Theses and Dissertations (Health Studies)
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Item Preceptorship model for newly qualified professional nurses(2023-05-09) Hansen, Warriodene; Zuma, Sibusiso MemoryTransitioning to a professional role is not easy for newly qualified professional nurses. In South Africa, the newly qualified professional nurses are reported to have great difficulties when assuming independent professional practice. This study aimed to explore newly qualified professional nurses’ professional transition experiences to develop a preceptorship model. A qualitative, descriptive phenomenological study was conducted by applying semi-structured interviews to gather facts from eleven newly qualified professional nurses, seven preceptors and seven operational managers. Purposive sampling was utilised to select participants. Twenty-five participants participated in this study. Trustworthiness was adhered to by applying the concepts, credibility, transferability, dependability and confirmability. The ethical principles of respect for autonomy, beneficence and justice were applied. Data were analysed using Braun and Clarke’s (2006) six steps to thematic analysis. Three themes emerged, preparedness for the role, clinical ability to professional practice and to be clinical independent. This study provides a theoretical definition as well as a conceptual framework and a preceptorship model for the facilitation of guidance and support in the clinical area for newly qualified professional nurses.Item Strategies for adolescents' sexual and reproductive health role modelling at a municipality in Bojanala District North West Province, South Africa(2024-11) Ramalepa, Tshiamo Nerville; Netangaheni, Thinavhuyo RobertThe purpose of the study was to explore the perspectives of adolescents regarding sexual and reproductive health (SRH) role modelling at a municipality in Bojanala district, North West province. A multi-method qualitative, exploratory, and descriptive approach was conducted in three phases. Phase 1 was a scoping review of 223 articles from EBSCO-host, Medline, Sabinet, Pubmed and grey literature. Eleven articles were included in the final review. In phase 2, adolescents were purposively selected and interviewed using semi-structured interviews. The sample size was 13 participants, determined by data saturation. Data were analysed using content analysis. In Phase 3, applicable strategies were adapted using the Three-step for Adapting Strategies to Promote Implementation Strategies. The scoping review indicated an unavailability of literature focusing on SRH role modelling. However, there were only a few studies that contained strategies for SRH role modelling. The themes from Phase 2 include perceptions regarding SRH role models, family as a source of role models, adolescents’ SRH challenges, role models in the health and safety of adolescents and community involvement. Adolescents indicated that they look up to sexual and reproductive health role models. They learn from and are guided by their role models since they have experience and knowledge about sexual and reproductive health. There is a need for a dialogue between adolescents and their role models. When based on openness and trust, role model advice can offer adolescents a safe space to talk about their sexual and reproductive health and make informed choices.Item A strategy to reduce neonatal mortality in Addis Ababa, Ethiopia(2024-08) Kidist Engida Kelilie; Mmusi-Phetoe, RMThis study aimed to investigate the determinants of neonatal mortality that remains a significant public health challenge in Addis Ababa, Ethiopia, despite improvements in healthcare delivery system infrastructure. The study employed a convergent mixed cross-sectional study design, using both quantitative and qualitative research techniques. Quantitative data were collected from 400 medical records of mothers of deceased neonates in four selected hospitals in Addis Ababa, Ethiopia. Qualitative data were collected through semi-structured interviews with the mothers/ caregivers whose newborn babies were hospitalised due to pregnancy and childbirth-related illness or complications, and from purposefully selected health professionals working in neonatal intensive care units (NICUs) of four hospitals. The quantitative data were analysed using SPSS version 28 software, while qualitative data were analysed by using Colaizzi’s seven-step method for data analysis. Results of the study revealed that the leading causes of neonatal mortality at the selected hospitals were preterm birth complications (33.5%), sepsis (29.75%), intrapartum-related complications (perinatal asphyxia) (27.75%) and the remaining 9% died from birth defects and meconium aspiration. Furthermore, the poor socioeconomic status of several of the studied mothers related to accessibility and affordability of health care services were found to contribute to increased risk of neonatal mortality. Importantly, the study found that the awareness level of mothers about their health status before and during pregnancy and in delivery and post-delivery periods played a critical role in determining the health status of the neonates. In response to the findings identified, the researcher developed an alternative strategy that would help to reduce neonatal mortality rates (NMR) in Addis Ababa, Ethiopia. The strategy primarily focuses on the need for the government (policy makers)to increase focus on the identification of neonatal mortality determinants. The study further calls on stakeholders and partners to support improving the quality of maternal and newborn services.Item Evaluating the implementation of ehealth systems in Ethiopia(2024-05) Alemu Tamiso Debiso; Ramukumba, MMEthiopia has launched various eHealth systems, including Electronic Medical Recording (EMR), the District Health Information System (DHIS2), and