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Background: Certain determinants can be associated with avoidable perinatal deaths, and audits are needed to establish what these determinants are, and what can be done to prevent such deaths. Objectives: The study aimed at identifying and describing determinants associated with avoidable perinatal deaths at a district hospital in Lesotho and strategies to curb their occurrence. Method: A retrospective descriptive study was conducted using 142 anonymised obstetric records from January 2018 to December 2020. A data collection tool was adopted from the Perinatal Problem Identification Programme. In this tool, avoidable determinants are referred to as ‘factors’ or ‘problems’. Results: A concerning number of perinatal deaths were secondary to avoidable patient factors, namely a delay in seeking medical care, inappropriate responses to antepartum haemorrhage, and inadequate responses to poor foetal movements. Medical personnel factors are also worth observing, namely incorrect use of partograph, insufficient notes to comment on avoidable factors and ‘other’ medical personnel problems. Ranking highest among administrative problems were the unavailability of intensive care unit beds and ventilators and inadequate resuscitation equipment. Administrative problems accounted for more perinatal deaths than the patient-related factors and medical personnel factors. Conclusion: There is an urgent need for periodic audits, health education for patients, staff competency and the necessary equipment to resuscitate neonates. Contribution: Avoidable determinants associated with perinatal deaths in a district hospital in Lesotho could be identified. This information provides an understanding of what can be done to limit avoidable perinatal deaths.

Abstract Background Nursing education starts in the classroom environment with a focus on the nurse educator-nursing student relationship. ‘Presence’ is defined as “a practice where the caregiver relates her/himself to the other in an attentive and dedicated way, by doing so learns to see what is at stake for the other; from desires to fear, and, in connection with this, come to understand what could be done in this particular situation and who she/he can be for the other”. ‘Presence’ forms an integral part of the nursing profession and the value thereof should be facilitated during teaching and learning. Reflective practices may offer a teaching–learning strategy to facilitate presence in nursing students by nurse educators in large class settings. Having large classes presents challenges including from nurse educators’ lack of knowledge about alternative teaching approaches; time demands for designing, implementing and testing new teaching methods; a lack of confidence in implementing new teaching approaches in the classroom; selecting and grading assessments; as well as feelings of discomfort and anxiety. A model to facilitate presence through reflective practices has already been developed and published by the present authors. The model relies on well-established steps in theory development covering concept analysis, model development and description (published in two papers by the present researchers) and model evaluation (the subject of this paper). The evaluation was carried out by a panel of experts and nursing participants. Methods An explorative and descriptive qualitative design was followed. The developed model was evaluated and refined in two steps (covered in this paper). In Step 1, the model was evaluated by a panel of experts in model development, reflective practices and presence. The panel used critical reflection resulting in the refinement of the model. Step 2 involved an empirical phase where the model was evaluated by participants through participatory evaluation. Participants were selected through purposive sampling. Data collection methods included online semi-structured focus group interviews with nurse educators and virtual World Café sessions with nursing students. Content analysis was done through open coding. Results Five themes emerged from the empirical phase, namely: Theme 1: understanding of the model; Theme 2: benefits of the model; Theme 3: limitations of the model; Theme 4: pre-existing conditions needed for successful implementation of the model; and Theme 5: recommendations for further development of the model. Conclusions The results produced a refined model to be implemented into the curriculums of undergraduate, postgraduate and continuous professional development programmes across nursing education institutions. This model will significantly contribute to the body of knowledge and increase nurses’ awareness of presence by transforming the way they feel, think, care and act in practice, which contributes to personal and professional development.

Abstract Background Nurse educators are required to be present and reflective while directly involving nursing students in teaching–learning using creative and innovative interaction. Heavy daily workloads (including the teaching of large classes, clinical supervision and research) could hamper facilitating their presence through reflective practices. There is insufficient information on how nurse educators can facilitate their presence through reflective practices in large class groups of nursing students. Methods The researchers followed Walker and Avant’s strategy of statement and theory synthesis to develop this model. Three iterative steps to theory synthesis involved identifying, defining, and classifying main and related concepts, defining relational statements, and organising the main and related concepts, relational statements, and the conceptual framework into an integrated and efficient representation. This was done by reviewing the literature. Conclusion statements were formulated using statement synthesis. Results A model to facilitate the presence of nurse educators in large class settings using reflective practices was developed as a theoretical framework to guide teaching–learning practices. Six conclusion statements emerged on the theoretical constructs presence and reflective practices of nurse educators. Conclusions The model addresses the gap in the literature and contributes substantially to deepening the body of knowledge in the nursing education domain of South Africa and internationally, to serve as a model for guiding nurse educators in their teaching–learning practices.

Background: Long stay in forensic mental healthcare hospitals is a risk for forensic mental healthcare users. Families are reluctant to receive such mental healthcare users for leave of absence and discharge. Aim: To explore and describe the perceptions of families on receiving forensic mental health care users for leave of absence and discharge. Methodology: The research used a descriptive qualitative design. The sample size was 13 families, comprising 21 participants. Data was collected through the Mmogo method and interviews. A six-step data analysis strategy was employed. Findings: The families’ perceptions were ambivalent, influenced by the behaviour of the forensic mental healthcare user and the type of offense committed. Families accept the forensic mental healthcare user, but endured behavioural, social, psychological, and emotional discomfort. Conclusions: Families’ perceptions provide the multidisciplinary team with an understanding of support required by the family prior to re-integrating the forensic mental healthcare user within communities.

