Suria Ellis

A tale of two systems—Nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey

OBJECTIVE To examine the practice environment, nurse reported quality of care and patient safety, and nurse workforce outcomes in medical and surgical units in private and public hospitals in South Africa (SA), and determine the association of modifiable features of the hospital such as the practice environment and patient to nurse workloads on these outcomes. DESIGN Cross-sectional survey of nurses. SETTING AND PARTICIPANTS Nurses were surveyed in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in SA. A total of 1187 nurses completed the survey. MEASUREMENTS Practice environment, patient to nurse workloads, nurse reported quality of care and patient safety, and nurse workforce outcomes including burnout, job satisfaction and intention to leave. RESULTS On a national level, more than half, 54.4% (634/1166) of nurses intend to leave their hospital within the next year due to job dissatisfaction and 52.3% (600/1148) rate their practice environment as poor or fair, while almost half, 45.8% (538/1174) report high levels of burnout and 44.9% (517/1152) are not confident that management will resolve patient problems. Public hospital nurses report more negative outcomes than private hospital nurses. Some 71% (320/451) of public hospital nurses rate their practice environment as poor/fair, 62.9% (281/447) are not confident management will resolve patient problems, and 59% (272/461) intend to leave their hospital within the next year due to job dissatisfaction. On a national level, more favourable practice environments are significantly associated with more positive nurse reported quality of care, and nurse workforce outcomes. This is true for private and public hospitals. Patient to nurse workloads are also significantly associated with more positive nurse reported quality of care and patient safety, and nurse workforce outcomes, but primarily in public hospitals. CONCLUSIONS Improving the practice environment, including patient to nurse ratios holds promise for retaining a qualified and committed nurse workforce and may benefit patients in terms of better quality care.

Benefits of team sport for organisations

People travel to destinations for different reasons and the same applies to sporting events. To fulfil the needs of athletes and ensure that the event remains competitive, it is important to understand the needs of different markets through market segmentation. Reasons for participation (travel motives) were used to identify different market segments at the largest open-water swimming event in the world, the Midmar Mile in South Africa. The survey was conducted during the registration period in February 2010. A total of 461 questionnaires were administered and a factor analysis was conducted. Three motivational factors were identified: socialisation and escape, fun and entertainment and intrinsic achievement. ANOVAs were applied and the results showed that the swimmers did not have homogenous motives for participation. The results confirmed that motives for participating differ according to the sporting event, and that marketers and sport event organisers need to be aware that not all participants are the same. These findings can assist organisers to differentiate between the needs of different markets, and thereby adapt their marketing campaigns accordingly, which would lead to a more competitive and sustainable event.

Gene–environment and gene–gene interactions of specific MTHFR, MTR and CBS gene variants in relation to homocysteine in black South Africans

The methylenetetrahydrofolate reductase (MTHFR), cystathione-β-synthase (CBS) and methionine synthase (MTR) genes interact with each other and the environment. These interactions could influence homocysteine (Hcy) and diseases contingent thereon. We determined single nucleotide polymorphisms (SNPs) within these genes, their relationships and interactions with total Hcy concentrations within black South Africans to address the increased prevalence of diseases associated with Hcy. The MTHFR 677 TT and MTR 2756 AA genotypes were associated with higher Hcy concentrations (16.6 and 10.1 μmol/L; p<0.05) compared to subjects harboring the MTHFR 677 CT/CC and the MTR 2756 AG genotypes (10.5, 9.7 and 9.5 μmol/L, respectively). The investigated CBS genotypes did not influence Hcy. We demonstrated interactions between the area of residence and the CBS T833C/844ins68 genotypes (p=0.005) so that when harboring the wildtype allele, rural subjects had significantly higher Hcy than their urban counterparts, but when hosting the variant allele the environment made no difference to Hcy. Between the CBS T833C/844ins68 or G9276A and MTHFR C677T genotypes, there were two-way interactions (p=0.003 and=0.004, respectively), with regard to Hcy. Subjects harboring the MTHFR 677 TT genotype in combination with the CBS 833 TT/homozygous 844 non-insert or the MTHFR 677 TT genotype in combination with the CBS 9276 GA/GG displayed higher Hcy concentrations. Therefore, some of the investigated genotypes affected Hcy; residential area changed the way in which the CBS T833C/844ins68 SNPs influenced Hcy concentrations highlighting the importance of environmental factors; and gene-gene interactions allude to epistatic effects.

Determinants of Visitor Spending: An Evaluation of Participants and Spectators at the Two Oceans Marathon:

This paper investigates the socio-demographic and behavioural determinants that influence visitor expenditure at the Two Oceans Marathon in South Africa, based on a participant and spectator survey conducted at the race in 2011. Regression analyses were applied and the results indicate that greater length of stay, paid accommodation, number of marathons participated in per year and higher level of education signficantly influence higher participant spending at the marathon, while a high-income occupation and paid accommodation are associated with higher levels of spectator expenditure. These findings not only generate strategic insights into the marketing of the event; knowledge of these determinants will also lead to a greater economic impact and competitive advantage.

Hypercontextualized Learning Games: Fantasy, Motivation, and Engagement in Reality

A Hypercontextualized Game (HCG) is a locally designed game that supports its players in gathering context-specific information and in-depth understanding and knowledge regarding the context of a site. LIEKSAMYST, an exciting mobile application, with which visitors can play various games based on stories, was originally developed for the open-air section of the Pielinen Museum and is an example of such a hypercontextualized game. Each individual game (which together make up LIEKSAMYST) was developed in, for and with the co-operation of the Pielinen Museum. In its design, LIEKSAMYST purposefully attempts to connect users to the local history and thus promote affective engagement. With the co-operation of both a local school (Lieksan Keskuskoulu) and the museum authorities, we set out to discover how LIEKSAMYST guides the informal learning experience of Grade 7 pupils. We gathered information from 101 pupils on-site (through questionnaires) and used this data, as well as the pupils’ academic grades, to elucidate our study by investigating the relationship between engagement and motivation. The data were analyzed using a quantitative method guided by a qualitative interpretational approach and we found a significant correlation between (a) fantasy and (b) affective and cognitive engagement. The study highlighted the importance of evoking and harnessing both affective and cognitive engagement, through the fundamental element of fantasy, in the game narrative.

