Esmeralda Ricks

Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa

BACKGROUND Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. METHODS This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. RESULTS The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. LIMITATION Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. CONCLUSIONS Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.

SELF-MANAGEMENT EXPERIENCES IN PERSONS LIVING WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus (DM) is a progressive disease which has the potential of negatively affecting virtually all the systems of the body, causing debilitating and life-threatening complications if blood glucose levels are not controlled. A high level of self-management is required in order to control blood glucose levels and prevent or delay the onset of complications which may have severe physical, psychological and financial implications for the individuals and their families. As no research on the experiences of persons living with the condition was previously conducted in Nelson Mandela Bay, South Africa, a qualitative, descriptive, exploratory and contextual study was conducted between January and April 2009. Nineteen participants from both the private and public health care sectors were recruited making use of purposive sampling. The following themes emerged from the data collection: persons living with DM experience a wide range of emotions on initial diagnosis; gradually they experience an acceptance and acknowledgment of their condition; persons living with DM have definite opinions on the concept of self-management; persons living with DM acknowledge both positive and negative factors which influence self-management and expressed views on how professional nurses can assist them in achieving self-management. Recommendations included allowing persons living with DM to take a leading role in decisions regarding management of their condition. They should make periodic reinforcements of their lifestyle modifications as part of an ongoing patient education process. Qualified Diabetes Nurse Educators should be employed at health care facilities, both in the public and private sector. Finally, specialized courses covering all areas of management of DM should be more readily available to health care workers.

Experiences of Managers and Healthcare Personnel Involved in a Functional Healthcare Public Private Partnership

This study explored the experiences of managers and healthcare personnel involved in a functional healthcare public private partnership (PPP) in a semi-rural area situated in the Eastern Cape Province, South Africa. Data on how managers and healthcare personnel experienced their involvement with a functional healthcare PPP in the operational phase were collected from medical and non-medical participants from the administration, facility maintenance, and hospital departments (n = 9, females = 56%, public sector = 44%). The data were thematically analysed. Findings suggest that PPPs result in improved healthcare delivery standards as well as mutual benefits for both partners. Identified facilitators were: good communication and relationships, support from authorities, and perseverance and commitment. Lack of leadership, lack of skills, and attitude (non-compliance, negative attitudes) were identified barriers towards PPPs. PPPs have the potential to enable the public healthcare services in their efficiency.

Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

Background The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. Aim To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. Setting The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. Methodology The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied. Results Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. Conclusion Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

An Educational Strategy Supporting Kangaroo Mother Care: Interviews with Healthcare Practitioners

Kangaroo Mother Care (KMC) has multiple benefits for mothers, infants and healthcare organisations. Sound clinical decision-making regarding KMC is enhanced if healthcare practitioners are empowered through education and training, which is possible by developing an educational strategy. In this study perceptions of healthcare practitioners were therefore sought to explore and describe the content, format and requirements for such an educational strategy. Purposive sampling was done, and healthcare practitioners participated electronically and in either semi-structured face-to-face or telephonic interviews. The healthcare practitioners’ perceptions regarding format, content and requirements for the strategy were audiotaped, verbatim transcribed and qualitatively analysed using thematic analysis. Major findings indicated that the content of the strategy should include the theoretical concept of KMC and its practice. The strategy’s format needs to make provision for a target group existing of multiple stakeholders and various teaching methods and formats. The strategy’s frequency and duration depends on the type of strategy and the availability of staff that can be released to attend the educational strategy. Requirements in terms of facilitating factors to successfully implement this strategy include buy-in and support of management, leadership, alignment of the strategy with existing structures, and also rewards and incentives. Participants agreed that an educational strategy must be flexible in terms of its content, format and requirements in order to be implemented in various contexts. Investigations into how an educational strategy could be further developed and implemented in different contexts could be fruitful to support sound clinical decision-making regarding KMC.

