Training for transformation: reorientating primary health care nurses for the provision of mental health care in South Africa

Using programme research, this paper reports on the evaluation of a programme designed to orientate primary health care nurses towards the provision of a comprehensive approach to care. In addition to training in psychiatric care, this was deemed necessary in order to facilitate comprehensive integrated primary mental health care in South Africa. Nurse-patient consultations were evaluated on indicators of comprehensive care before and after the programme. Interviews were also conducted with the participants individually and in a group. The results indicate that there are several factors which mediate the provision of comprehensive care by primary health care nurses. These include individual factors as well as contextual factors, inter alia, the structure and organization of the health care system, which historically has been organized to promote biomedical care. Furthermore, biomedicine has dominated training models in South Africa, instilling in nurses a biomedical approach to patient care.     

Accident and Emergency nurses' attitudes towards health promotion

AIM: This paper presents a study exploring Accident and Emergency nurses' attitudes towards health promotion. BACKGROUND: Much has been written about nurses and health promotion. Research has focused mainly on community nurses, less on nurses working in acute hospital settings, and apparently not at all on those working in Accident and Emergency units. METHODS: Q methodology, a technique for extracting subjective opinions, was used. Eleven nurses working in Accident and Emergency departments completed 33-item Q-sorts and wrote personal definitions of health promotion. Based on published literature in the field, the Q sample was structured with reference to nurses' attitudes as they related to health promotion. Factor analysis was performed on the data, and the resulting factors were interpreted. The data were collected in 2003. RESULTS: Three alternative constructions emerged from the data, representing three alternate views about health promotion. The most widely held opinion (representing nine of the 11 nurses) was a positive view of health promotion and the nurses' role in health promotion in Accident and Emergency environments. CONCLUSIONS: It is not possible to generalize the findings of this study due to the small number of participants. However, their knowledge of, and commitment to, health promotion is encouraging. Recommendations for practice are that there is continued and increased post-registration education in health promotion for nurses and continuing exploration of the hospital nurses' health promotion role. Further research is needed to explore nurses' perceptions of barriers to effective health promotion and nurses' health promotion activities in Accident and Emergency environments.     

HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa

Title. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. Aim. This paper is a report of a study exploring HIV/AIDS‐related knowledge, attitudes, practices and perceptions of nurses in the largely black and rural Limpopo Province of South Africa. Background. Studies of HIV/AIDS knowledge, attitudes and practices among healthcare workers in developing countries have shown gaps in knowledge and fear of contagion, coupled with ambivalent attitudes in caring for patients with HIV/AIDS and inconsistent universal precautions adherence. Method. A cross‐sectional study of a random sample of primary health care (PHC) (n = 71) and hospital nurses (n = 69) was carried out in 2005, using a questionnaire, focus groups and in‐depth interviews. Findings. Hospital nurses reported a higher frequency of care for patients with HIV/AIDS (P < 0·05), but less HIV/AIDS training when compared to PHC nurses (P < 0·001). HIV/AIDS knowledge was moderately adequate and associated with professional rank, frequency of care and training (P < 0·001). Attitudes towards patients with HIV/AIDS were mainly positive and were statistically significantly correlated with HIV/AIDS knowledge (P < 0·01) and training (P < 0·05). Three out of four nurses reported that they practised universal precautions (76·1%), but fear of occupational HIV transmission and lack of injection safety was found. Seven in 10 nurses reported previous needlestick injuries, but postexposure prophylaxis was not available in all healthcare facilities. Participants reported a higher workload because of HIV/AIDS, lack of training impacting negatively on their work, and stigma and shared confidentiality affecting them emotionally. Conclusion. There is a need for accelerated HIV/AIDS training of rural nurses and for wider implementation of universal precautions and postexposure prophylaxis availability in public health facilities in southern Africa.     

Global challenges in health and health care for nurses and midwives everywhere

The next decade is likely to produce any number of global challenges that will affect health and health care, including pan-national infections such as the new coronavirus COVID-19 and others that will be related to global warming. Nurses will be required to react to these events, even though they will also be affected as ordinary citizens. The future resilience of healthcare services will depend on having sufficient numbers of nurses who are adequately resourced to face the coming challenges.     

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork team identity, leadership, access to general practitioners, philosophies of care, understanding of team members' roles and responsibilities, and, disagreement regarding roles and responsibilities Differences in the various views and experiences of teamwork were identified Midwives and health visitors emerged as the least integrated members of the primary health care team Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups The potential for teamwork in the future is discussed     

Undergraduate nursing students' attitudes towards smoking health promotion

Despite the fact that nurses have a key role in health promotion, many continue to smoke at much the same rate as the general population. This paper investigates the influence of smoking status, gender, age, stage of education, and smoking duration on undergraduate nursing students' attitudes towards smoking health promotion. The study took place in one university's School of Nursing in Victoria, Australia. Respondents completed the Smoking and Health Promotion instrument. Researchers obtained ethics approval prior to commencing the study. Smoking status was the main factor that affected respondents' attitudes towards smoking health promotion, with age and education stage having a minor effect, and gender and smoking duration not significant. Nurses have an important role in modeling non-smoking behaviors for patients. There needs to be consistency between personal and professional beliefs for nurses to properly engage in smoking health promotion. The findings have implications for undergraduate nursing education curricula, nursing practice and research, and these are discussed.     