Determinants of visitor expenditure at the Aardklop National Arts Festival.

The Aardklop national Arts festival is one of the most popular arts festivals in South Africa and, given the economic value of the festival, an understanding of expenditure patterns and the determinants influencing spending behavior is vital to the festival marketers/organizers-especially from a sustainability point of view. Therefore, the aim of this article is to investigate the sociodemographic and behavioral determinants that influence visitor expenditure at Aardklop, based on visitor surveys conducted at the festival in 2008. Regression analysis was applied to establish the most significant determinants and results indicate that higher income, occupation, age, people paid for, tichets purchased, and attendance of other festivals are significant determinants influencing the amount of money spent by visitors at the festival. These findings will not only generate strategic insights on marketing for the festival, but knowledge of these determinants can also lead to a greater economic impact, as well as a competitive advantage.

The Influence of Travel Motives on Visitor Happiness Attending a Wedding Expo

ABSTRACT Events are an important motivator in travel and tourism, therefore contributing to related benefits at the tourism destination. This study presents the findings of a structural equation model used to investigate the factors that motivate visitors attending a Wedding Expo and how these travel motives influence their happiness. A self-administered questionnaire was distributed to visitors attending the Wedding Expo in Johannesburg, South Africa. The data from 375 (N) eligible questionnaires was captured and analyzed using SPSS. From the study’s findings, managerial recommendations were made with the aim of maximising the happiness of visitors attending the Wedding Expo. The study found that satisfaction with life and happiness of visitors attending a Wedding Expo is enhanced more by the event’s attributes/attractiveness and enhancement of kinship/relationship than by the event’s novelty. The research contributes to the literature related to events management, happiness, and marketing management in tourism.

Triglyceride concentration and waist circumference influence alcohol-related plasminogen activator inhibitor-1 activity increase in black South Africans

We investigated the association between alcohol consumption and plasminogen activator inhibitor-1 activity (PAI-1act) and fibrinogen concentration in a black South African population presenting with lower PAI-1act and higher fibrinogen than what is typically observed in white populations. We, furthermore, wanted to investigate the effect of urbanization, sex, central obesity, increased triglycerides, 4G/5G polymorphism (PAI-1 only) and BMI on the association of alcohol with PAI-1act and fibrinogen. Data from 2010 apparently healthy, randomly collected black South African volunteers from the Prospective Urban and Rural Epidemiological (PURE) study were cross-sectionally analyzed. Alcohol consumption was recorded using quantitative food frequency questionnaires and fasting blood samples were collected for biochemical analysis including PAI-1act and fibrinogen. Heavy alcohol consumption is associated with significantly increased PAI-1act, in the total population as well as in the women separately, and tended to be so in men. This alcohol-related PAI-1act increase was observed in volunteers with increased triglycerides and central obesity but not in volunteers with normal levels and waist circumference. Urbanization, the 4G/5G polymorphism and BMI did not affect the association of alcohol with PAI-1act. Moderate alcohol consumption is associated with decreased fibrinogen concentration. Sex and level of urbanization did not affect the association of alcohol with fibrinogen. Fibrinogen decreased in normal and overweight volunteers but not in obese and centrally obese volunteers following moderate alcohol consumption. Triglyceride levels and waist circumference influence alcohol-related PAI-1act increase potentially through modulating adipocyte and triglyceride-induced PAI-1 production. Obesity prevented alcohol-related fibrinogen decrease possibly by counteracting the anti-inflammatory effect of moderate alcohol consumption.

Occupational stress and mental well-being in a cohort of Black South African teachers

This study explored levels of occupational stress and mental well-being of a cohort of Black South African teachers. 200 secondary school teachers completed the Teacher Stress Inventory (TSI: Boyle, Borg, Falzon, & Baglion, 1995), General Health Questionnaire (GHQ-28: Goldberg & Hillier, 1979) and Mental Health Continuum-Short Form (MHC-SF: Keyes, 2006). Correlations and Structural Equation Modelling (SEM) were used to determine the levels of occupational stress and well-being of participants, and to establish the relation between these variables. A significant majority of the teachers reported high levels of mental health (flourishing) despite high levels of teacher stress. These results show teachers’ ability to withstand and cope with stress whilst maintaining their mental health. This suggests the presence of protective factors that mediate the effect of work-related stressors and, in so doing, contribute to the teachers’ levels of resilience.

Psychosocial Health of an African Group before Awareness of HIV Status: A Comparative Study

This study aimed to explore the psychosocial health profiles of people with and without HIV before they learned their infection status. A total of 1,025 participants (males = 386, females = 639, age range = between 32 and 87, infected = 153) completed questionnaires on psychosocial well-being and were tested for HIV. Participants who were infected with HIV had a lower sense of coherence and a lower capacity to succeed in joint community activities than the participants infected with HIV. Some differences were detected between rural and urban areas. It is concluded that mental health and quality of life may be compromised in some ways even before HIV status is known and overt symptoms of infection noticed. Proactive interventions on community level to promote mental health and prevent problems are suggested focusing amongst others on coping skills, relationship building, and finding meaning and engagement in community activities.