OpenUCT :: Browsing by Author "Kyriacos, Una"

Browsing by Author "Kyriacos, Una"

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Open Access
A critical analysis of the concept 'care' in the practice and discourse of nursing
(1999) Haegert, Sandy; Shutte, Augustine; Kyriacos, Una
This research sought to answer the question: " What meanings has the nursing profession given to the concept 'caring'"? This was achieved by means of a three-fold approach: interpretive phenomenology combined with linguistic analysis [Wittgenstein's as interpreted by Bowden], and, a conceptual philosophical framework. Narratives, from registered nurses working in hospices and oncology/haematology units, were obtained and analyzed through juxtaposing them with selected theorists, and each other, to construct 'family resemblances' and 'layers of understanding'. Their meanings, obtained by requesting them to draw on memories of being cared-for or caring, resulted in descriptive understandings of their use of the concept 'care'; and, to a relational ethic enabling the construal of a normative ethic: one allegedly embedded in the practice and experience of these practitioners. The findings show it is not possible to give a simple definition to explain the concept 'caring'. The meanings, contained in the collected narratives, reveal strong 'family resemblances' in their usage of the term, verifying the Wittgensteinian observation: that no single meaning, no singular essence captures every cultural, individualized use of the term. The findings pointed to these 'meanings' being 'private' but not in the sense of being 'false'. Within the research one becomes aware that the term 'care' is not an ethical notion. To be ethical care is dependent upon context and responsible attitudes and actions. The discourses comprise the personal 'passion', an ethical ideal, held by most respondents; but, their ideal was not always the caring they were enabled to give. Institutionalized care whether hospice or not fell below the ideal because of socio-economic constraints and concerns. The original thesis question was from O'Malley: "[W]hether in encounter man himself makes his own meaning or is made by the meaning made of and for him ...". This research led to the assertion that the reality of the practice setting shapes the 'public' meaning of caring these practitioners act upon, but, they shape their own 'private' meanings and implement it on a micro level. It is at the macro-level of care/caring that there should also be concern. Although not true of all respondents, a possible reason for this less-than-ideal-type caring is the possibility that in institutions there are nurses who for some reason(s) fail to 'grow' - to develop in a fully integrated way that includes the freedom to exercise one's spirituality and to become morally caring not merely on a micro [one-to-one] basis but on a macro level [whole unit basis].
Open Access
A description of final year nursing students' ability to recognize abnormal vital signs recordings and clinical decision-making process
(2014) Leonard, Martha Maria; Kyriacos, Una
The aim of this study was to determine whether final year nursing students can recognize and respond to abnormal vital sign recordings, and to analyse their clinical decision-making processes.
Open Access
A descriptive survey of renal unit practitioners' knowledge, attitude and practice relative to use and effects of unfractionated heparin in selected adult chronic haemodialysis centres in the Cape Town metropole
(2014) Ockhuis, Debra; Kyriacos, Una
Background: Chronic haemodialysis treatment of 3-4 hours' duration two or three times a week is the most common renal replacement therapy for adult patients diagnosed with stage 5 end-stage kidney failure. During the procedure 200-250 ml/minute of the patient's blood volume is extracorporeal and patency of the circuit is maintained by an anticoagulant, for example, unfractionated heparin (UFH). Incorrect dosage or time of administration of UFH can have serious adverse effects if not fatal consequences for patients. It is important to perform base-line clotting studies before the initial administration and subsequent doses of UFH. There is a paucity of published information on renal unit practitioners' knowledge, attitude and practice (KAP) concerning the administration of UFH globally and no published South African studies were located. Aim: To describe renal unit practitioners' self-reported KAP regarding use and effects of UFH in purposively selected adult chronic haemodialysis centres in the Cape Town Metropole. Secondly, to determine whether there is an association between KAP regarding the use and effects of unfractionated heparin and selected variables (category of renal unit practitioner, years of experience, duration of orientation to the adult chronic haemodialysis unit and in-service education on the pharmacology of UFH).
Open Access
A descriptive survey of the nursing workforce in critical care unit in hospitals of the Western Cape Province
(2006) Gillespie, Rencia S; Kyriacos, Una; Mayers, Pat
A global shortage of Registered Nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical Care Nurses (CCNs) especially are in great demand and short supply. This has affected the quality of patient care. The purpose of this study was to perform a workforce analysis and needs assessment of critical care nursing services in the Western Cape Province as at 1 January 2005. The study design is a descriptive survey conducted on site in the critical care units of the private and public sector hospitals of the Western Cape, using a structured questionnaire, with a 96.5% return rate. Findings showed that the 35 hospitals surveyed in the public and private healthcare sectors had 80 functional critical care units including Intensive Care Units and High Care Units for adults, children and neonates, and High Dependency Units for adults. Factors that contribute to the demand for critical care nurses include the number of critical care beds, patient admissions, severity of illness, available facilities, medical, nursing and support staff. Compared to internationally accepted norms, the Western Cape units have a deficit of 74% of Registered Nurses (RNs) in the public sector hospitals, and a deficit of 82% in the private sector. This equates to an actual shortage of 3010 RNs for both sectors. If all categories of nursing staff are included in the calculation, the public sector meets 49% of its requirements and the private sector 24%. Half of the private sector and 28.9% of the public sector Registered Nurses are Critical Care Nurses. Few measures appear to be taken to recruit and retain nursing staff. The number of students being trained at both the undergraduate (300 during 2004) and the postgraduate (80 CCNs during 2004) level at the educational institutions, in conjunction with the hospitals, is inadequate. Clinical training institutions are available, but the numbers of educators and clinical mentors are inadequate to train the number of nurses required to meet the demand.
