BackgroundStudies on voluntary medical male circumcision (VMMC) have provided convincing evidence on its efficacy to provide partial protection against female-to-male HIV transmission in circumcised men. The World Health Organization and UNAIDS subsequently formulated recommendations for VMMC implementation that included implementation of neonatal medical male circumcision (NMMC) to all infants up to two months old. Knowledge regarding the acceptability of NMMC by pregnant women who are candidates for granting of consents for NMMC procedures or its ideal placement within health programmes is low.ObjectivesWe sought to establish NMMC acceptability by pregnant women and the feasibility of its integration within Maternal, Child and Women's Health (MCWH) programmes to inform implementation guidelines.MethodNurses and counsellors at two public health facilities were trained to provide NMMC counselling and offer NMMC to 1778 pregnant women presenting for antenatal care services. Univariate and bivariate analyses were performed on data collected on NMMC acceptance and refusals. Thematic analysis was also performed on qualitative reasons for refusals.ResultsAcceptability of NMMC by women was high (82.9%). Refusals resulted from the need for consultations with partners and/or family members prior to consenting (41.3%), fear of the procedure (23.8%), cultural reasons (15.9%) and no reasons given (15.3%).ConclusionThe acceptability of NMMC by pregnant women and its integration with MCWH services was feasible. However socio-cultural factors, including the need for further consultation prior to consenting for NMMC procedures and preference of traditional circumcision by some women, need to be addressed in order to increase uptakes.

Nurses in intensive care units (ICUs) are exposed regularly to huge demands interms of fulfilling the many roles that are placed upon them. Unit managers, in particular, are responsible for the efficient management of the units and have the responsibilities of planning, organising, leading and controlling the daily activities in order to facilitate the achievement of the unit objectives. The objective of this study was to explore and present the challenges encountered by ICU managers in the management of large ICUs. A qualitative, exploratory and descriptive study was conducted at five hospital ICUs in Gauteng province, South Africa. Data were collected through individual interviews from purposively-selected critical care unit managers, then analysed using the matic coding. Five themes emerged from the data: challenges related to the layout and structure of the unit, human resources provision and staffing, provision of material resources, stressors in the unit and visitors in the ICU. Unit managers in large ICUs face multifaceted challenges which include the demand for efficient and sufficient specialised nurses; lack of or inadequate equipment that goes along with technology in ICU and supplies; and stressors in the ICU that limit the efficiency to plan, organise, lead and control the daily activities in the unit. The challenges identified call for multiple strategies to assist in the efficient management of large ICUs.

A preceptor is a specialised tutor who provides practical training to students in the practice setting. They are frequently used to orientate nursing students to prepare them for their duties as professional nurses. In the Western Cape Province professional nurses attend a training programme to prepare them for the role of preceptor. After completion of the training it is unclear how the trained nurse preceptors perceive their preparation for the role. The perceptions of preceptors may influence their commitment to their role. The purpose of this study was to explore nurse preceptors' perceptions of benefits, support and commitment to the preceptor role. A conceptual framework guided the study which replicated previous studies that explored nurse preceptors' perceptions. A quantitative approach utilising a descriptive correlational design was used in this study to address the research questions. A convenience sample was drawn from preceptors (n = 60) who had completed a preceptor training programme at the University of the Western Cape. Instrumentation for the study included the following scales: preceptors' perceptions of benefits and rewards, preceptors' perceptions of support, and commitment to the preceptor role. Data analysis was performed using SPSS 20.0. The findings indicate that nurse preceptors were committed to their role. The findings of this study are supported by Kanter's model of structural determinants of behaviour in organisations, since preceptors who see themselves as having access to opportunity and support are likely to be committed to their role.

The present study evaluated the prevalence of anaemia and its determinants in one- and three-year-old children from the Capricorn District of Limpopo Province, South Africa. A prospective cohort study conducted in rural villages in the Capricorn District of Limpopo Province, South Africa. At birth, a cohort of 219 children was followed until they were one and three years of age. Data collected included the children's anthropometric measurements, blood for biochemical analysis (full blood count, ferritin, folate and vitamin B12) and socio-demographic status. At one year, anaemia (Hb < 11 g/dL) was present in 52% of the children, decreasing to 22% by the third year. Iron deficiency (ferritin < 12 µg/mL) was common in these children (39% and 33% at one year and three years, respectively) particularly in the presence of anaemia. Folate and vitamin B12 deficiencies (< 5 ng/mL and < 145 pg/mL, respectively) were common at one year, with the children accumulating enough vitamin B12 by three years; however, folate deficiency levels remained fairly constant between the two time points. There was a high prevalence of anaemia in the study participants at one year and three years of age. Factors that increased the risk of anaemia at three years were: a mother with only a primary school education, anaemia at one year, male gender, overweight, and combined overweight and stunting. Protective factors against anaemia were having a younger mother who served as the main caregiver.

Simulation in healthcare education is common practice. Although this teaching strategy increases patient safety, it is not proven to enhance patient-centred care in practice. Simulated patients are used to teach communication skills and to contribute to the authenticity of the simulation. Could this enhanced authenticity help bridge the gap from simulated practice to practice with live patients where patient-centredness is of crucial importance? This study’s objective was to determine whether students who acquired a skill in simulation using a simulated patient displayed more patient-centredness in practice than students who used a mannikin. A pre-experimental, post-test-only design with a comparison group was used. The population sample comprised all second-year B.Cur. students (N = 36) at a tertiary institution, who were divided into two cohorts. Cohort 1 was trained to administer an intramuscular injection using a simulated patient with a strap-on injectable device, whilst cohort 2 used an injection model. All participants were assessed on their procedural skills as well as patient-centred care whilst administering an injection to a patient in hospital. A comparison was made of mean scores for patient-centred care rendered by the two cohorts. Fisher’s exact test revealed that the mean score for patient-centredness of cohort 1 (88%) was significantly higher (p = < 0.001) than that of cohort 2 (74%). Using a simulated patient to teach administration of an intramuscular injection enhanced students’ patient-centredness when performing the procedure in practice. Recommendations include making use of a bigger sample and including a pre-test the next time research of this nature is carried out.