Background: Presence is a therapeutic skill that has a healing effect not only on the mental healthcare user but also the nurse. There was a need to explore nurses’ perceptions on factors that limit presence, especially in a public psychiatric hospital in a rural province such as North West, South Africa, where there are limited resources and nurses need to rely heavily on their therapeutic use of self. Objectives: To report on nurses’ perceptions of factors limiting presence when working in a public psychiatric hospital. Method: A qualitative descriptive inquiry was applied, with purposive sampling. Semistructured individual interviews were held with 10 nurses. Thematic data analysis was applied. Results: Intrapersonal factors that were found to limit presence arose from the view that mental healthcare users (MHUs) are difficult to engage with; the tendency to view ‘good care’ primarily as physical care with limited insight into presence was also recognised. Interpersonal and transpersonal factors related to difficulties in communicating with MHUs and in the work environment. Conclusion: Addressing factors that limit presence were found to require courage, the overcoming of interpersonal distance and a transformational process. Contribution: This article contributes important insights that can be used by nurse leaders to promote the practice of presence to improve the quality of psychiatric nursing care in developing contexts, such as a rural province in South Africa.

Background: Comprehensive care means ensuring quality services, protecting rights, promoting available social services and using protocols and standards that emphasise quality assurance for all mental healthcare users (MHCUs). It also involves advocacy, early detection and rehabilitation, as well as encouraging appropriate patient-centred care to ensure adequate psychiatric care. However, according to research, there is a vacuum in the provision of comprehensive mental healthcare to MHCUs. As a result, there is an immediate need to consult healthcare providers on providing comprehensive community-based care to MHCUs. Objectives: The purpose of this study was to explore and describe the views of healthcare practitioners on the aspects that hinder providing comprehensive care for MHCUs, the role players needed to execute comprehensive care and what can be done to improve comprehensive care for MHCUs in the community setting in one of the subdistricts of the North West province (NWP), South Africa (SA). Method: A qualitative research design that was exploratory, descriptive and contextual was adopted. The healthcare practitioners that took part in the study were chosen through purposive sampling. The sample size was established through data saturation, and 19 telephonic semistructured individual interviews were held with registered nurses and one medical doctor. Tesch’s eight steps were used to analyse the data. Results: The four main themes identified were: (1) healthcare practitioners’ understanding of comprehensive care to MHCUs, (2) factors hindering comprehensive care to MHCUs, (3) stakeholders needed for providing comprehensive care to MHCUs and (4) suggestions for improving comprehensive care to MHCUs. Conclusion: Healthcare practitioners in the community advocate for the need for comprehensive psychiatric treatment. They are of the view that greater coordination of psychiatric services will improve mental treatment and minimise relapse in MHCUs. To sustain integrated psychiatry, stakeholders and other psychiatric programmes must be included. Contribution: The findings and conclusions of this study indicated that improvement is needed in mental healthcare in general, and all relevant aspects to improve comprehensive care among MHCUs in a community setting should be given full attention.

Clinical mentoring has been the norm to coach new nursing professionals to achieve professional competency. Structured mentoring programmes are effective. However, there is a need for research to understand newly graduated professional nurses’ initial workplace transition. Purpose: To explore and describe the perceptions of newly graduated professional nurses and experienced professional nurses regarding clinical mentorship and competency. Design and method: A qualitative descriptive research design was used. The research population included newly graduated professional nurses and experienced professional nurses working together in two regional hospitals in Lesotho, where most government health projects are piloted. Purposive sampling and semi-structured interviews were used for both groups. Data was analysed through content analysis by categorising data and formulating themes. Findings: Two categories emerged. Firstly, the perceptions of newly graduated professional nurses describe their experience as newly graduated professional nurses, with four themes, namely a delay in getting employed post-graduating, the need for orientation, taking on a high level of responsibility and the fact that competency levels are influenced by various factors. Secondly, findings from both newly graduated and experienced participants could be divided into three themes with sub-themes, namely: standardisation of nursing competency; safe and cost-effective nursing care; and emphasis on persona and self-efficacy. Conclusion: There is a considerable gap in supporting newly graduated nurses to gain confidence. It is recommended to nurse leaders to plan, restructure, and implement structured clinical mentorship.

Background: This research addressed the need to have a deeper understanding of nursing students’ experiences of clinical placement and support in primary healthcare (PHC) settings. Aim: To explore and describe the experiences of nursing students’ clinical placement in PHC settings. Setting: The study was conducted at PHC clinics in a specific province in South Africa. Method: A qualitative, exploratory, descriptive and contextual research design was used. The population comprised fourth-year nursing students selected using purposive sampling. Five semi-structured focus group interviews were conducted. Data saturation determined the sample size which comprised 25 nursing students. Thematic data analysis produced four main themes. Results: The main themes were (1) the meaning of placement, (2) experiences of clinical placement, (3) needs for support, and (4) resilience of nursing students. Conclusions: Nursing students encountered negative and positive experiences. Both experiences confirmed that PHC settings can be valuable learning opportunities for nursing students. Nursing students appreciated the supervision of professional nurses who created an atmosphere conducive for teaching and learning by welcoming and encouraging nursing students’ independence. Recommendations include: appointing a professional nurse specifically for supervision of nursing students, tutor support before summative examinations, improvement of services, including the availability of resources. Contribution: This article contributes to awareness of how nursing students manage to stay resilient irrespective of negative experiences during clinical placement and how tutors and professional nurses can support them. The study’s recommendations can guide professional nurses, nurse educators, nurse managers and other healthcare PHC workers to support nursing students.