Open Access
The development and validation of a modified Situation-Background-Assessment-recommendation (SBAR) communication tool for reporting early signs of deterioration in patients
(2015) Burger, Debora; Kyriacos, Una; Jordan, Sue E
Background: Errors in communication are prevalent in healthcare and affect patient safety and cause unnecessary patient deaths. Reporting early signs of physiological or clinical deterioration could improve patient safety and prevent 'failure to rescue' or unexpected intensive care admissions, cardiac arrest or death. The structured Situation-Background-Assessment-Recommendation (SBAR) communication tool enables nurses to provide doctors with pertinent information about a deteriorating patient in a logical order, based on a complete assessment. In addition, nurses have increased confidence in their findings and are better able to initiate a call and to convince a doctor to provide orders promptly or see a patient. Aim: The aim of this sub-study of a randomized controlled trial was to develop and validate a modified SBAR communication tool incorporating components of a local MEWS vital signs observations chart. Methods: The modified SBAR communication tool was developed following a review of available published examples and validated by employing a mixed methods approach: 1) cognitive interviews (n=3 nurses, 2 doctors), 2) determining the index of content validity with nurses (n=5), physicians (n=5) and surgeons (n=8) and 3) inter-rater reliability testing, with calculation of kappa values (n=2 nurses). Results: Cognitive interviews prompted more changes to the modified SBAR communication tool than determined by the content validity index. For cognitive interviews, there were 15/42 (35.71 %) modifications: 11 items were added (26.19 %) and three removed, (7.14 %) resulting in 49 items whereas for content validity index there were 4/49 (8.16%) modifications, 5/49 (10.20%) items removed and one item added (2.04%). Four of 49 items (8.16%) rated as relevant by <70% of nurses and doctors were revised or deleted. No additional modifications were needed following review by surgeons, as all items were rated as relevant by the pre-determined ≥70% of experts. Inter-rater reliability of the SBAR tool was established by two nurses who were mostly in substantial to full agreement on 37/45 items on the modified tool. The exceptions were: 'Calling from' (Cohen's Kappa-0.05) and 'this is a change from' (Cohen's Kappa-0.07), representing agreement below the level of chance. However, the high percentage agreement and nature of the questions suggest that the questions are sound. Percentage agreement amongst participants for these items was 91 % (95% confidence interval (CI): 71 to 99 ) and 86% (95% CI: 65 to 97 ) respectively. Deciding whether a doctor should see the patient now (Cohen's Kappa 0.09) or in the next 30 minutes, achieved fair agreement (Cohen's Kappa 0.20). This reflects a difference in clinical judgement as the decision when to call for assistance depended on the individual nurse's clinical judgement. IRR was not possible to test on 4/45 items, as those items required a response by the person being summoned. Overall, nine of 42 items were removed, 12 were added and 19 substantially modified, leaving 45 items. Conclusion: The modified SBAR communication tool was valid and reliable for use in a local context in conjunction with the Cape Town Modified Early Warning Score (MEWS) vital EWS) vital signs chart.
Open Access
Development and validation of a questionnaire on nurses' knowledge and recognition of early signs of clinical deterioration
(2018) Berning, Briony; Kyriacos, Una
Introduction: There is evidence-based concern that nurses on general wards do not recognise signs of physiological and clinical deterioration and delay calling for more skilled assistance for review of a patient showing signs of deterioration. Aim: The development and validation of a questionnaire to assess factors influencing general ward nurses’ ability to recognise and respond to patient deterioration; nurses’ knowledge of physiological and clinical parameters associated with patient deterioration; and nurses’ self-reported clinical reasoning ability. Methodology: A mixed methods sequential 4-phase study design was employed: 1) an indepth literature review to identify and develop content domains and item statements for a prototype questionnaire; 2) determining the index of content validity (CVI) (n=5 expert registered professional nurses) of all item statements; 3) conducting cognitive interviews (n=3 expert registered professional nurses) to explore face validity and the quality of the revised prototype questionnaire; and 4) assessing stability of the final validated questionnaire through test-retest reliability testing (n=30 nurses: Registered Professional Nurses with four years of training, Enrolled Nurses with two years of training, Enrolled Nursing Auxiliaries with one year of training) two weeks apart. Results: The CVI exceeded the pre-set proportion of ≥70% agreement for 56/65 (86.2%) item statements scoring 3 (relevant only needing minor editing) or 4 (extremely relevant); removal of 3/65 (4.6%) items from the prototype questionnaire. Cognitive interviews then resulted in amendment of 30/78 (38.5%) item statements; removal of 2/78 (2.6%) from the revised prototype questionnaire. The weighted kappa statistic for level of agreement beyond chance for nurse respondents’ test-retest data was fair (0.21-0.4) for 18/47 (38.3%) items, moderate (0.41-0.6) for 12/47 (25.5%) items and substantial (0.61-0.8) for 13/47 (27.7%) items. Registered Professional Nurses’ responses between time 1 and time 2 were more consistent than for Enrolled Nurses and Nursing Auxiliaries. Conclusion and recommendations: The researcher-developed questionnaire was validated by registered professional nurses, but there is concern about its stability, tested on three categories of nurses. The questionnaire should be reassessed for content and face validity using a sample inclusive of all categories for nurses who take and interpret patients’ vital signs in an attempt to improve the reliability of the questionnaire.
