Research Outputs (Public Health)
Permanent URI for this collectionhttps://hdl.handle.net/10539/36984
This collection includes content from the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) which has been operating the Agincourt health and demographic surveillance system since 1992. Work has evolved since then into a robust research infrastructure supporting advanced community-based research with studies ranging from the biomedical to the ethnographic, making rural voices heard.
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Item Social accountability and nursing education in South Africa(2015) Armstrong, S.J; Rispel, L.CBACKGROUND: There is global emphasis on transforming health workforce education in support of universal health coverage. OBJECTIVE: This paper uses a social accountability framework, specifically the World Health Organization's six building blocks for transformative education, to explore key informants' perspectives on nursing education in South Africa. METHODS: Using a snowballing sampling technique, 44 key informants were selected purposively on the basis of their expertise or knowledge of the research area. Semi-structured interviews were conducted with the key informants after informed consent had been obtained. The interviews were analysed using template analysis. RESULTS: South Africa has strategic plans on human resources for health and nursing education, training, and practice and has a well-established system of regulation and accreditation of nursing education through the South African Nursing Council (SANC). Key informants criticised the following: the lack of national staffing norms; sub-optimal governance by both the SANC and the Department of Health; outdated curricula that are unresponsive to population and health system needs; lack of preparedness of nurse educators; and the unsuitability of the majority of nursing students. These problems are exacerbated by a perceived lack of prioritisation of nursing, resource constraints in both the nursing education institutions and the health training facilities, and general implementation inertia. CONCLUSION: Social accountability, which is an essential component of transformative education, necessitates that attention be paid to the issues of governance, responsive curricula, educator preparedness, and appropriate student recruitment and selection.Item 'Practice what you preach': Nurses' perspectives on the Code of Ethics and Service Pledge in five South African hospitals.(2015) White, J; Phakoe, M; Rispel, L.CBACKGROUND: A recent focus of the global discourse on the health workforce has been on its quality, including the existence of codes of ethics. In South Africa, the importance of ethics and value systems in nursing was emphasised in the 2011 National Nursing Summit. OBJECTIVE: The study explored hospital nurses' perceptions of the International Code of Ethics for Nurses; their perceptions of the South African Nurses' Pledge of Service; and their views on contemporary ethical practice. METHODS: Following university ethics approval, the study was done at a convenience sample of five hospitals in two South African provinces. In each hospital, all day duty nurses in paediatric, maternity, adult medical, and adult surgical units were requested to complete a self-administered questionnaire. The questionnaire focused on their perceptions of the Code of Ethics and the Pledge, using a seven-point Likert scale. STATA(®) 13 and NVIVO 10 were used to analyse survey data and open-ended responses, respectively. RESULTS: The mean age of survey participants (n=69) was 39 years (SD=9.2), and the majority were female (96%). The majority agreed with a statement that they will promote the human rights of individuals (98%) and that they have a duty to meet the health and social needs of the public (96%). More nuanced responses were obtained for some questions, with 60% agreeing with a statement that too much emphasis is placed on patients' rights as opposed to nurses' rights and 32% agreeing with a statement that they would take part in strike action to improve nurses' salaries and working conditions. The dilemmas of nurses to uphold the Code of Ethics and the Pledge in face of workplace constraints or poor working conditions were revealed in nurses' responses to open-ended questions. CONCLUSION: Continuing education in ethics and addressing health system deficiencies will enhance nurses' professional development and their ethical decision-making and practice.Item Factors influencing agency nursing and moonlighting among nurses in South Africa(2014) Rispel, L.C; Blaauw, D; Chirwa, T; et alBACKGROUND: In South Africa, nurses are the largest category of the health care providers. Their optimal performance is critical for the successful implementation of impending health sector reforms. OBJECTIVE: This paper examines the occurrence of agency nursing, moonlighting, and overtime among nurses in South Africa, and the factors influencing moonlighting. DESIGN: This cross-sectional survey was a one-stage cluster random sample of 80 hospitals in four South African provinces, selected with stratification from the public and private health sectors. On the survey day, all nurses working in critical care, theatre, emergency, maternity, and general medical and surgical wards completed a self-administered questionnaire after giving informed consent. In addition to demographic information, the questionnaire elicited information on the frequency of agency nursing, moonlighting, and overtime, and the nurses' reasons for doing moonlighting. Survey data were weighted and analysed using STATA version 12. RESULTS: The majority of survey participants (n = 3,784) were South African (98.0%), female (92.7%), and employed in government (52.8%). Their mean age was 41.5 years (SD 10.4). The occurrence of moonlighting among nurses in the 12 months preceding the survey was 28.0% [95% CI: 24.2-32.1], the frequency of agency nursing was 37.8% [95% CI: 32.4-43.6], while 56.0% of nurses did overtime [95% CI: 51.4-60.4]. In the multiple logistic regression analysis, predictors of moonlighting were province, sector of primary employment, unit of work, category of nurse, and having children. The odds of moonlighting was 1.51 [95% CI: 1.03-2.21] times higher for private sector nurses than for public nurses, while the odds ratio for auxiliary nurses was 0.61 [95% CI: 0.47-0.79] compared to professional nurses. The odds of moonlighting was 1.49 [95% CI: 1.18-1.89] for nurses with children, compared to those without. CONCLUSIONS: Agency nursing, moonlighting, and overtime are common among South African nurses, but have received insufficient policy attention. These issues need to be addressed as part of the implementation of comprehensive health workforce strategies.Item Exploring the characteristics of nursing agencies in South Africa(2015) Rispel, L.C; Olojede, O.LBackground: Nursing agencies are temporary employment service providers or labour brokers that supply nurses to health establishments. Objective: This study was conducted to determine the characteristics of nursing agencies and their relationship with clients in the health sector. Methods: During 2011, a cross-sectional national survey of 106 nursing agencies was conducted. After obtaining informed consent, telephone interviews were conducted with a representative of the selected nursing agency using a pretested structured questionnaire. Questions focused on the following: ownership, date of establishment, province of operation, distribution of clients across private and public health facilities; existence of a code of conduct; nature of the contractual relationship between nursing agencies and their clients, and numbers and cadres of nurses contracted. The survey data were analysed using STATA† 12. Results: Fifty-two nursing agencies participated in the survey, representing a 49% response rate. The study found that 32 nursing agencies (62%) served private-sector clients only, which included private hospitals, homes for elderly people, patients in private homes, and private industry/company clinics, and only four (8%) of the agencies served the public sector only. Twenty-seven percent of nursing agencies provided services to homes for elderly individuals. Nursing agencies were more likely to have contracts with private-sector clients (84%) than with public-sector clients (16%) (p 0.04). Although 98% of nursing agencies reported that they had a code of conduct, the proportion was higher for private-sector clients (73%) compared to public-sector clients (27%). In terms of quality checks and monitoring, 81% of agencies agreed with a statement that they checked the nursing council registration of nurses, 82% agreed with a statement that they requested certified copies of a nurse’s qualifications. Only 21% indicated that they conducted reference checks of nurses with their past employers. Conclusions: Nursing agencies should enhance their quality assurance mechanisms when engaging contracted staff. Overall, the study findings suggest the need for improved governance and management of nursing agencies in South Africa.