*Faculty of Health Sciences (ETDs)
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Browsing *Faculty of Health Sciences (ETDs) by SDG "SDG-4: Quality education"
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Item A survey of current practice in anaesthesia for caesarean delivery in a Department of Anaesthesiology(2024) Watermeyer, Benjamin DavidSouth Africa has an increasing caesarean delivery (CD) rate and as such anaesthesia for CD has become a fundamental skill for all levels of anaesthetists. The Essential Steps in the Management of Obstetric Emergencies (ESMOE) guidelines provide a framework for practitioners with specific focus on dosage in neuraxial anaesthesia, perioperative fluids and management of hypotension. Aims The aim of this study was to describe the current practices of anaesthesia for patients requiring CD, including the management practices of common complications, within the University of the Witwatersrand Department of Anaesthesiology. Methods: A prospective, contextual and descriptive study design was followed using an anonymous, self-administered online questionnaire. Descriptive statistics were used to assess adherence to guidelines and comparison made between senior and junior anaesthetist’s practices. Results: Junior anaesthetists performed significantly more CD anaesthetics per month and had more training in ESMOE guidelines compared to senior anaesthetists. Senior anaesthetists were more likely to use a higher dose of bupivacaine. Phenylephrine as a first line anti-hypotensive agent was used by 99.4% of participants. The considered safe minimum platelet count for spinal anaesthesia was 75 x 10^9/l by 61.3% of participants. A significant difference between junior and senior anaesthetists was found where senior anaesthetists were more likely to accept a lower platelet count. A sensory level post administration of spinal anaesthetic was assessed by all participants with 53.1% using an ice brick and 35.0% requesting the surgeon to pinch the patient. Conclusion: In the Witwatersrand Department of Anaesthesiology anaesthetists do follow the ESMOE guidelines of clinical practice for CD. While there are some differences in practice approaches, these were found to be within internationally accepted practice. There would be a benefit of improved awareness of the ESMOE guidelines within the department as well as further training on the different approaches to CD anaesthesia.Item Adequacy of availability of antidotes for common and critical drug poisonings and doctors’ perspectives thereof: a study in teaching hospitals in the Southern Gauteng City-Region(2024) Fitchett, Margaret PenelopeBackground: Drug poisoning is an important area of study in South Africa (SA) as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in SA. Objectives: To assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. Methods: A data sheet assessing the availability of antidotes in the Emergency Departments (EDs) and pharmacies was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Results: N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol and pyridoxine were present in all EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate or pyridoxine (85.7%, 83.3%, 87.3% and 75.4% of 126 respondents respectively). Conclusion: The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply which will be an important avenue for further research.Item Educational programmes used in teaching nurses mechanical ventilation in adult intensive care units: a scoping review(2024) Davis, Daniele RuthIntroduction Mechanical ventilation is a common form of life support intervention and nurses are the key personnel in providing safe and specialized care to these patients. Their education determines whether patients receive optimal quality care and attain the best possible outcomes. Purpose: To identify the available evidence on invasive mechanical ventilation educational programmes developed for teaching all nurses working in adult intensive care units; regardless of their level of qualification or years of experience. It includes the content taught and the method of instruction used. Methods: Due to the breadth of the review topic, a scoping review methodology was considered appropriate and guided by The Joanna Briggs Institute (JBI) Scoping Review methodology. Eligibility criteria using the PCC framework, and relevant keywords and phrases originating from these criteria were used to search five databases in July and August 2022 (PubMed, EBSCO CINAHL, Wiley Online, Scopus and ProQuest). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were used to report the results. Results: Nine studies fulfilled the inclusion criteria for full review. Four studies were relevant to invasive mechanical ventilation; two studies were specifically related to ventilator associated pneumonia and one each on weaning, endotracheal tube cuff pressure management and the development of a programme for nurses transitioning into the intensive care unit. Conclusion: There is limited evidence of comprehensive educational programmes on invasive mechanical ventilation for all nurses working in the intensive care unit.Item Experiences of professional nurses in providing support to student nurses in the clinical practice environment of a private hospital in Gauteng(2021) Jones, JenniferQuality in nursing education is a global focus due to the many challenges facing healthcare the world over. Clinical learning is an important component in nursing training and nursing experiences during clinical placement are crucial to prepare the student to become safe, competent Professional Nurses. However recent studies have shown that the students’ clinical training is not always effective in preparing them for their future role. Support in the clinical environment by the Professional Nurse is crucial to assist the student to develop confidence and competence to transition into the Professional Nurse role. The objective of this study was to describe the experiences of Professional Nurses in providing support to student nurses in the clinical practice environment of a private hospital. An exploratory qualitative study using in depth interviews of fifteen Professional Nurses was done. The data collected was then analysed using thematic analysis. The identified themes and categories were discussed to offer meaning and insight. The study provided an understanding of how support of the student nurse is currently experienced and perceived by the Professional Nurse in the clinical practice environment with a view to identifying ways of improving support to the student nurse in the future. It was found that the clinical environment is unpredictable and whilst the Professional Nurses acknowledged they needed to support the student, it was often challenging to do this effectively leaving them feeling frustrated and disappointed. The study took place during the COVID -19 pandemic which caused major disruptions to the everyday functioning and operations of hospitals globally, and the study