Open Access
The development, validation and testing of a vital signs monitoring tool for early identification of deterioration in adult surgical patients
(2011) Kyriacos, Una; Jelsma, Jennifer
Patients often exhibit premonitory abnormalities in vital signs before an adverse clinical outcome. Patient survival may depend on the decisions of nurses to call for assistance. There is a paucity of published early warning scores (EWS) literature for general ward use from South Africa. In a public hospital in South Africa, the study aimed to develop, validate and test the impact of implementation of a modified early warning scoring (MEWS) system vital signs chart and training programme designed to improve hospital nurses’ performance in early identification of postoperative clinical and physiological deterioration in adult patients.
Open Access
Early warning scoring systems versus standard observations charts for wards in South Africa: a cluster randomized controlled trial
(BioMed Central, 2015-03-20) Kyriacos, Una; Jelsma, Jennifer; James, Michael; Jordan, Sue
Background: On South African public hospital wards, observation charts do not incorporate early warning scoring (EWS) systems to inform nurses when to summon assistance. The aim of this trial was to test the impact of a new chart incorporating a modified EWS (MEWS) system and a linked training program on nurses’ responses to clinical deterioration (primary outcome). Secondary outcomes were: numbers of patients with vital signs recordings in the first eight postoperative hours; number of times each vital sign was recorded; and nurses’ knowledge. Methods/design: A pragmatic, parallel-group, cluster randomized, controlled clinical trial of intervention versus standard care was conducted in three intervention and three control adult surgical wards in an 867-bed public hospital in Cape Town, between March and July 2010; thereafter the MEWS chart was withdrawn. A total of 50 out of 122 nurses in full-time employment participated. From 1,427 case notes, 114 were selected by randomization for assessment. The MEWS chart was implemented in intervention wards. Control wards delivered standard care, without training. Case notes were reviewed two weeks after the trial’s completion. Knowledge was assessed in both trial arms by blinded independent marking of written tests before and after training of nurses in intervention wards. Analyses were undertaken with IBM SPSS software on an intention-to-treat basis. Results: Patients in trial arms were similar. Introduction of the MEWS was not associated with statistically significant changes in responses to clinical deterioration (50 of 57 received no assistance versus 55 of 57, odds ratio (OR): 0.26, 95% confidence interval (CI): 0.05 to 1.31), despite improvement in nurses’ knowledge in intervention wards. More patients in intervention than control wards had recordings of respiratory rate (27 of 57 versus 2 of 57, OR: 24.75, 95% CI: 5.5 to 111.3) and recordings of all seven parameters (5 of 57 versus 0 of 57 patients, risk estimate: 1.10, 95% CI: 1.01 to 1.2). Conclusions: A MEWS chart and training program enhanced recording of respiratory rate and of all parameters, and nurses’ knowledge, but not nurses’ responses to patients who triggered the MEWS reporting algorithm. Trial registration: This trial was registered with the Pan African Clinical Trials Registry (identifier: PACTR201309000626545) on 9 September 2013.
Open Access
An evaluation of the effects of a lifestyle intervention on eating and physical activity behaviours of urban adolescents in junior public secondary schools in Botswana: a pragmatic randomised controlled trial
(2017) Lubinda-Sinombe, Gaonyadiwe; Kyriacos, Una
Background: The prevalence of overweight and obesity is an increasing health problem among adolescents due to unhealthy eating habits and inadequate physical activity. There are 434,000 (21%) adolescents aged 10-19 years in Botswana. The prevalence of overweight among adolescents aged 12-18 years in 2011 in urban private secondary schools in Botswana was 27.1% (192/702) and 13.1% (93/702) in public secondary schools. There is, however, a paucity of data on eating habits and physical activity behaviours and no published evidence was located on the prevalence of overweight among 13-15 year old adolescents in public junior urban secondary schools in Botswana. The determinants of adopting a healthy lifestyle such as information (knowledge), motivation (intentions) and behavioural skills (self-efficacy) have been identified in cross-sectional studies in other countries, but not in Botswana. A culturally suited lifestyle intervention program aimed at motivating adolescents to adopt a healthy lifestyle was not located in the published literature. In the absence of such a lifestyle intervention program for adolescents, the development, implementation and evaluation of the intervention for this study was guided by the Information, Motivation and Behavioural skills (IMBs) model to measure change in eating habits and physical activity behaviours of adolescents in Botswana. Methods: A 2-part study was conducted from 1 November 2015 to18 March 2016. Study One - three research designs were employed: 1) a descriptive design for development of a 3-part questionnaire from existing published literature; 2) a mixed methods approach to validate the prototype questionnaire by determining the index of content validity (n=10 respondents), face validity by cognitive interviewing (n=33 respondents who were scholars), and reliability by test-retest pilot testing (same 33 respondents); and 3) a cross-sectional survey by validated questionnaire of n= 252 respondents' (scholars) eating habits, physical activity behaviours and weight, height and waist circumference to determine the prevalence of overweight. Results from the cross-sectional survey provided baseline data for Study Two. For Study Two a descriptive design was employed to develop and describe a lifestyle intervention movement (LIMO) program followed by a