Experiences of registered nurses with regard to accessing health information at the point-of-care via mobile computing devices

Background The volume of health information necessary to provide competent health care today has become overwhelming. Mobile computing devices are fast becoming an essential clinical tool for accessing health information at the point-of-care of patients. Objectives This study explored and described how registered nurses experienced accessing information at the point-of-care via mobile computing devices (MCDs). Method A qualitative, exploratory, descriptive and contextual design was used. Ten in–depth interviews were conducted with purposively sampled registered nurses employed by a state hospital in the Nelson Mandela Bay Municipality (NMBM). Interviews were recorded, transcribed verbatim and analysed using Teschs data analysis technique. Ethical principles were adhered to throughout the study. Gubas model of trustworthiness was used to confirm integrity of the study. Results Four themes emerged which revealed that the registered nurses benefited from the training they received by enabling them to develop, and improve, their computer literacy levels. Emphasis was placed on the benefits that the accessed information had for educational purposes for patients and the public, for colleagues and students. Furthermore the ability to access information at the point-of-care was considered by registered nurses as valuable to improve patient care because of the wide range of accurate and readily accessible information available via the mobile computing device. Conclusion The registered nurses in this study felt that being able to access information at the point-of-care increased their confidence and facilitated the provision of quality care because it assisted them in being accurate and sure of what they were doing.

STATUS OF RESEARCH-RELATED ACTIVITIES OFSOUTH AFRICA’S UNIVERSITY NURSING SCHOOLS

The development of research programmes is a relatively novel phenomenon amongst nurse researchers in developing countries. Academics and researchers are faced with the demands for postgraduate and publication outputs, but with little or no support. In South Africa, benchmarks have been set for expected research outputs per university and per academic. However, nursing schools are finding it a challenge to meet these targets. This chapter provides an overview of the status of nursing research in South Africa and determines the overall research outputs for the various South African nursing schools. The data was collected through a structured self-administered questionnaire. The survey was distributed to all 22 university nursing schools in South Africa of which 17 completed surveys were returned (77% response rate). The nursing dean was expected to verify all information submitted. Data collected reflects the years 2008-2010. Only 23.54% of nurse academics in South Africa have doctoral degrees impacting on the throughput rates of doctoral and master’s degree students. There are high intakes for doctoral and master’s degree programmes with limited availability of research supervisors. The results also revealed that almost half (46%) of the academics employed at nursing schools are employed in a full-time contract position. In South Africa, each year 4.7 articles per nursing school per year are published in accredited journals. It is evident from the results that there is an increase in the output of publications and funding for research, but that the output rate of postgraduate students has shown nominal improvement, especially regarding doctorates. Problems affecting research outputs included writing challenges, a lack of stability or constant change in management in many nursing schools, as well as a shortage of experienced supervisors. Unrealistic workloads were also singled out as challenges that impact on research outputs. However, support programmes have been established to support researchers, and this seems to have had a positive impact.

A COLLABORATIVE PROJECT INITIATIVE BETWEEN A UNIVERSITY AND A NURSING COLLEGE

The Atlantic Philanthropies approved a grant of R13.8 million to Nelson Mandela Metropolitan University for the purpose of strengthening the institutional capacity of the Lilitha College of Nursing in order to enhance their training and research development. This article describes what the project entailed and what lessons were learnt. A situation analysis indicated problems in terms of the organizational structure, the learning environment and human resources/capacity. Four sub-projects were planned and implemented dealing with establishing relevant teaching and learning paradigms: information technology training; leadership and management development and lastly governance, organisational restructuring and management. Based on identified needs, Short Learning Programmes on a range of topics were offered to different target groups within these sub-projects. The College was also assisted to plan for the upgrading of their library system and clinical simulation laboratories. The project was managed by a Steering Committee and was branded to communicate the importance of the work. The staff of both partners learnt valuable lessons with regard to the nursing education system in the country, project management and educational skills.