Background : Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice. Objective : This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals. Method : A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng. Results : The response rate was 35.33% (n = 53), most respondents being professional nurses (88.68%; n = 47) working in neonatal intensive care units (80.77%; n = 42); 24 (45.28%) had less than 5 years' and 29 respondents 6 or more years' working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p < 0.05) was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64%) reported that there were no pain management guidelines in the neonatal wards in which they worked. Conclusion : The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates.

Community involvement is one of the crucial principles in the implementation of successful community-based education programmes. However, a gap continues to exist between the rhetoric of this principle and the reality of involving or engaging communities in the education of health professionals. This study investigated the experiences of a community regarding its involvement in a community-based education programme offered by a university nursing school in Durban, South Africa. An interpretive existentialist-phenomenological design was employed for its richness in extracting human experiences. Individual interviews were held with school teachers and coordinators from non-government organisations, whilst focus groups were used for school children and community health workers. Although focus group discussions are not well suited for phenomenological studies, they can promote active participation and reduce possible intimidation by providing support through group interaction. Analysis of data was guided by Schweitzer's model for analysing phenomenological data. Themes that emerged from the data include: (1) Community experience of unmet expectations; (2) Benefits to the community from its involvement in the University Nursing School community-based education programme; (3) Existing partnership between the community and the university; (4) Sharing in the case-based learning activities; (5) Awareness of available services, human rights and self-reliance. The researched community indeed benefited in its participation in the University Nursing School (UNS) CBE programme. However, there is a need to improve the communication between partners to make the partnership more sustainable through close relationships and interaction. There is also a need for further research on related aspects of the community's involvement.

Patients in intensive care units require rest and sleep to recuperate, but might suffer from sleep deprivation due to ongoing unit activities. The study aimed to identify and describe the factors contributing to sleep deprivation in one multi-disciplinary intensive care unit (MDICU) in a private hospital in South Africa. Quantitative, descriptive research was conducted to identify factors contributing to sleep deprivation in the research setting, and to make recommendations to enhance these patients' abilities to sleep. Structured interviews were conducted with 34 adult non-ventilated patients who had spent at least one night in the MDICU and who gave informed consent. Out of the 34 interviewed patients 70.6% (n=24) indicated that they suffered from sleep deprivation in the MDICU. The five major factors contributing to sleep deprivation in a MDICU were, (1) not knowing nurses' names, noise caused by alarms, (2) stress, (3) inability to understand medical terms, and (3) blood pressure cuffs that restricted patients' movements and smelled badly. Patients' abilities to sleep were enhanced by reassuring nurses whose names they knew and with whom they could communicate. By attending to the identified five major factors, patients' abilities to sleep in a MDICU could be enhanced enabling patients to recuperate faster. The implementation of such measures need not incur financial costs for the MDICU concerned.

Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. The objectives of the study was to describe a decentralised nursing management education programme located in Durban, South Africa and describe the perceptions of nursing faculty facilitators regarding implementation of this teaching method. Data was collected through the use of one-on-one interviews and also focus groups amongst the fifteen facilitators who were using a case-based curriculum to teach the programme content. The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse for between 11 and 20 years; slightly more than half had worked as a facilitator for three or more years. The facilitators identified themes related to the student learners, the learning environment, and strengths and challenges of using facilitation to teach the content through cases. Decentralised nursing management educational programmes can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services. Nursing faculty facilitators need knowledgeable and accessible contact with centrally based full-time nursing faculty in order to promote high quality educational programmes.

Background : Postpartum haemorrhage (PPH) is a leading cause of maternal mortality especially in the developing world. Misoprostol, a highly effective drug is highly effective in inducing uterine contractions and has been proposed as a low-cost, easy-to-use intervention for PPH. Objective : This study assessed evidence of the effectiveness of misoprostol for the prevention and treatment of PPH. Method : Databases searched included MEDLINE, PUBMED, CINHAL, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE. Reference lists and conference proceedings were also searched for more studies. Three studies included in the meta-analysis were limited to randomised controlled trials (RCT). Two reviewers independently screened all articles for methodological quality using a standardised instrument adapted from the Cochrane Collaboration website. Data were entered in Review Manager 5.1 software for analysis. Results : Three trials (n = 2346) compared misoprostol to a placebo. Misoprostol was shown not to be effective in reducing PPH (risk ratios [RR] 0.65; 95% confidence interval [CI] 0.40-1.06). Only one trial reported on the need for a blood transfusion (RR 0.14; 95% CI 0.02-1.15). Shivering (RR 2.75; 95% CI 2.26-3.34) and pyrexia (RR 5.34; 95% CI 2.86-9.96) were significantly more common with misoprostol than with a placebo. Conclusion : The use of misoprostol was not associated with any significant reduction in the incidence of PPH. Therefore, in order to verify the efficacious use of misoprostol in the treatment of PPH, specialised investigations of its dose and routes of administration for clinically significant effects and acceptable side effects are warranted.