pragmatic randomised controlled trial for implementing and evaluating the effectiveness of the LIMO program (n=25 respondents in the intervention trial arm; n=21 in the control arm from Study One). Null hypothesis: A lifestyle intervention movement (LIMO) program guided by the Information, Motivation and Behavioural skills (IMBs) model will not result in less fatty and sugar intake, an increase in fruit and vegetable consumption, engaging in physical activity 6 or more times a week and doing exercises, a reduction in sedentary behaviour and an increase in nutrition knowledge (P≥0.05). Alternate hypothesis: A lifestyle intervention movement (LIMO) program guided by the Information, Motivation and Behavioural skills (IMBs) model will result in less fatty and sugar intake, an increase in fruit and vegetable consumption, engaging in physical activity 6 or more times a week and doing exercises, a reduction in sedentary behaviour and an increase in nutrition knowledge (P≥0.05). Results: Study One: Good response rate of 95%. The mean age of the respondents was 14.3 years (SD 0.79); mean body mass index (BMI) was 20.1 kg/m2 (SD 3.9) and mean waist circumference score was 71.2 cm (SD 8.71). There were more females in the sample (147/252, 58.3%) than males (105/252, 41.7%). Most of the respondents (153/252, 53.6%) had a low socio-economic status as categorised by the present study. The majority (188/252, 74.6%) had a normal BMI and few (22/252, 8.7%) were underweight. Twenty-seven (10.7%) respondents were overweight, 4/252 (1.6%) were obese and 11/252 (4.4%) were obese with risk. Although few respondents had an abnormal waist circumference (females 17/252, 6.7%; males 14/252, 5.6%) more females (131/252, 52%) than males (90/252, 35.7%) had a normal waist circumference. The most frequently eaten foods were sweets (132/252, 52.4%) and snacks (92/252, (38.1%). Television adverts were sometimes (137/252, 62.3%) considered to be honest. Parents controlled slightly more than half (128/252, 50.8%) of the respondents' food choices whereas peers had little influence (21/252, 8.3%). Of the food types, most ate breakfast comprising of coffee and bread (115/252, 45.6%). Dinner was mostly eaten at home with the whole family (181/252, 71.8%). Of the listed foodstuffs, the majority preferred foods that contained sugar (41/252, 16.3%). Slightly more than half (135/252, 53.6%) of the respondents walked 6 or more times per day each week and more (150/252, 58.7%) reported that they did get exercise. Many intended to change their eating habits (220/252, 87.3%) and physical activity behaviours (143/252, 56.7%) and reported self-efficacy to do so (180/252, 71.4% and 174/252, 69.1% respectively). The majority of respondents (142/252, 56.3%) failed (≤49%) the nutrition knowledge test. The prevalence of overweight was 16.7% (42/252) by body mass index (BMI) and 12.3% (31/252) by waist circumference (WC) respectively. Study Two: There was no statistically significant difference in eating habits between the trial arms (fruit P=0.275, vegetables P= 0.604, sweets P=0.066, fatty foods P=0.402); although there was a difference in sugar consumption this was not statistically significant. There was no statistically significant difference in physical activity (walking 6 times or more a day each week) between trial arms (P=0.267), in doing exercise (P=0.288) and in sedentary behaviour (P=0.362). There was a difference in nutrition knowledge between trial arms but it was not statistically significant (P=0.079). Conclusion and recommendations: Although adolescents had good intentions and self-efficacy to change their eating and physical activity behaviours they engaged in unhealthy behaviours. The LIMO program demonstrated minimal but promising effects on changing behaviours. However further research is needed to determine the best intervention to impact behaviour change.
Open Access
Experiences perceptions and understanding of mothers of children living with albinism in Malawi: a qualitative descriptive study
(2019) Likumbo, Naomi; Kyriacos, Una; de Villiers, Tania
Background: Albinism affects approximately 1 in 17,000 individuals globally with the highest prevalence in SubSaharan Africa with an estimation of 1 in 2000 - 5000 live births and 1 in 2000 live births in Malawi. The total number of people living with albinism in Malawi is estimated to be 7000 - 10,000 of the total population. Albinism is a stigmatised condition particularly in Africa and children are particularly vulnerable. Purpose of the study: to explore and describe the experiences, perceptions and understanding of mothers who have children living with albinism in Malawi. Study design: Qualitative descriptive study. Data collection Methods: The study, conducted between June and July 2018 in Malawi, included voluntary participation of ten mothers 18 years and older who had children with albinism. Purposive sampling was used to select participants who met the inclusion criteria to answer the research question and achieve the purpose of the study. Semi structured interviews were conducted in the participants’ preferred language Chichewa. Interviews were audio recorded and transcribed. Data translation of the questionnaire from English to Chichewa was done by three different translators from Malawi using forward and backward translation. The same process was followed for translation of the data from the interviews. Data analysis: Thematic analysis guided the process of data analysis. Trustworthiness of the data analysis process was maintained. To ensure transparency in reporting the study and to allow replication, reporting guidelines from the equator Network were used to evaluate the quality of the study. The quality of semistructured interviews was evaluated by using the Consolidated Criteria for Reporting Qualitative Studies (COREQ), a 32-item checklist. The Standards for Reporting Qualitative Research (SRQR) were used to evaluate the quality of the completed study. Findings: Four themes emerged from the data: 1) stigmatisation, discrimination and harm, 2) Mothers’ impression of a child with albinism, 3) Mothers’ awareness of albinism and 4) Psychosocial effects of albinism. Conclusion: A description of the experiences and perceptions of mothers of children living with albinism in Malawi and their understanding of the condition has revealed that these children are stigmatised and unsafe in their communities and that these mothers experienced this acutely even though they were overwhelmingly positive about accepting and loving their children and attempted to protect them from harm whatever the cost. Being the first such reported Malawian study it has filled a gap in the existing knowledge in this field and provides a foundation for further research specific to people living with albinism in Malawi