Background: Nursing students learn the science and art of nursing, including presence, from classroom content, using skills in practice, or by watching an experienced nurse interact with a patient. Nursing education must be designed so that nursing students can construct the art and science of nursing practice. Nursing students must be educated to be sound practitioners in the ‘being’ of nursing practice. Nurse educators modelling presence to nursing students will improve the quality of patient care during clinical training and throughout their professional role. Aim: To explore and describe nurse educators’ role modelling of presence to nursing students. Setting: This study was conducted at a public nursing college in the North West province. Methods: A qualitative, ethnographic study was conducted. Purposive sampling was used. Four nurse educators participated in the study and data saturation was reached. Data were collected through shadowing and informal reflective conversations over a period of 8 days. Results: The following relationships emerged: nurse educators model ‘being professional’, ‘being facilitating, nurturing, caring and compassionate, encouraging, and motivating’, and ‘being purposeful in their nursing education approach’. Conclusion: Participants role modelled presence to nursing students despite daily challenges in their work. Contribution: Creating awareness of how nurse educators can model presence despite daily challenges in their work will influence and motivate nursing students to develop presence skills. This will have a positive impact on managing patients in practice. Recommendations can guide nursing education, policy development and future research to strengthen nurse educators modelling presence.

Background: Women in a sub-district of one of the most rural provinces in South Africa are at a high risk of experiencing gender-based violence. Professional nurses are at the frontline of providing healthcare to these women. Caring presence is a valuable resource to professional nurses in these settings. Aim: To explore and describe the experiences of professional nurses in providing nursing care to women experiencing gender-based violence. Setting: A primary health clinic, community health centre, out-patient department and emergency department in the rural sub-district. Methods: An interpretive phenomenological design was applied. Purposive sampling was used and semi-structured one-on-one interviews were held with professional nurses. Interpretive phenomenological analysis was done and data saturation was achieved (n = 15). Results: Participants were willing to provide nursing care but worked in difficult environments, and their level of competence influenced how they engaged with these women. They realised that the lifeworld of the women made it difficult for them to disclose that they are experiencing gender-based violence. Participants emphasised the importance of multidisciplinary and multi-sectoral collaboration. A final theme, caring presence, also emerged. Conclusion: Participants felt compassion and were willing to provide nursing care. However, they experienced reluctance due to hindrances that limited them in connecting with and attuning to the women. This left them feeling frustrated, and with a deepened sense of empathy, as they realised how deeply the women are suffering. Recommendations were formulated. Contribution: This study revealed nurses’ need to be guided in providing relational care to women who are experiencing gender-based violence. Based on the findings, it is recommended that infrastructure should be updated to ensure private and safe spaces for women, debriefing and training should be provided and multidisciplinary collaboration should be strengthened. Policy for improved referral systems, the assessment and management of women experiencing gender-based violence and the wellness of professional nurses should be developed.

Background: Medication adherence remains a challenge in the management of mental healthcare users (MHCUs), despite it being regarded as crucial for better health outcomes. Nurses at primary healthcare (PHC) facilities can play an important role through nursing presence in enhancing MHCUs’ medication adherence. Aim: This article aimed to investigate the relationship between MHCUs’ self-reported medication adherence and their perception of the nursing presence by registered nurses in PHC. Setting: An urban health district in Gauteng province, South Africa. Methods: A quantitative, descriptive correlational, cross-sectional design was used. The sample included 180 MHCUs. Data were collected using the Medication Adherence Rating Scale and the Presence of Nursing Scale. Results: The overall adherence level of respondents was partially adherent, with an average score of 6.45 out of a total score of 10. Respondents also reported a low level of perceived nursing presence demonstrated by registered nurses, with an average score of 72.2 out of 125. The results indicated a positive correlation between respondents’ self-reported medication adherence and their perceived nursing presence of registered nurses as evidenced by the positive value of the correlation coefficient of 0.69 with a corresponding significance probability value of 0.000 (r = 0.69; p = 0.00). Conclusion: The level of perceived nursing presence demonstrated by registered nurses played a significant role in influencing MHCUs’ level of medication adherence. The registered nurses can improve MHCUs’ medication adherence by demonstrating nursing presence skills such as good listening skills and taking care of MHCUs as individuals and not as a disease. Contribution: The results of this study confirm that there is a correlation between nursing presence and medication adherence. This holds significant value for future research in nursing presence. These findings also provide registered nurses in PHC with a valuable tool to improve medication adherence, namely nursing presence.

Background: Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing. Aim: This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital. Setting: The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa. Methods: A descriptive phenomenological method, specifically Husserl’s approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi’s seven-step method. Results: Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not. Conclusion: Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.

