conversations about life-altering disease trajectories, potential outcomes from treatment, and end-of-life decisions is a learned practice. To stand steady with conflict, allowing for expression of grief, loss, anger, and frustration, yet remaining fully present, maintaining neutrality, and actively listening continue to be challenging concepts in practice. To do so is integral to collaborative practice and essential to effective engagement. A literature review identified key elements of intentional interactions which lead to significant opportunities to “wander more fully” in the patient narrative. Case studies used in discussion will demonstrate how patient/clinician encounters, such as end-of-life discussions; afford the interdisciplinary team members purposeful engagement with patients. Application of these principles will support clinicians in real world situations to delve more deeply into the patient experience. Such exploration lays the foundation for assuring goals of care are aligned with patient’s individual goals and values. Cases also demonstrate how the use of symbols by patients can be understood to assist in dialogue related to expressions of illness or tasks of dying. When directed and focused, intentional facilitation occurs, the patient’s unique holistic needs and values are identified and goals of care can be clarified. Practice implications are presented using research and clinical applications.Persistent nausea and vomiting associated with hyperemesis gravidarum in early pregnancy remains a significant health problem that result in negative side effects on women and their pregnancy. The aim of the study: Was to evaluate the effectiveness of nurses using for P6 acupressure on nausea, vomiting and retching in women with hyperemesis gravidarum. Methods: A Randomized clinical Trial was used, the study conducted on 120 women diagnosed with hyperemesis gravidarum admitted to maternity high risk care unit Mansoura University Hospital, Egypt in a period of six months and divided randomly in P6 acupressure and conventional therapy group. Data were collected by two tools; 1 st A structured Interviewing Questionnaire Schedule and 2 nd Rhodes Index of Nausea, Vomiting and Retching (INVR). Results: It showed that there no statistically significant difference was found in baseline characteristics of nausea, vomiting and dry retching scores between the P6acupressure and conventional therapy group; while there was significant decrease in the average mean scores of nausea, vomiting and retching and the total score from base line to 4 th day. Difference between the base line improvements in conventional group is significantly better than acupressure group in different days. The rate of improvement compared in P6 acupressure to conventional was 71.9% to 100% respectively. Conclusion: The study concluded that using of P6-acupressure has an effective role in reducing nausea, vomiting and retching episodes in women with hyperemesis gravidarum.Findings: Most (86%) of the pregnant women reported that their sleep was disturbed by their child, at least once a week and (63%). The PSQI global score mean was 8.3 (SD=2.3). Ninety-three% (n=65) of the subjects met the criteria for being poor sleepers. Participants in the study reported their mean sleep duration of 7.5 hours (SD=1.7), with an average of 22.5 minutes to fall sleep (SD=15.3). Trimester and total PSQI have a positive correlation (r=0.25, P<0.05), while a negative correlation was found between working and sleep latency (r=-0.301 p<0.005).E degrees strongly impact professional development. In Japan, no studies have examined the relationship between educational degrees and nursing professionalism. The aim of this study is to examine the effect of educational degrees on nursing professionalism among Japanese nurses. Wheel of professionalism in nursing model was applied as a theoretical framework and the corresponding inventory, behavioral inventory for professionalism in nursing, was used to measure the relationship between education and level of professionalism. A total of 2,972 surveys were distributed and 1,846 respondents returned surveys from 25 hospitals in the random sample in Japan. The results revealed that nursing professionalism was related significantly to higher educational preparation (F=154.47, p<0.0001) by a one-way ANOVA, and the Tukey-Kramer multiple comparison test revealed that graduate degree was significantly associated with high scores of professionalism (p<0.0001). The correlation and regression analyses also showed a moderate to strong relationship between education preparation and nursing professionalism (r=0.20, p<0.0001; β=0.52, p<0.0001). The results confirm that higher level of educational preparation, especially graduate degree, is associated with higher nursing professionalism. Awareness of important professional factors is essential to continually maintain nursing professionalism.T health care system presents an ever increasing complexity that requires nurses to possess multiple skills including interprofessional collaboration skills, cost effectiveness, currency, informatics skills, technical skills, clinical reasoning skills and a need for life-long learning. Both the Institute of Medicine (2011) and the Carnegie Foundation for the Advancement of Teaching (2010) have called for radical transformation in the way nurses are educated. A particular challenge to nursing education is the need to bridge the gap between theory and clinical. Nursing education often clearly demarcates acquisition of theory knowledge in the classroom and clinical practice and does not effectively assist students with the application of theory knowledge to hands on patient care. This sharp separation of classroom and clinical teaching must be overcome. “Teaching for a sense of salience” dictates that nurse educators better assist students with this translation of theory to practice. This challenge in nursing education includes the need to not only improve the way students acquire theory based knowledge (signs, symptoms, pathophysiology), but to also effectively translate theory knowledge to the clinical area to provide effective hands on patient care in order to improve patient outcomes. Chronic illnesses such as diabetes mellitus are multidimensional and require nurses not only to possess theory knowledge but effective clinical skills as well. Strategies for increasing salience related to diabetes mellitus management in classroom and clinical settings includes evolving case studies, in class active learning strategies, simulation activities and strategies to promote teaching effectiveness of adjunct clinical instructors.B cancer is the most commonly diagnosed cancer among women in the United States. Breast cancer screening with mammography has proved effective in reducing breast cancer mortality. While the incidence and overall mortality in Caucasian women has steadily decreased in the past decade, incidence and mortality rates among non-Caucasian, particularly Asian/Pacific Islander women has remained unchanged. Additionally, Korean immigrant women (KIW) living in the United States have extremely low screening rates as compared with other races. There is a paucity of studies that focused on factors that influence screening rate in Korean women. The purpose of this pilot study is to identify key health beliefs that influence Korean immigrant women’s decision to participate in breast cancer screening so that the findings can contribute to increased KIW participation in breast health screening. Utilizing health belief theoretical model participants responded to two questionnaires used to measure the attitudes of KIW in their decision to have a mammogram. Certain health beliefs were significantly correlated with benefits and barriers of health screening. Focusing on improving health motivation through breast health education for this population will increase mammogram screening rate, thus increasing possibility toward improved overall health care.