Open Access
Monitoring vital signs: development of a modified early warning scoring (MEWS) system for general wards in a developing country
(Public Library of Science, 2014) Kyriacos, Una; Jelsma, Jennifer; James, Michael; Jordan, Sue
Objective The aim of the study was to develop and validate, by consensus, the construct and content of an observations chart for nurses incorporating a modified early warning scoring (MEWS) system for physiological parameters to be used for bedside monitoring on general wards in a public hospital in South Africa. METHODS: Delphi and modified face-to-face nominal group consensus methods were used to develop and validate a prototype observations chart that incorporated an existing UK MEWS. This informed the development of the Cape Town ward MEWS chart. Participants One specialist anaesthesiologist, one emergency medicine specialist, two critical care nurses and eight senior ward nurses with expertise in bedside monitoring (N = 12) were purposively sampled for consensus development of the MEWS. One general surgeon declined and one neurosurgeon replaced the emergency medicine specialist in the final round. RESULTS: Five consensus rounds achieved ≥70% agreement for cut points in five of seven physiological parameters respiratory and heart rates, systolic BP, temperature and urine output. For conscious level and oxygen saturation a relaxed rule of <70% agreement was applied. A reporting algorithm was established and incorporated in the MEWS chart representing decision rules determining the degree of urgency. Parameters and cut points differed from those in MEWS used in developed countries. CONCLUSIONS: A MEWS for developing countries should record at least seven parameters. Experts from developing countries are best placed to stipulate cut points in physiological parameters. Further research is needed to explore the ability of the MEWS chart to identify physiological and clinical deterioration.
Open Access
Newly qualified nurses lived experience of role transition from student nurse to community service nurse a phenomenological study Reinette Roziers.
(2012) Roziers, Reinette; Kyriacos, Una
The phenomenological study explored the experience of role transition of newly qualified nurses undertaking compulsory community service in health service facilities in the Western Cape in 2011.
Open Access
Nurses' lived experience of caring for long-term mechanically ventilated patients in intensive care units : a phenomenological study
(2004) Fouché, Nicola Anne; Kyriacos, Una
Includes bibliographical references (leaves 110-129).
Open Access
Optimising nursing shift handover in Paediatric Intensive Care
(2013) Davis, Clare; Coetzee, Minette; Kyriacos, Una
Includes abstract. Includes bibliographical references.
Open Access
Perceptions of cataracts and cataract services of elderly persons in Mathangwane, Botswana
(2008) Ndlovu, Keeleditse; Kyriacos, Una; Mayers, Pat
Background: Cataract is the leading cause of blindness globally. In Botswana about 60% of blindness is due to cataract. Health services in Botswana are free, as are cataract services. Despite the free health services offered, the Batswana do not fully utilize the available eye care services especially the cataract services. Many Batswana access health care in public hospitals, where patients may have to wait for long periods for clinic appointments and surgery. Research question: What are the perceptions that elderly persons in Mathangwane village in Botswana, have of cataracts and cataracts services? Aim: To explore and describe the perceptions of elderly persons in Mathangwane about cataracts and cataract services. Objectives: 1. Explore and describe elderly persons' perceptions of cataracts; 2. Explore and describe elderly persons' perceptions of cataract services; 3. Explore reasons for use and non-use of current cataract services. Methods: Qualitative exploratory descriptive methods were used. A qualitative study design with purposeful sampling was used to identify participants for interviews and focus group discussion. Semi-structured interviews with seven participants aged sixty-five years and older with diagnosed cataract as well as a focus group with six of the seven participants were conducted. Data was analysed using a content analysis approach. Results: Five themes emerged from the interviews and a focus group discussion: i. Cataract as the 'spider web'; ii. Curing cataract with traditional herbs; iii. Cataract a problem of the elderly caused by modem food; iv. The burden of cataract blindness: 'mealie on the fire'; v. The ambivalent voice of elderly persons about cataract services. Conclusion: Findings from this study show that the participants had a general understanding of what cataract is and they had a particular description for this. Both positive and negative feelings were expressed in relation to the services available. Although cataract surgery was perceived to restore vision a major concern of the elderly persons was in relation to delays they experienced while waiting for the cataract to fully mature. Despite the free services offered at community level there is a great need for affordable and accessible transportation services for elderly persons utilising the cataract services.