Background: No description of the clinical role of the advanced psychiatric nurse in the management of children with sensory processing disorder could be found for the South African context. This is a loss in clinical nursing practice with regard to diagnosis, treatment and research. Aim: To explore and clarify the perceptions of healthcare professionals in South Africa on the clinical role of the advanced psychiatric nurse in sensory processing disorder to provide a description of this role. Setting: The research was conducted by inviting registered healthcare professionals practicing in South Africa to complete several rounds of an on-line survey. Methods: An explorative and descriptive design was used. Purposive sampling was used to identify an initial sample of healthcare professionals, followed by snowball sampling. The Delphi technique was implemented with three sequential rounds, gathering data on the perceptions of the healthcare professionals regarding the clinical role of the advanced psychiatric nurse in sensory processing disorder. Results: The following main themes crystallised from the data – (1) Specialised training of the advanced psychiatric nurse (APN) on sensory processing disorder; (2) Interventions carried out by the APN with regard to sensory processing disorder; (3) Adequate support to the family with regard to sensory processing disorder; and (4) Referral of a child with sensory processing disorder. Conclusion: The study indicates that the healthcare professionals who are experts in delivering healthcare to children with sensory processing disorder agree that the APN with additional training in this condition has a clinical role to play in rendering healthcare to these healthcare users. A preliminary clinical role description could be formulated. Recommendations for nursing practice, nursing education and further research were formulated.

Background: Although mental health is regarded by the International Council of Nurses as a very important element of wellness, healthcare to patients with intellectual disabilities still remains neglected and under-resourced in most societies. Auxiliary nurses are crucial in providing nursing care to patients with intellectual disabilities. These nurses may not be prepared to handle challenges in providing nursing care to these patients, but their resilience can help them to manage these challenges. Limited research is available with regard to the resilience of auxiliary nurses providing nursing care to patients with intellectual disabilities. Objectives: To explore and describe the perceptions of auxiliary nurses providing nursing care to patients with intellectual disabilities on their resilience and protective mechanisms and vulnerability factors that influence their resilience when providing nursing care to these patients. Method: A qualitative, descriptive inquiry approach was used. The population comprised approximately 220 auxiliary nurses providing nursing care to patients with intellectual disabilities at a mental healthcare institution. Auxiliary nurses were selected through purposive sampling with the assistance of a mediator. The sample size was determined by data saturation. The data were collected through four focus group interviews with altogether 32 participants. Results: Five main themes emerged from the data. Practical wisdom was applied by the participants. They also made use of different forms of interactions, including the application of strategies such as utilising induction programmes and being willing to learn, in order to remain resilient. Protective mechanisms and vulnerability factors influence their resilience. Conclusions: Recommendations to strengthen the resilience of auxiliary nurses caring for patients with intellectual disabilities were formulated from the research findings, including recommendations for nursing practice, education and nursing research. Informal peer support, as well as addressing ethical issues, improving nurse–patient communication, training to handle adverse working conditions, and continuing education and further research on the practical wisdom of auxiliary nurses, is recommended.

Background: Research on coping and resilience is on the rise. However, there is a paucity of information addressing strengths, assets, competence or resilience that enable nurses to remain committed and cope in their profession despite the adversities they face in their working environment. Objective: The purpose of this research was to explore and describe how to strengthen the resilience of nurses in a work environment with involuntary mental health care users. Method: An exploratory and descriptive research design, which is contextual in nature, was used. Results: Narrative responses to two open-ended questions (How do you cope with providing mental health care to involuntary admitted mental health care users? and; How can your resilience be strengthened to provide mental health care to involuntary mental health care users?) yielded coping mechanisms and resilience strengthening strategies. Conclusion: Nurses caring for involuntary mental health care users are faced with challenging situations while they themselves experience internal conflict and have limited choices available to be assertive. To strengthen their resilience, the following factors should be taken into account: support, trained staff, security measures and safety, teamwork and in-service training and education.

Background: The South African mining healthcare sector faces injuries, illnesses including HIV and AIDS and high staff turnover rates. In this sector, nurse managers should create an optimal environment for providing nursing care by motivating, influencing and empowering nurses. Objectives: This study aimed to investigate the relationship between nurse managers’ resilience and empowering leader behaviour in this sector. Method: The study employed a quantitative, descriptive and correlational design. The research population comprised 31 nurse managers, 101 professional nurses, 79 enrolled nurses and 79 enrolled nursing auxiliaries who participated in the study. Two questionnaires were used as data collection methods, namely Wagnild and Young’s Resilience Scale Questionnaire to investigate the resilience of nurse managers and the Empowering Leadership Questionnaire to measure empowering leader behaviour of the nurses supervised by a particular nurse manager. Results: Out of 31 nurse managers, 8 had a low level, 19 had a moderate level and 4 had a high level of resilience. According to Hoteling’s t-test the nurse managers in the low resilience group displayed lower empowering leader behaviour as perceived by their team members than those in the high resilience group in terms of the five factors included in the Empowerment Leadership Questionnaire. Conclusion: Respondents with high resilience scores tended to have higher leader empowering behaviour. Recommendations include the strengthening of nurse managers’ resilience through workshops and reflection practices, debriefing and performance feedback sessions.