Nurses' attitudes towards primary health care: development of an instrument

In many countries nurses are the largest group of professionals providing health care If health care is to be provided following a primary health care philosophy, nurses must be among the leaders in making the change in the way health care is delivered To be effective nurses must develop positive attitudes towards primary health care and incorporate its principles into practice The purpose of this paper is to present the development and testing of an instrument to measure nurses' attitudes towards primary health care The instrument has 35 items divided into five domains based on the principles of primary health care Two scales, one for attitude and one for importance of concept of professional role, are scored on six-point Likert scales Initial psychometric evaluation resulted in alpha coefficients of 0 07 to 0 58 for the domains, 0 70 for the attitude scale and 0 93 for the importance scale Details are provided on the measures taken to establish validity of the instrument Plans for future testing are included     

Training primary care nurses to conduct alcohol screening and brief interventions in South Africa

Although progress has been made in developing a scientific basis for alcohol screening and brief intervention (SBI), training packages are necessary for its widespread dissemination in primary care settings in developing societies. Using a training package developed by the World Health Organisation 121 nurses from one rural site (29 clinics in Vhembe District) and one urban site (3 clinics and 6 mobile clinics in Polokwane/ Seshego) in South Africa were compared before and after SBI training regarding knowledge and attitudes, and the subsequent practice of SBI in routine clinical practice. Although the training effects were at times moderate, all changes were in a direction more conducive to implementing SBI. Health care providers significantly increased in knowledge, confidence in SBI and higher self-efficacy in implementing SBI at follow-up after 9 months after receiving the training. When delivered in the context of a comprehensive SBI implementation programme, this training is effective in changing providers' knowledge, attitudes, and practice of SBI for at-risk drinking.     

Knowledge and attitudes of patients with diabetes mellitus in a primary health care system

The objective of this study was to characterize patients with type 2 diabetes mellitus, according to sociodemographic and clinical variables, and to analyze scores of knowledge and attitudes regarding the disease. Participants were 79 users who received care in a primary health care service, in 2008. The Diabetes Mellitus Knowledge (DKN-A) and Attitude (ATT-19) questionnaires were used for data collection. The population was formed by adults and elderly adults, who were between 30 and 80 years old. Most were literate (96.3%); married (63.3%); female (63.3%) and classified as class-2 obesity. As to the knowledge about the disease, subjects obtained scores lower than 8, indicating unsatisfactory results on self-care. Scores obtained regarding attitudes show difficulties to cope with the disease. Results evidence the need to adopt a Diabetes Education Program at the studied unit.     

Knowledge,confidence and attitudes towards mental health of nurses working in NHS Direct and the effects of training

BACKGROUND: NHS Direct, the United Kingdom's 24-hour nurse-led telephone advice service, was announced in December 1997. By November 2000 the service was available throughout England and Wales. Initial research had shown that people with mental health problems used the service and that, prior to its going live, this was one area about which nurses felt least confident. AIMS: The aim of the study was to measure confidence in dealing with mental health calls, knowledge of mental health issues, and attitudes to mental health before and after training. METHODS: A postal questionnaire was sent to all nurse advisers working in 17 NHS Direct sites in England before and after mental health training had been received. The questionnaire was designed to measure confidence, knowledge and attitudes. This was done through scenarios of real calls to NHS Direct, questions from the World Health Organization guide to Mental Health in Primary Care and the Depression Attitude Questionnaire. RESULTS: Confidence increased in nurses who received mental health training. Although there was no statistically significant increase in knowledge scores after training, those who had received training increased by on average one point. After training, attitudes towards depression had shifted in that nurses now felt more positive towards their role in treating depressed patients. CONCLUSIONS: Training in mental health can lead to increases in confidence and a change in attitudes and would be beneficial for all nurses working in NHS Direct and in other primary care fields. It would also be beneficial to repeat the study with a larger number of nurses and after a longer period of time to assess the long-term effects of training.     