Open Access
Prevalence of overweight and obesity in children aged 5 to 6 years exposed to Gestational Diabetes Mellitus complicated pregnancies in the Western Cape, South Africa
(2018) Haynes, Magret C.; Kyriacos, Una; Levitt, Naomi S.; Chivese, Tawanda
Background: Gestational Diabetes Mellitus (GDM) has been linked with later metabolic abnormalities in offspring due to subsequent overweight and obesity. In Sub-Saharan Africa, there is a paucity of data on the outcomes of children exposed to GDM in utero. Aims: The primary aim of this sub-study was to investigate the prevalence of overweight and obesity in 5 and 6-year-old children from GDM complicated pregnancies and macrosomia at birth in the same cohort. The secondary aim was to identify risk factors associated with overweight and obesity in these 5 and 6-year-old children. Outcome measures: The main outcome was the prevalence of overweight and obesity in these children as measured by their age-specific body mass index (BMI) and Z-scores. Additionally, the association between other risk factors, overweight and obesity was investigated. Methods: A cross-sectional sub-study design was employed nested within a larger study that is investigating the progression to type 2 diabetes in women managed for GDM during 2010 and 2011. Mothers who participated in the larger study were informed about the sub-study and invited to allow their children to participate in the sub-study. Written informed consent was obtained from the mothers for the sub-study. The following data were collected: anthropometric data at birth and pregnancy related information from the mothers’ hospital record, additional demographic, social and medical information by questionnaire from the mother and at the research center. In addition, the children were weighed and had their height measured using standardized methods. Anthropometry was standardized using WHO standards. Risk factors for overweight and obesity were tested using a BMI>1 Z-score cut-off, (as a binary variable) in a manual multivariate logistic regression model. Results: The sub-study recruited 176 participants; 78 boys (44.3%) and 98 girls (55.7%). The mean (SD) Z-scores for the children’s anthropometry at ages 5 to 6 years were 0.28 (1.40) for weight, 0.01 (1.07) for height and 0.37 (1.63) for BMI. The overall prevalence of macrosomia at birth (birth weight>4000 gm) was 12.3 % (95% CI 8.2-9.1). The overall prevalence of overweight in the 5 and 6-year-old children was 13.4% (95% CI 8.6-20.4), while the prevalence of obesity was 14.2% (95% CI 9.2-21.2). The combined prevalence of overweight and obesity was 27.6% (95% CI 20.6-35.9). The prevalence of macrosomia (P=0.53) or overweight/obesity proportions (P=0.37) at ages 5 to 6 years did not differ by gender. In multivariate logistic regression analysis, factors independently associated with the risk of overweight and obesity were: mothers’ oral glucose tolerance test 2-hour blood glucose level during pregnancy (AOR=2.06, 95% CI 1.14-3.74, P=0.02), birth weight (AOR=1.00, 95% CI 1.00-1.00, P=0.01), child’s age in years (AOR=0.03, 95% CI 0.002-0.29, P=0.004) and number of adults in the house (AOR=0.38, 95% CI 0.17-0.86, P=0.02). Conclusion: This is the first study to report the prevalence of overweight and obesity in children born from GDM complicated pregnancies, in the Western Cape, South Africa. The combined prevalence of overweight and obesity found in 5 and 6-year-old children exposed to GDM in the Western Cape is higher than overweight and obesity in children reported in other South African studies. This can imply a higher tendency towards overweight and obesity in children exposed to GDM which needs further exploration.
Open Access
Record keeping : self-reported attitudes, knowledge and practice behaviours of nurses in selected Cape Town hospitals
(2010) Olivier, Johann Marthinus; Kyriacos, Una
Background: South African law holds nurses accountable for their acts and omissions and all documentation pertaining to patient care may serve as evidence in a court of law or at South African Nursing Council (SANC) hearings. Documentation can confirm or refute negligence and therefore should be an accurate and current reflection of what happened to the patient, particularly as litigation often arises long after care was rendered. Objective: To describe the self-reported attitudes towards, knowledge of and practice behaviours of nurses, and the association between these factors and selected variables (category of nurse, gender, hospital sector, years of experience after registration/enrolment, day/night shift and practice discipline) relative to record keeping. Methods: A quantitative, non-experimental study design, using a cross-sectional survey method to describe attitudes, knowledge and practice behaviour against predetermined measurement scales. Stratified random sampling and a questionnaire was used, with a 52.54% (186/354) response rate. Logistic regression models were fitted to determine factors associated with attitudes, knowledge and practice behaviour, fitted as binary dependent variables, each in a separate model. Strength of association was expressed as an odds ratio (OR), and a p-value of 0.05% was considered significant. Setting: Three tertiary Government hospitals and three Private hospitals in the Cape Town Metropole, South Africa. Findings: Demographically, the sample consisted of 92 Registered Nurses (RNs), 42 Enrolled Nurses (ENs) and 50 Enrolled Nursing Auxiliaries (ENAs) of which 94.62% (n=176) were female and 4.30% (n=8) male. The mean age of all respondents were 42.26 years (range 23 to 64) while 48.92% (n=91) of the respondents had more than 15 years of experience after registration/enrolment. Of the 186 respondents, 54.85% (n=102) worked in Government Hospitals, comprising 53 (51.96%) RNs, 25 (24.51%) ENs and 22 (21.57%) ENAs. The 45.16% (n=84) Private Hospital respondents consisted of 39 (46.43%) RNs, 17 (20.24%) ENs and 28 (33.33%) ENAs. Most respondents (18.82%, n=35) worked in Surgical Units and on day duty (70.43%, n=131). A predominantly positive self-reported attitude towards record keeping was evident (71.74%, n=132/184). The negative attitude ratio in the Private sector (58.49%, n=31/53) was larger than in the Government sector (41.51%, n=22/53) (OR=2.049, 95% CI=1.043-4.025, p=0.037). A larger ratio of respondents working day duty reported a negative attitude (60.00%, n=30/50), compared to those working