Background: A shortage of nurses caring for older persons is experienced due to adverse working conditions. Resilience might empower nurses to persevere while caring for older persons. Research regarding the resilience of nurses caring for older persons is scarce. Objectives: The objectives were to explore and describe the strengths and coping abilities of nurses caring for older persons and to formulate recommendations to strengthen their resilience. Methodology: An explorative, descriptive qualitative research design was used. An allinclusive sample of nurses caring for older persons in an urban setting in the North West Province, South Africa, participated in the study. During phase one, demographic information was obtained, and narratives were written (n = 43). Four focus group interviews were conducted in phase two (n = 17) and recommendations were formulated in phase three. Content analysis was used. Principal results: Participants experienced adverse working circumstances while caring for older persons and they needed resilience to balance the emotional nature of the work, work ethics, staff shortages, physical demands of the work and the dependency of the older persons. These nurses used personal, professional, contextual and spiritual strengths to handle adverse working conditions. Conclusions: By applying their personal, professional, contextual and spiritual strengths, nurses could further enhance these strengths and possibly their resilience. The participants' identified strengths were used to formulate recommendations to strengthen resilience of nurses caring for older persons.

Background: Relapse prevention in mental health care is important. Utilising the strengths of families can be a valuable approach in relapse prevention. Studies on family strengths have been conducted but little has been done on the strengths of family members to help limit relapse in mental health care users. The purpose of this research was to explore and describe the strengths of family members in assisting mental health care users to limit relapses. Methods: A phenomenological design was followed. Purposive sampling was used and 15 family members of mental health care users who have not relapsed in the previous two years participated. Individual unstructured interviews were conducted. Data were analyse dusing thematic analysis. Results: Four main themes were identified, namely accepting the condition of the mental health care users, having faith, involving the mentally ill family members in daily activities and being aware of what aggravates the mentally ill family members. Conclusions: Family members go through a process of acceptance and receive educational information and assistance from health professionals. In this process families discover and apply their strengths to limit relapses of mentally ill family members. It is important that family members caring for mentally ill family members are involved in their treatment from the onset, and that they are guided through a process of acceptance.

Despite acknowledgement of the importance of sharing HIV- and AIDS-related information with people living with HIV, it is still unclear as to what their actual comprehension is of this information. This research was part of a larger project, Tswaragano, conducted in the North-West Province, South Africa, which explored and described the competence, ability and strengths of the family of the HIV-positive patient during home support. This research focused on Potchefstroom in the North-West Province. This article focuses on research with the objective being to explore and describe the comprehension of HIV-positive patients and their families with regard to HIV- and AIDS-related information, and to formulate recommendations to improve their comprehension of this information. A quantitative, explorative and descriptive survey design was followed. Data were collected by means of questionnaires completed by HIV-positive patients (n= 79) and their family members (n= 34). Descriptive statistical analysis by means of frequency analysis was conducted. Ethical considerations and mechanisms to enhance validity and reliability are discussed. The results indicated that both HIV-positive respondents and their families face social and financial challenges due to unemployment and low income. A strength found in this research is that the majority of respondents are linked to a church, which can be a valuable platform to share information on HIV and AIDS. With regards to sharing, sources and comprehension of HIV- and AIDS-related information, it is apparent that respondents perceived that pre- and post-counselling provided an opportunity for information sharing, but that they need health care workers to spend more time with them, to be non-judgemental and to make more use of visual aids. It furthermore seems that the majority of HIV-positive respondents in this study did comprehend the need for and negotiate for safer sexual practices. It was concluded that although HIV-positive patients and their families have relatively good levels of comprehension of HIV- and AIDS-related information, there are certain gaps in their comprehension of this information. Accordingly, recommendations regarding improving comprehension of HIV-related information were formulated. Recommendations for nursing education, research and practice were formulated. These recommendations highlight the importance of openness in communication, building trust relationships, collaboration, cultural sensitivity and empowering HIV-positive patients and their families.

Background: Operating room (OR) nurses need to be resilient in order to cope with extreme demands in their workplace. This research focused on the effectiveness of sensory stimulation therapy (SST) to strengthen the resilience of nurses in the OR of a private hospital in the North West Province. Purpose: The purpose was to determine the effectiveness of SST as an intervention to strengthen the resilience of OR nurses.Design: A quasi-experimental design was used. Method: The population consisted of OR nurses and ICU nurses at private hospitals in the North West Province. All-inclusive sampling was used. Forty-one OR nurses formed the intervention group. A pilot group (8 subjects, OR nurses), as well as a comparison group (23 subjects, ICU nurses), was also sampled. An intervention, namely SST, was implemented with the intervention group. The resilience of the intervention group, pilot group and comparison group was measured before and after the implementation of the SST by means of Wagnild and Young’s resilience questionnaire. The intervention group also completed a self-report questionnaire on their needs and suggestions for SST and wrote short narratives on their experience of SST. Data were analysed using descriptive and inferential statistics, and by thematic coding. Results: Results indicated a significant statistical increase in the intervention group’s resilience levels. Results from the narratives confirmed that the intervention group’s resilience may have been strengthened through SST. Conclusion: SST has potential to strengthen the resilience of OR nurses.