护理专业实习生从事生活护理意愿和态度的研究

目的调查护理专业实习生从事生活护理的意愿和态度。方法抽取在天津市某三甲医院实习的147名护理专业实习生为调查对象,采用问卷调查实习生从事生活护理的意愿和态度。结果实习生对执行各项生活护理的意愿评分均低于3分,学历高的实习生从事生活护理的意愿相对消极(P<0.05);独生子女对生活护理的态度比非独生子女消极(P<0.05);实习生对生活护理的意义和内涵认知积极,尤其是高学历实习生,但对从事生活护理的感受较为消极。结论实习生从事生活护理的行为意愿不积极,实施生活护理时存在负面心理感受。应注重引导实习生更新服务理念,加强职业态度,提高对生活护理的认知和行为意愿。     

Attitudes towards, and knowledge of, clinical effectiveness in nurses, midwives, practice nurses and health visitors

The dual concepts of evidence-based practice and clinical effectiveness have become ever more important for nurses, midwives and health visitors in recent years. In order that suitable initiatives can be derived and future policy shaped and evaluated it is important that the current level of knowledge and attitudes towards these concepts are recorded. The current study set out to examine these variables in a large, representative sample (n = 370, response rate = 74%) of nurses, midwives and health visitors. Results indicated that although a positive attitude towards evidence-based practice exists, individuals consider themselves to be lacking in certain key skills. Specifically, these appeared to be related to research-based skills. However, despite this, respondents indicated a large take up of evidence-based practice, although this may have been greater were it not for the considerable clinical workload. The necessity for greater dissemination of key research principles to nurses, midwives and health visitors by members of their own profession is emphasized.     

Knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine

AIMS: The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. BACKGROUND: Over recent years there has been increased interest among the lay public and health care professionals in complementary and alternative medicine (CAM). Previous studies have shown that several variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. Conflicting reports were found with respect to the relationship between health locus of control and the use of CAM. Israel is a small country comprised mostly of immigrants from vastly differing cultures with differing beliefs about health and health care. Nurses whose origins are similar to the general population are also caregivers who are used to integrating diverse therapies into the plan of care devised with the client. No study was found which investigated these issues among Israeli nurses. DESIGN/METHODS: A systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem, Israel were invited to participate in the study. Informed consent was obtained. Four self-administered, pencil and paper, questionnaires were distributed to the study participants: a questionnaire designed by the authors to determine the level of knowledge and attitudes towards complementary and alternative medicine; a questionnaire which measured satisfaction with the patient-physician relationship; a questionnaire which measured health locus of control; and a demographic questionnaire. Participants received a packet containing the questionnaire and a note explaining the study. The anonymous questionnaires were collected by the ward secretaries and sent in bulk to the researchers. RESULTS: Results demonstrated that nurses in this sample perceived that they had little knowledge of complementary and alternative medicine but were very interested in learning more. Few used complementary and alternative medicine in their nursing practice but levels of personal use were similar to that of the general population. Nurses who used complementary and alternative medicine were satisfied with their care. CONCLUSIONS: In general, nurses tended to be wary of the use of complementary and alternative medicine. Nurses were also not satisfied with their relationships with their physicians. Those of middle age were more likely to use complementary and alternative medicine but no other demographic characteristics were associated with knowledge or attitudes towards complementary and alternative medicine. Nurses had higher levels of internal health locus of control which was associated with more positive attitudes and knowledge levels of complementary and alternative medicine.     

Knowledge, beliefs and attitudes of community health workers about hypertension in the Cape Peninsula, South Africa

This article explores the perceptions and attitudes of community health workers (CHWs) about hypertension. The level of knowledge of hypertension, as well as their personal attitude towards this is crucial in the style and quality of their interventions. CHWs, whose role in health promotion is being increasingly recognised, can help contain or reduce the prevalence of hypertension by influencing the community to adopt healthy lifestyles. Forty-three CHWs employed by Zanempilo in two study areas, Sites B and C in Khayelitsha in the Cape Peninsula, South Africa, were included in the study. Firstly, focus group discussions were conduced with 17 purposively selected CHWs to explore attitudes, beliefs and perceptions of hypertension. Secondly, interviews were conducted to assess their basic knowledge about causes, prevention and control of hypertension. The focus group discussions revealed that CHWs were uncertain about the causes of hypertension. They also found it difficult to grasp the fact that people without risk factors, such as overweight or a family history of hypertension, could be hypertensive. Many CHWs believe in traditional medicines and home-brewed beer as the best treatment for hypertension. They believe that people who take medical treatment become sicker and that their health deteriorates rapidly. Risk factors of hypertension mentioned during the structured interviews include inheritance, lack of physical activity, consuming lots of salty and fatty food. Conclusions drawn from the findings of the CHWs' responses highlighted their insufficient knowledge about hypertension as a chronic disease of lifestyle. Meanwhile they are expected to play a role in stimulating community residents' interest in the broad principle of preventive health maintenance and follow-up. Data obtained from this research can be used for the planning of health-promotion programmes. These should include preventing hypertension and improving primary management of individual sufferers. Because of their working relations and close link with CHWs, community nurses in primary health-care facilities need to recognise these beliefs and attitudes since these may differ from their own.