night duty (40.00%, n=20/50) (OR=2.171, 95% CI=1.066-4.423, p=0.033). Although adequate knowledge levels relative to record keeping were reported by the majority of respondents (74.86%, n=137/183), there were some knowledge deficits. Inadequate knowledge level ratios were more evident amongst ENAs (45.65%, n=21/46) when compared to RNs (30.43%, n=14/46) (OR=4.179, 95% CI=1.873- 9.321, p=0.000). Similarly, acceptable levels of self-reported record keeping practice behaviour were evident amongst the majority of respondents (68.31%, n=125/183). A higher ratio of unacceptable practice behaviour was reported by RNs (39.66%, n=23/58) when compared to ENs (34.48%, n=20/58) (OR=2.727, 95% CI=1.266-5.877, p=0.010). The most prominent practice behaviours reported by respondents included making use of a combination of record keeping approaches when keeping records, having regular record keeping audits, having sufficient supervision relative to record keeping, reading what other nurses have written and nurses writing in the progress notes themselves. The three top ranked barriers to effective record keeping were interruptions while keeping records, insufficient time to effectively keep records and a lack of confidence in the ability to keep accurate records. Conclusion: Although respondents, particularly RNs, reported predominantly positive attitudes towards, adequate knowledge of and acceptable practice behaviour relative to record keeping, there are concerns that the deficiencies amongst ENs and ENAs may have serious implications for patient safety for both the Government and Private Health sectors. Significance to clinical practice: Deficiencies relative to record keeping attitudes, knowledge and practice behaviours were identified. The identified deficiencies could be used to implement record keeping improvement strategies.
Open Access
Record review of post-haemodialysis blood results to assess adherence to guidelines for end stage renal disease
(2021) van der Nest, Yolinda Louise; Kyriacos, Una
Background: End Stage Renal Disease is an irreversible decline in kidney function and fatal in the absence of renal replacement therapy. Resource constraints in the South African public healthcare sector limits patients' access to renal replacement therapy: here 14.8% are on haemodialysis compared to 85.2% in private dialysis units. Quality indicators in internationally accepted guidelines address complications of End Stage Renal Disease for patients on haemodialysis to reduce mortality and morbidity. Monitoring clinical outcomes for patients on haemodialysis is essential for good quality of life. Aim: To design and validate a record review template for monitoring and describing target and actual outcomes for each clinical indicator to assess adherence to established guidelines. Methods Design: Retrospective chart review. Participants: Patient records were accessed from an electronic database in 8 private units between 01 January and 31 December 2018. Data instruments: Data were captured and analysed in SPSS. DAG Stat was used for the Kappa statistic for interrater reliability (test-retest). A P-value of <0.05 was taken as significant. Results: Of the dialysis population (N=412) for the study period n=243 (58.98%) records were excluded. The median age of the convenience sample (169/412, 41.01%) was 60 years (IQR: 21-86), comprising 100/169 (59.17%) males and 69/169 (40.8%) classified as Coloured. Most patients (55/169, 32.54%) had Diabetic Nephropathy. Suboptimal dialysis adequacy (Kt/V levels) was present in 86/133 (64.6%) of the patients, similarly 102/166 (62.5%) for serum phosphate. Arterio-venous fistula or graft is recommended for vascular access for HD and 112/169 (66.27%) patients had either. While all patients should receive erythropoiesis stimulating agents and iron therapy, 110/169 (65.08%) and 104/169 (61.53%) respectively did. For the required phosphate binders and Vitamin D supplements there were recordings for 57/169 (33.72%) and 54/169 (32.72%) patients respectively. Conclusion: Adherence to clinical guidelines for 3/5 quality indicators was considered unsatisfactory which has implications for patients' quality of life.
Open Access
Record review to explore the adequacy of post-operative vital signs monitoring using a local modified early warning score (mews) chart to evaluate outcomes
(Public Library of Science, 2014) Kyriacos, Una; Jelsma, Jennifer; Jordan, Sue
Objectives 1) To explore the adequacy of: vital signs’ recordings (respiratory and heart rate, oxygen saturation, systolic blood pressure (BP), temperature, level of consciousness and urine output) in the first 8 post-operative hours; responses to clinical deterioration. 2) To identify factors associated with death on the ward between transfer from the theatre recovery suite and the seventh day after operation. Design Retrospective review of records of 11 patients who died plus four controls for each case. Participants We reviewed clinical records of 55 patients who met inclusion criteria (general anaesthetic, age >13, complete records) from six surgical wards in a teaching hospital between 1 May and 31 July 2009. METHODS: In the absence of guidelines for routine post-operative vital signs’ monitoring, nurses’ standard practice graphical plots of recordings were recoded into MEWS formats (0 = normal, 1-3 upper or lower limit) and their responses to clinical deterioration were interpreted using MEWS reporting algorithms. RESULTS: No patients’ records contained recordings for all seven parameters displayed on the MEWS. There was no evidence of response to: 22/36 (61.1%) abnormal vital signs for patients who died that would have triggered an escalated MEWS reporting algorithm; 81/87 (93.1%) for controls. Death was associated with age, ≥61 years (OR 14.2, 3.0-68.0); ≥2 pre-existing co-morbidities (OR 75.3, 3.7-1527.4); high/low systolic BP on admission (OR 7.2, 1.5-34.2); tachycardia (≥111-129 bpm) (OR 6.6, 1.4-30.0) and low systolic BP (≤81-100 mmHg), as defined by the MEWS (OR 8.0, 1.9-33.1). CONCLUSIONS: Guidelines for post-operative vital signs’ monitoring and reporting need to be established. The MEWS provides a useful scoring system for interpreting clinical deterioration and guiding intervention. Exploration of the ability of the Cape Town MEWS chart plus reporting algorithm to expedite recognition of signs of clinical and physiological deterioration and securing more skilled assistance is essential.