Background: Little research has been conducted in private nursing schools with regard to the educator–student relationship to strengthen the resilience of nursing students and to improve the educator–student relationship. An effective educator–student relationship is a key factor to ensure a positive learning climate where learning can take place and resilience can be strengthened. Purpose: The purpose was to explore and describe nursing students’ view on the basic elements required for an effective educator–student relationship to strengthen their resilience and the educator–student relationship. Method: This study followed an explorative, descriptive and contextual qualitative design in a private nursing education institution in the North West Province. Purposive sampling was used. The sample consisted of 40 enrolled nursing auxiliary students. The World Café Method was used to collect data, which were analysed by means of content analysis. Results: The following five main themes were identified and included: (1) teaching–learning environment, (2) educator–student interaction, (3) educator qualities, (4) staying resilient and (5) strategies to strengthen resilience. Conclusion: Students need a caring and supportive environment; interaction that is constructive, acknowledges human rights and makes use of appropriate non-verbal communication. The educator must display qualities such as love and care, respect, responsibility, morality, patience, being open to new ideas, motivation, willingness to ‘go the extra mile’ and punctuality. Students reported on various ways how they manage to stay resilient. It thus seems that basic elements required in an effective educator–student relationship to strengthen the resilience of students include the environment, interaction, educator and student’s qualities and resilience. Keywords: Educator-student relationship, nursing education, nursing education institution (NEI), nursing student, learning environment, resilience

Background: Although families caring for a mentally-ill family member may experience challenges, some of these families may display strengths that help them to overcome difficulties and grow even stronger in caring for their family member. In cases where these families are unable to cope, the mentally-ill family member tends to relapse. This indicated the need to explore the strengths of families that cope with caring for mentally-ill family members. Objective: The purpose of this study was to explore and describe the strengths of families in supporting mentally-ill family members in Potchefstroom in the North-West Province. Method: A qualitative, explorative, descriptive and contextual design was employed, with purposive sampling and unstructured individual interviews with nine participants. Tesch’seight steps of thematic content analysis were used. Results: Twelve themes emerged from the data. This involved strengths such as obtaining treatment, utilising external resources, faith, social support, supervision, calming techniques, keeping the mentally-ill family member busy, protecting the mentally-ill family member from negative outside influences, creative communication, praise and acceptance. Conclusion: Families utilise external strengths as well as internal strengths in supporting their mentally-ill family member. Recommendations for nursing practice, nursing education and for further research could be formulated. Psychiatric nurses should acknowledge families’ strengths and, together with families, build on these strengths, as well as empower families further through psycho-education and support.

Background: Interventions have been developed and implemented to reduce the stigma attached to mental illness. However, mental healthcare users are still stigmatised. Objective: The objective of this study was to critically synthesise the best available evidence regarding interventions to reduce stigma attached to mental illness. Method: An exploratory and descriptive research design was followed to identify primary studies; systematic review identifid primary studies answering this research question: What best evidence is available regarding interventions to reduce the stigma attached to mental illness? A search was done on selected electronic databases. Seventeen studies (n = 17) were identifid as providing evidence that answered the research question. The following instruments were used: Critical Appraisal Skills Programme, John Hopkins Nursing Evidence-Based Practice research evidence appraisal tool and the Academy of Nutrition and Dietetics Evidence Analysis Manual. The study was submitted to the Post-graduate Education and Research Committee of the School of Nursing Science at Potchefstroom Campus of North-West University for approval. Results: Results indicated some interventions that reduce the stigma attached to mental illness, such as web-based approaches, printed educational materials, documentary and antistigma fims, as well as live and video performances. Conclusions: Humanising interventions seems to have a positive effect on reducing stigma attached to mental illness. From the results and conclusions recommendations were formulated for nursing practice, nursing education and research. Agtergrond: Ingrypings is ontwikkel en geïmplementeer om die stigma verbonde aan geestesongesteldhede te verminder. Die persone wat aan geestesongesteldhede ly, ondervind egter steeds dat daar 'n stigma aan hulle kleef. Doelstellings: Die doel van die studie was om die beste beskikbare voorbeelde van intervensies om stigmatisering van geestesongesteldhede te verminder, krities saam te vat. Metode: ’n Verkennende en beskrywende navorsingsontwerp is gevolg om primêre studies te identifieer. ’n Sistematiese oorsig is gekies as metode om primêre studies te identifieer om die volgende navorsingsvraag te beantwoord: Wat is die beste beskikbare voorbeelde van ingrypings om die stigma verbonde aan geestesongesteldhede te verminder? ’n Ondersoek is gedoen op ’n uitgesoekte elektroniese databasis. Resultate: Tydens die keuring van studies is 17 studies geïdentifieer (n = 17) as bewyslewering en wat die navorsingsvraag beantwoord. Die volgende instrumente is gebruik: ‘Critical Appraisal Skills Programme’, ‘John Hopkins Nursing Evidence-Based Practice’, ‘Research Evidence Appraisal Tool and Evidence Analysis Manual’, en ‘Academy of Nutrition and Dietetics’. Gevolgtrekking: Die studie is aan die Nagraadse Onderrig- en Navorsingskomitee van die Skool van Verpleegkunde van die Potchefstroomkampus, Noordwes-Universiteit, voorgelê vir goedkeuring. Aanbevelings is geformuleer vir die verpleegpraktyk, verpleegonderrig en navorsing.

