Lufuno Makhado

A longitudinal study of the aftermath of rape among rural South African women.

Objective: Sexual assaults against women are a global health crisis, with alarmingly high rates in South Africa. However, we know very little about the circumstances and the aftermath of these experiences. Further, there is limited information about how factors specific to the rape (e.g., fighting back) versus those that are specific to the individual—and potentially modifiable—influence mental health outcomes. This study examined how situational characteristics of rape as well as individual and situational factors confer risk for symptoms of depression, posttraumatic stress disorder (PTSD), and dysfunctional sexual behavior at 12-month follow-up. Method: Two hundred nine (N = 209) South African women were recruited from rural rape clinics in the Limpopo Province (LP) and North West Province (NWP) of South Africa. Interviews were conducted at baseline (within 6 months of the rape incident) and at 6 and 12 months by trained staff at the clinics in English or the women’s native languages. Women were interviewed after services were provided in a private room. Results: One hundred thirty-two (n = 132) women were lost to follow-up at 12 months, resulting in 77 women with interview data for all time points. Undermining by the survivor’s social support system and an increased belief in myths about rape were associated with increased dysfunctional sexual practices and symptoms of depression. Conclusions: These findings demonstrate the need for interventions that address the most pervasive effects of rape over time. These behaviors can increase risks for revictimization and reduce psychological well-being in the aftermath of rape.

Knowledge and uptake of occupational post-exposure prophylaxis amongst nurses caring for people living with HIV

Background Nurses caring for people living with HIV (PLWH) are at higher risk of exposure to the human immunodeficiency virus (HIV) by needle sticks, cuts, getting body fluids in their eyes or mouth and skin when bruised or affected by dermatitis. Objectives To determine knowledge, insight and uptake of occupational post-exposure prophylaxis (OPEP) amongst nurses caring for PLWH. Method A cross-sectional descriptive design was used in this study. Stratified random sampling was used to sample 240 nurses. The study was conducted in a regional hospital in Limpopo province. Both parametric and non-parametric statistics were employed to analyse data. Results A total of 233 nurses participated in the study. Sixty per cent (n = 138) of all nurses had a situation at work when they thought that they were infected by HIV and 100 (43%) nurses had experienced the situation once or more in the past 12 month. Approximately 40% did not know what PEP (post-exposure prophylaxis) is, and 22% did not know or were not sure if it was available in the hospital. Only few participants (n = 68, 29%) had sought PEP and most (n = 37, 54%) of them did not receive PEP when they needed it. There was a significant association between the knowledge and availability of PEP (r = 0.622). Conclusion The study recommend an urgent need for policy makers in the health sector to put in place policies, guidelines and programmes that will rapidly scale up PEP services in health care settings, so that preventable occupationally acquired HIV infection can be minimised amongst nurses.

Barriers to tuberculosis and human immunodeficiency virus treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy in KwaZulu-Natal and North West provinces

Background Nurses, as front-line care providers in the South Africa’s health care system, are called upon to deliver integrated interventions for tuberculosis and human immunodeficiency virus (TB and HIV) including nurse-initiated management of anti-retroviral therapy (NIMART) and anti-TB treatment. Adherence to treatment guidelines and factors associated with non-adherence to treatment guidelines among nurses remain under explored. Purpose To explore and describe barriers to treatment guidelines adherence among nurses initiating and managing anti-retroviral therapy and anti-TB treatment in KwaZulu-Natal and North West provinces. Design This study employed a qualitative exploratory descriptive design. Methods Four semi-structured focus group interviews were conducted during 2014 each consisting of four to eight NIMART trained nurses. Audiotaped interviews were transcribed verbatim and analysed using Atlas T.I. software. Findings During data analysis, two themes emerged: (1) NIMART trained nurses’ distress about TB and HIV guidelines adherence that is inclusive of lack of agreement with guidelines, poor motivation to implement guidelines, poor clinical support and supervision, resistance to change, insufficient knowledge or lack of awareness and (2) exterior factors inhibiting nurses’ adherence to treatment guidelines which incorporated organisational factors, guidelines-related factors and patient-related factors. Conclusion This qualitative study identified that nurses have substantial concerns over guideline adherence. If NIMART trained nurses’ barriers inhibiting adherence to treatment guidelines cannot be remedied, patient outcomes may suffer and South Africa will struggle to meet the 90-90-90 targets.

TB/HIV Exposure among Nursing Students in the Clinical Practice Environment

Nurses are faced with challenges regarding inadequate precautionary resources and the lack of support for occupational health practices still experienced in the clinical setting which expose them to the risk of contracting TB and HIV. Hence this study sought to investigate TB/HIV exposure among nursing students in the clinical practice environment. A cross-sectional descriptive design was used in this study. The study sample included nursing students from first to fourth year level from the School of Nursing Sciences at the North-West University who were purposively selected. A high percentage of nursing students reported that they have experienced a situation where they were afraid that they might have been infected with both TB and HIV. Awareness about post-exposure prophylaxis (PEP) was marked among the majority of nursing students. The uptake of PEP differed across junior and senior levels of nursing students. The results revealed that the higher the level of study, the greater the exposure. The lack of sufficient clinical support from nursing staff and preceptors had equally contributed to the exposure of nursing students to both HIV and TB, therefore, more support must be provided to nursing students.

Professional nurses’ lived experiences regarding the performance management system in the Mopani district

Background The purpose of the performance management system (PMS) is planning, monitoring, evaluation and development of employees to meet the organisational goals and objectives and transform of service delivery to excellence of the organisation. However, public services are deteriorating and implementation of PMS stimulated different views among professional nurses (PNs) in the Mopani district clinics, which warrants exploration and documentation of the findings. Objective The objective of this study was to explore and describe the PNs’ perceptions towards PMS. Methods A qualitative, phenomenological research was conducted to explore and describe the nurses’ lived experiences regarding PMS. A purposive sampling method was used. Data collection was done using focus group interviews. Three focus group discussion sessions were conducted, inclusive of six to nine participants in each session. Results Twenty-two PNs were interviewed. The findings revealed the following themes: PNs’ uncertainty regarding the implementation of PMS, poor implementation of PMS and its process, lack of knowledge and understanding of PMS implementation and its process, and negative attitudes towards the implementation of PMS. Conclusion PNs perceived PMS negatively. There is a need to improve leadership and management behaviour by enhancing productivity, job satisfaction and organisational commitment. Constructive feedback, training and capacity development, including standardisation and stabilisation of performance instrument, might improve the process.

Conceptual Model: Psychosocial Implications of Caring for People Living with HIV among Nurses

Abstract Nursing is an occupation that is subjected to a high degree of stress. Stress had been seen as a predictor of the nature of care provided by nurses caring for people living with Human Immunodeficiency Virus (HIV) (PLWH). The purpose was to develop a conceptual model for establishment of Nurse-Environment-Patient Relationship in hospital setting. A descriptive, cross-sectional paper was conducted. The Maslach Burnout (MBI) and Beck’s Depression Inventories (BDI), and Acquired Immunodeficiency Syndrome (AIDS) impact scale was used to assess the impact of caring for PLWH among nurses. The paper adopted the assumptions of cognitivism and cognitive appraisal theory. Majority of nurses reported to suffer grief and loss and identification with their patients. A moderate to high level of burnout was marked. A conceptual model of psychosocial impact of caring for PLWH is a comprehensive model that projects the impact of caring for PLWH among nurses and a link between nurses, their working environment and patients. Quality of care provided to patients is purely determined by the psychosocial state of nurses and the level of environmental stressors. Maintaining a conducive working environment and caring for caregivers is imperative in the provision of quality care.