Open Access
Self-reported perceptions of factors influencing error reporting in one Nigerian hospital: a descriptive cross-sectional study
(2018) Afolalu, Olamide Olajumoke; Kyriacos, Una
Background: Over the past decade the concern about patient safety due to the occurrence of medical errors has become a priority in healthcare. Medical errors occur from virtually all processes in the delivery of healthcare and while most have little risk for patient harm, some do result in injury, increased health care cost, lost income, decreased productivity, disability, morbidity and mortality. Under-reporting of medical errors is a global issue endangering patient safety and compromising health outcomes. Awareness and use of a hospital's error reporting system is an initial step towards improved reporting rates. Aim: The aim of the study was to describe doctors' and nurses' self-reported perceptions of factors influencing error reporting in a Nigerian hospital by survey questionnaire. Methods: This study employed a descriptive cross-sectional design to survey a random sample of 230 health professionals (n=90 doctors, n=130 nurses) working in all the units and departments of a Nigerian tertiary health institution. A theoretical model of a health information technology framework with implications for patient safety served as a guide for the literature review and interpretation of study findings. A 47-item self-administered survey questionnaire served as the data collection instrument. The questionnaire was developed following the review of available published literature and validated by four experts (n=2 doctors, 2 nurses), who determined the index of content validity. Inter-rater reliability of the instrument was subsequently measured by test-retest reliability of data from a pilot study of 30 raters (n=13 doctors, n=17 nurses). The validated questionnaire was used to determine doctors' and nurses' awareness and use of an error reporting system, frequency of reporting various types of errors, perceived barriers to error reporting and factors that facilitate an error reporting culture. Data collection took place for four weeks in February 2017. Data were analyzed in SPSS using descriptive and inferential statistics. Results: The median age of the respondents was 36 years (range of 25-59). The typical nurse respondent was female having a diploma in nursing and no Master's degree or PhD, in contrast to the doctors, most of whom were male and a few had a postgraduate qualification. The gender difference between the two groups was statistically significant (P<0.001). The majority of the respondents had 6-10 years of work experience and were in full-time employment and the difference in current work status (P=0.001) and years of work experience (P<0.001) between the two groups was statistically significant. Awareness of error reporting system: most respondents disagreed that the hospital had a system in place for reporting errors but more nurses (56/140, 40.0%) than doctors (16/90, 17.8%) were aware of such a system and the difference in responses between the two groups achieved statistical significance (X²(4, n=230) = 13.302, P<0.010); knew where and when to report errors (nurses 48.6%, n=68/140; doctors 20.0%, n=18/90) (X²(n=230) = 23.843, P<0.001); how to locate an incident form (nurses n=60/139, 43.2%; doctors n=28/89, 31.5%) (X²(4, n=228) = 9.842, P=0.043); and who to report an incident or error to (nurses n=72/140, 51.4%; doctors n=33/90, 36.7%) (X²(4, n=230) = 11.845, P=0.019). Results for type and frequency of errors reported and factors facilitating an error reporting culture did not achieve statistical significance. Perceptions of barriers to error reporting: lack of confidentiality (nurses n=62/140, 44.3%; doctors n=27/87, 31.0%) (X²(n=227) = 11.697, P=0.019). Most respondents were unsure if error reporting forms were easy to complete (nurses n=49/137, 35.8%; doctors n=26/88, 29.5%), (X²(4, n=225) = 9.926, P=0.042). Factors not perceived as barriers: positive feedback when reporting errors (nurses n=61/140, 43.6%; doctors n=24/90, 26.7%), (X²(n=230) = 10.939, P=0.026); reporting an error that did not cause harm (doctors n=40/90, 44.4%; nurses n=50/139, 36.0%), (X²(4, n=229) = 9.618, P=0.047); time involved in reporting (nurses n=76/138, 55.1%; doctors n=26/89, 29.2%), (X²(4, n=227) = 17.327); and learning from the error (doctors n=42/90, 46.7%; nurses n=40/138, 29.0%), (X²(4, n=228) = 20.777, P<0.001) Conclusion: Doctors and nurses were mostly unaware of the hospital's error reporting system which can be concluded to be an organizational factor. Respondents would be willing to report incidents if perceived barriers are removed. There is an urgent need for an effective error reporting system to be implemented in the local setting and for appropriate awareness training and educational interventions to improve doctors' and nurses' knowledge and use of medical error reporting. Relevance to clinical practice. Effective error reporting systems in the Nigerian healthcare sector that improve awareness and use of these systems should enhance a reporting culture and thereby improve patient safety.