Background: Non-compliance to treatment remains one of the greatest challenges in mental healthcare services, and how to improve this remains a problem. Aim: The aim of this study was to critically synthesise the best available evidence from literature regarding interventions to promote psychiatric patients’ compliance to mental health treatment. The interventions can be made available for mental health professionals to use in clinical practice. Method: A systematic review was chosen as a design to identify primary studies that answered the following research question: What is the current evidence on interventions to promote psychiatric patients’ compliance to mental health treatment? Selected electronic databases were thoroughly searched. Studies were critically appraised and identifid as answering the research questions. Evidence extraction, analysis and synthesis were then conducted by means of evidence class rating and grading of strength prescribed in the American Dietetic Association’s manual. Results: The systematic review identifid several interventions that can improve patients’ compliance in mental health treatment, for example adherence therapy and motivational interviewing techniques during in-hospital stay. Conclusions: Conclusions were drawn and recommendations formulated for nursing practice, education and research. Agtergrond: Geen-samewerking met behandeling bly steeds een van die grootste uitdagings in geestesgesondheidsorgdienste, en genoegsame kennis oor hoe om dit te verbeter, is steeds ’n probleem. Doelwit: Die doel van hierdie studie was om die beskikbare bewyse vanuit literatuur aangaande intervensies ter bevordering van psigiatriese pasiënte se samewerking met geestesgesondheidsbehandeling krities te sintetiseer. Hierdie intervensies kan aan professionele gesondheidsorgpersoneel beskikbaar gestel word ter bevordering van psigiatriese pasiënte se samewerking met geestesgesondheidsbehandeling. Metode: ’n Sistematiese literatuuroorsig is gekies as die ontwerp om primêre studieste identifieer wat die volgende navorsingsvraag beantwoord: Wat is die huidige kennis ten opsigte van intervensies wat psigiatriese pasiënte se samewerking met geestesgesondheidsbehandeling bevorder? Resultate: Studies is ingesluit vir kritiese gehalte-beoordeling ten opsigte van metodologie, en is uiteindelik geïdentifieer as bronne van bewyse wat die literatuuroorsigvraag toepaslik beantwoord. Bewysonttrekking, -analise en -sintese is gedoen deur middel van die beoordeling van bewysklas en -gradering van bewyssterkte, soos voorgeskryf in die American Dietetic Association se handleiding. Die sistemiese literatuuroorsig het aangedui dat daar heelparty intervensies is wat psigiatriese pasiënte se samewerking met behandeling kan verbeter, byvoorbeeld samewerkingsterapie en motiveringsonderhoudstegnieke. Gevolgtrekking: Gevolgtrekkings is gemaak en aanbevelings is geformuleer vir die verpleegpraktyk, verpleegonderrig en navorsing in verpleging.

There is limited understanding on marijuana use by psychiatric patients, specifically with regard as to why they continue to smoke marijuana despite the negative consequences, such as readmittance to psychiatric hospitals following marijuana-induced psychosis. It is, therefore, important to understand why psychiatric patients continue to use marijuana, despite experiencing its negative effects. The purpose of this study was to explore and describe the perceptions of psychiatric patients with regard to marijuana use in Potchefstroom, North West Province, as well as to formulate recommendations for nursing education, nursing research and nursing practice, with the aim of reducing the readmission of psychiatric patients following marijuana-induced psychosis. A qualitative, exploratory, descriptive and contextual research design was followed in order to give ‘voice’ to the perceptions of psychiatric patients about marijuana use. Purposive sampling was utilised to identify participants who complied with selection criteria. The sample size was determined by data saturation, which was reached after 10 individual interviews with psychiatric patients. Unstructured individual interviews were utilised to gather data after written approval from the Ethics committee of the North-West University (Potchefstroom Campus), North West Provincial Department of Health, the clinical manager of the psychiatric hospital where data were collected, as well as from the psychiatric patients. The co-coder and the researcher analysed the data independently. The findings of this study include perceptions of psychiatric patients on the use of marijuana, the negative effects of marijuana use, marijuana use and mental illness, and quitting marijuana. Recommendations were formulated for nursing education, nursing research as well as for nursing practice. Opsomming Insig in die gebruik van marijuana deur psigiatriese pasiënte is beperk, spesifiek met betrekking tot hulle redes vir voortgesette marijuana verbruik ten spyte van die negatiewe gevolge daarvan, byvoorbeeld hertoelating tot psigiatriese hospitale na marijuanageïnduseerde psigotiese episodes. Dit is dus belangrik om te verstaan waarom psigiatriese pasiënte voortgaan om marijuana te gebruik ten spyte van die negatiewe uitwerking daarvan. Hierdie navorsing was ten doel om die persepsies van psigiatriese pasiënte in verband met die gebruik van marijuana in Potchefstroom in die Noordwesprovinsie te verken en te beskryf. So kan aanbevelings gemaak word vir verpleegonderrig, verpleegnavorsing en verpleegpraktyk om meer toepaslike versorging en behandeling te verseker en uiteindelik die heropname van psigiatriese pasiënte as gevolg van marijuana-geïnduseerde psigose te verminder. ‘n Kwalitatiewe, verkennende, beskrywende en kontekstuele navorsingsontwerp is gevolg om ‘n ‘stem’ te gee aan die persepsies van psigiatriese pasiënte aangaande die gebruik van marijuana. Doelgerigte steekproefneming is gebruik om deelnemers te identifiseer wat sou voldoen aan seleksiekriteria. Die steekproefgrootte is bepaal deur dataversadiging, wat bereik is na 10 individuele onderhoude met psigiatriese pasiënte. Ongestruktureerde individuele onderhoude is gebruik om data te versamel ná geskrewe toestemming van die Etiekkomitee van die Noordwes-Universiteit (Potchefstroom Kampus), van die Noordwes Provinsiale Departement van Gesondheid, die Kliniese bestuurder van die psigiatriese hospitaal waar die data versamel is, sowel as van die psigiatriese pasiënte. Die medekodeerder en die navorser het die data onafhanklik van mekaar geanaliseer. Die bevindings van hierdie studie het die persepsies wat psigiatriese pasiënte het oor die gebruik van marijuana, die negatiewe effekte van die gebruik van marijuana, die gebruik van marijuana en psigiatriese toestande, en die staking van die gebruik van marijuana, uitgelig. Aanbevelings is geformuleer vir verpleegonderrig en verpleegnavorsing, sowel as vir die praktyk van verpleegkunde.