the Electronic Community Health Information System (eCHIS), among others, to improve healthcare delivery and management. However, the existing systems do not provide the information needed to achieve the intended health outcomes addressed in the Health Sector Transformation Plan. The purpose of this study was to evaluate the eHealth system’s implementation in Ethiopia and develop sustainable implementation guidelines to strengthen the health system. The study setting was public health facilities in the Sidaama region of South Ethiopia. A sequential, exploratory, mixed-method design was employed, and the modified Delphi technique was used to validate the guidelines. In phase one of the study, participants were selected from the Ministry of Health (MOH), regional health bureau (RHB), district health offices, and health facilities using purposive, maximum variation sampling. In phase two, healthcare providers, information technology professionals, and health extension workers were selected from various health facilities using multistage, stratified sampling techniques. In-depth interviews were conducted for phase one, while a questionnaire was employed to collect data for phase two. In phase three the researcher employed the modified Delphi technique to obtain consensus on the proposed guidelines from policymakers, planners, and eHealth experts. Version 9 of Atlas.ti was used to thematically analyse the qualitative data. Conversely, the Statistical Package for Social Sciences (SPSS) version 28 for Windows application was used to analyse the quantitative data. Results showed a disparity in the implementation of the eHealth system, with the DHIS2 being almost fully implemented (97.9%), while EMR (41.6%) and the eCHIS’s (90%) implementation lagged behind. The themes that emerged from the qualitative phase focused on the current status of eHealth implementation in Ethiopia, the benefits of eHealth, challenges related to eHealth implementation, and facilitators for eHealth implementation. The findings revealed that the poor delivery and quality of training posed a challenge to eHealth’s implementation. However, there was good awareness and knowledge among healthcare providers regarding the benefits of the eHealth system. Several factors were found to affect eHealth’s implementation in Ethiopia, including a lack of robust infrastructure, inadequate user readiness, insufficient management support and leadership, limited commitment and intersectoral collaboration, inadequate data sharing and integration, behavioural issues, and a lack of data demands at lower levels. Political willingness, regulatory frameworks, adequate resources and users’ e-readiness will have a positive impact on the implementation of eHealth in low and middle-income countries such as Ethiopia. The study assumes that the developed guidelines could expedite the implementation of EMR, the DHIS2, and eCHIS. This would have a positive effect on the sustainable implementation of eHealth and improve healthcare delivery in Ethiopia.Item Cooperative learning : an approach to enhance clinical reasoning of nursing students(2021-02-24) Neethling, Adele; Roets LizethClinical reasoning is an essential competency for nurses to enable them to provide quality nursing care. The optimal development of this skill will affect the quality of nursing care, and empower nurses to act as advocates for their patients. The purpose of this study was to design a cooperative clinical reasoning activity (CCRA) that could assist in developing final-year nursing students’ clinical reasoning skills in a private nursing education institution (PNEI). The theoretical underpinning of this study is constructivism, as it supports the understanding that students construct their knowledge and understanding from their own personal experiences. A multi-method design, using qualitative and quantitative data gathering methods over five phases, was employed. Phase 1A entailed the development of the CCRA after a thorough literature review. The draft CCRA was exposed to a two-step pre-test by students and educators to improve the quality and validity thereof. The draft CCRA was then validated in Phase 1B, by a group of nursing education experts, through a qualitative e-Delphi technique. Phases 2 and 4 of the study employed a quantitative, quasi-experimental, non-equivalent pretest– post-test control group method using an Outcome Present State (OPT) worksheet and marking rubric. Phase 2 focused on pre-testing the nursing students’ clinical reasoning skills at the commencement of their second year in the bridging programme. Phase 4 entailed the post-test of the same sample after administering the developed and validated CCRA to the experimental group. The CCRA was implemented with the experimental group during Phase 3. After the pre-test (Phase 2), implementation of the CCRA (Phase 3) and post-test (Phase 4), the CCRA was refined and adapted (Phase 5) through the use of a qualitative e-Delphi technique administered to the fieldworkers who coordinated the CCRA’s administration during Phase 3. The research findings revealed that poor clinical reasoning skills existed at the commencement of students’ second year in the bridging programme (Phase 2). After group participation in four CCRA opportunities (Phase 3), there was clear evidence to indicate the CCRA assisted in the development of nurses’ clinical reasoning skills. The post-test clinical reasoning (Phase 4) scores were significantly higher than the control group’s clinical reasoning scores. Observations and findings during the CCRA’s implementation (Phase 3) led to recommendations from the panellist in Phase 5 to adapt and refine the CCRA. The recommendations for implementing the developed CCRA should be followed in the private nursing education where the study was conducted, and the CCRA can be adapted for implementation in diverse settings.