site was no exception. Recommendations to improve support to the student nurse were made in the areas of Clinical Practice, Nursing Education and Research.Item Identification of third year midwifery skills that could benefit from simulated practice prior to clinical midwifery placements(2021) Singaram, Kerry-AnnNeophyte midwifery students often feel anxious and inadequate during their clinical placements, as they are expected to perform midwifery skills as early as their first day in the clinical environment. Midwifery educators are seeking out creative ways to create practice opportunities for their students with regards to skills practice, and simulation as a teaching strategy offers a learning environment for safe practice of skills. The use of simulation in midwifery is a fairly new concept, and its future growth is dependent upon research to provide a sound base from which it may grow and develop to meet the needs of the students. The purpose of the study was to identify key midwifery skills that could be taught and practiced using simulation prior to student midwives’ clinical placements that would better equip student midwives to manage their midwifery clinical placements. Findings from the study could serve as a foundational basis for future midwifery simulated programs. The research design and method was qualitative in nature and data was collected from focus group discussions with fourth-year student nurses and their respective midwifery lecturers. Clinical facilitators who are based in the clinical environment and responsible for the training of third year midwifery students were invited to participate in the study, however, were unable to attend. The researcher felt that, this created a limitation to the study as they might have added additional information or a different perspective about novice midwifery skills training. Findings identified specific midwifery skills that could benefit from simulated practice as well as how best skills could be practiced within facilitation of simulation in third year midwifery practice. Summary of findings included the identification of the following midwifery skills that participants identified as being important with regards to simulated practice: completion of documentation; vaginal examinations; management of second stage of labour and offering of psychological support. IV, Participants together with the researcher gives suggestions on how best simulation can be facilitated for developing confidence in neophyte student midwives before their first clinical placement. Based on the findings of this research, recommendations were made to guide midwifery lecturers when planning simulation activities.Item Nurses’ experiences in implementing Nurse Initiated Management of Anti-Retroviral Therapy (NIMART) in primary health care facilities in Dr Ruth Segomotsi Mompati District, North West Province(2024) Sibisi, NthabisengAim of study- This study aimed to explore the nurses’ experiences in the implementation of NIMART in Dr Ruth Segomotsi Mompati District since its inception in 2010 to 2017. Methods This study employed an exploratory qualitative research design. The study setting included nine PHC facilities in three sub-districts. The study included only those nurses who had been trained to implement the NIMART in the district PHC facilities from 2010-2017. The final sample included Sixteen (16) nurses, comprising of three males and thirteen females from the three eight-hour operational clinics and six 24-hour Community Health Centres (CHCs). Data were therefore collected using in-depth interviews lasting thirty-five minutes (minimum) one and half hours 1h30 minutes (maximum). These interviews were guided by a semistructured interview guide. Data were later transcribed verbatim using an electronic software O’ Transcribe, and then analysed using MAXQDA 2018v, where inductive coding was applied. Thematic analysis was employed to interpret and represent data, which was finally presented as themes based on participants’ dominant narratives. Results- There were five key themes that emerged from this study. These included: perceptions about the NIMART programme mostly related to it being a task-shifting strategy when managing HIV and Aids and the programme benefits; contextual elements affecting access and adherence to NIMART, and challenges such as socio-cultural factors, social norms, socio-political and governance factors; facilitators of NIMART implementation in terms of functional health information management system and clinical guidelines, multidisciplinary team and skilled personnel, impactful counselling services, and intrinsic nurse motivators. Challenges of NIMART implementation included insufficient human resources for health, services integration, poor management and health-service support systems, lack of capacity building, ART unavailability and poor patient compliance to ART, and nurse demotivation. The proposed interventions by the nurses included provision of training, increasing staff to curb workload, management support, and debriefing, health service support resources and patient support improvement. Conclusion Task-shifting and successful NIMART implementation are complex notions, which can be successful if accompanied by training, reorganisation of services, mentoring, supervision, and ongoing support from existing health-service system structures. The rural health context must be considered as unique, and policies should be tailored to suit the needs of rural healthcare workers and patients. Dr RSM case-study has shows the plight of farm labourers and the need for a multisectoral approach to address patient related issues in this context. The challenges to successful NIMART implementation suggest a need for reorientation of health-services to fit rural contexts.Item Students’ perceptions of the medical curriculum at the University of Limpopo(2024) Mamashela, Thakadu ArnoldAny educational program follows a process of development by various stakeholders. Program evaluation is an important step in curriculum development and implementation. This study evaluated the medical curriculum delivery from the perspective of the students at the new medical school of the University of Limpopo. The research employed a cross-sectional descriptive quantitative method using a survey. All students registered for the medical curriculum in their second to fifth years of study were invited to participate in the research. The findings of this research showed there was a perception of factual overload in some modules, however, most of the modules were perceived to have been well taught with mixed methods of assessment strategies applied across the year levels of study. The infrastructure and the equipment required for teaching and learning activities were not considered satisfactory. Students embraced the use of technology in teaching and learning. The university provided adequate support in relation to WiFi on campus. Recommendations for teaching/ practice and future research were made.