The emotional well-being of nurses working in a multi-skill setting may be negatively influenced by their challenging work environment. A qualitative, explorative, descriptive and contextual study was conducted to investigate this phenomenon. The purpose of this study was to explore and describe the experience, as well as perceptions of coping mechanisms, of nurses working in the multi-skill setting, and to formulate recommendations to promote their emotional wellbeing. The population consisted of nurses working in a multi-skill setting (a Level-2 hospital)and included professional nurses, enrolled nurses and nurse assistants. An all-inclusive sample was used. Semi-structured interviews were conducted with three professional nurses,six enrolled nurses and one nurse assistant. These interviews were analysed according to the method described by Creswell (2003:192). The findings indicated that nurses have positive as well as negative experiences of the multi-skill setup. They cope by means of prioritising tasks, faith, self-motivation and mutual support. They also made suggestions for the promotion of their emotional well-being, on personal as well as managerial levels. Recommendations for further research, nurse education and practice were formulated. Recommendations for practice include ‘on-the-spot’ in-service training, appropriate task allocation, clearly defined scope of practice, time for rest and debriefing, strengthened relationships with management, promotion of strengths and creating a support system. Opsomming Die emosionele welstand van verpleegkundiges werksaam in ‘n multivaardigheidsopset kan moontlik negatief beïnvloed word deur die uitdagende werksomgewing. ‘n Kwalitatiewe, verkennende, beskrywende en kontekstuele studie is uitgevoer om hierdie verskynsel te ondersoek. Die doel van hierdie studie was om die ervaring van verpleegkundiges, asook hul persepsies van hanteringsmeganismes, in ‘n multi-vaardigheidsopset te verken en beskryf, sowel as om aanbevelings vir die bevordering van hulle emosionele welstand te formuleer. Die populasie het bestaan uit verpleegkundiges werksaam in ‘n multivaardigheidsopset (‘n Vlak-2 hospitaal) en het professionele verpleegkundiges, ingeskrewe verpleegkundiges en verpleegassistente ingesluit. ‘n Alles-insluitende steekproef is gebruik. Semi-gestruktureerde onderhoude is met drie professionele verpleegkundiges, ses ingeskrewe verpleegkundiges en een verpleegassistent gevoer. Hierdie onderhoude is volgens die metode deur Creswell(2003:192) beskryf, geanaliseer. Die bevindinge het getoon dat verpleegkundiges positiewe sowel as negatiewe ervaringe van die multivaardigheidsopset het. Hulle gebruik taakprioritisering, geloof, selfmotivering en wedersydse ondersteuning as hanteringsmeganismes. Hulle het ook voorstelle gemaak vir die bevordering van hul emosionele welstand, op persoonlike sowel as bestuursvlak. Aanbevelings vir verdere navorsing, verpleegonderwys en die praktyk is geformuleer. Aanbevelings vir die praktyk sluit in ‘in-die-oomblik’ indiensopleiding,toepaslike taaktoewysing, duidelikheid oor bestek van praktyk, tyd vir rus en ontlading, verbeterde verhoudings met bestuur, bevordering van sterk karaktereienskappe en die skep van ‘n ondersteuningsnetwerk.

The initial use of the Delphi technique was forecasting in order to be able to plan ahead. Opsomming Die aanvanklike toepassing van die Delphi-tegniek was voorspelling met die doel om vooruit te kan beplan. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

This article is the last in a series of three articles on a strategy to promote nurses’ health research contribution in South Africa. Opsomming Hierdie artikel is die laaste in ‘n reeks van drie artikels oor ‘n strategie vir die bevordering van verpleegkundiges se gesondheids-navorsingsbydrae in Suid-Afrika. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

This is the second article in a series of three articles on a strategy to promote nurses’ health research contribution in South Africa. Opsomming Hierdie is die tweede artikel in ’n reeks van drie artikels oor ’n strategie om die gesondheidsnavorsingsbydrae van verpleegkundiges in Suid-Afrika te bevorder. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

During 1998 the discharge of as many as possible psychiatric patients from long-term psychiatric hospitals in the North-West Province, in other words deinstitutionalisation, were planned (Roos, 1998). Opsomming Gedurende 1998 is die ontslag van so veel moontlik psigiatriese pasiënte van langtermyn-psigiatriese hospitale in die Noordwes-Provinsie, met ander woorde deïnstitusionalisering, beplan (Roos, 1998). *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.