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Item The development of an educational programme to enhance the utilisation of cervical cancer services among women of reproductive age in the Otjozondjupa region, Namibia(University of Namibia, 2023) Anyolo, EpafrasThe aim of the study was to develop an educational programme to enhance the utilisation of cervical cancer services among women of reproductive age in the Otjozondjupa region, Namibia. Cervical cancer is among the top ten most common causes of cancer-related deaths among women globally. The setting of this study is the Otjozondjupa region, which is one of the fourteen regions of Namibia. The study was conducted in four phases as follows: Phase one entailed the situational analysis which described the knowledge, attitudes, and practices of the reproductive aged women regarding the prevention, screening, and treatment of cervical cancer in the Otjozondjupa region. Phase two of the study entailed the development of a conceptual framework of the study. Phase three was concerned with the process of developing the educational programme, and Phase four focused on identifying the guidelines for the implementation and evaluation of the educational programme interventions. The guidelines were identified in terms of the objectives and activities based on the cyclic curriculum development model. The study applied a quantitative approach with descriptive and cross-sectional designs to address the aim and specific objectives of the study in Phase one. A study population of 37066 women was divided into four strata representing four districts in the Otjozondjupa region and the sample was proportionally distributed to each stratum. Sample power calculation was done to determine the study sample size (381) using the Rao software programme. Multistage stratified random sampling was used in this study. Stage one: All four districts were included in the study and considered as strata. Stage two: All health centres and clinics were selected from each stratum for the study. Stage three: Proportionate stratified random sampling was used to select the clinics and respondents for the study at the facility level. Data were collected through a structured questionnaire with closed-ended questions using the 5 level Likert scale questions for the respondents to indicate their level of agreement to a statement as well as dichotomous questions. The quantitative data were analysed descriptively using Statistical Package for Social Science version 25. Chi-square statistical analysis was applied to establish the association between demographic data as the independent variable, and knowledge, attitude and practices as the dependent ii variables. Pearson correlation was used to determine the correlations between the study variables. The findings of the study revealed that the majority of the respondents (86.7%) scored low on knowledge regarding prevention, screening, and treatment of CC; 90.8% scored neutral level of attitudes regarding screening, prevention and treatment of CC and 32% scored low in terms of the uptake of cervical cancer screening. A conceptual framework was developed using the framework of the Practice-Oriented Theory by Dickoff et al., (1968). Subsequently, an educational programme to enhance the utilisation of cervical cancer services among women of reproductive age living in the Otjozondjupa region, Namibia, was developed. This was done according to the programme development process by Meyer and Van Niekerk (2008), the Cyclic curriculum development model of Nicholls and Nicholls (1972) as well as Kolb’s four stage model experiential learning theory (1984). Knowles’s learning theories will be used to facilitate teaching and learning during the implementation of the educational programme to the reproductive aged women regarding screening, prevention, and treatment for cervical cancer in the Otjozondjupa region. Finally, guidelines to facilitate the implementation and evaluation of the educational programme activities to enhance the utilisation of cervical cancer screening services among women of reproductive age in Otjozondjupa region were identified. Keywords: Knowledge, attitude, practices, screening, prevention, treatment, cervical cancer, reproductive and womenItem Guidelines to facilitate clinical nursing education of nursing students in the training health facilities of Oshana and Oshikoto regions, Namibia(University of Namibia, 2022) Uukule, NdapunikwaThe development of the guidelines was necessitated by the challenges experienced during facilitation of clinical nursing education. To meet these challenges, guidelines are required to serve as a guiding tool for registered nurses in their facilitation roles. Nursing is a practice-based profession; thus, student nurses who are attached to the clinical health facilities need to acquire the necessary clinical skills and competencies in nursing practice under the guidance and supervision of registered nurses. However, despite the teaching responsibility of registered nurses, not all are acquainted with teaching methods since nursing education is not part of the undergraduate nursing curriculum. Moreover, it seems that not all registered nurses hold postgraduate qualifications in Nursing Education or Clinical Instruction that could equip them with the necessary knowledge and skills to facilitate clinical nursing education. This consequently results in inconsistency in the way registered nurses facilitate clinical nursing education in the clinical environment. The purpose of the study was to develop guidelines to facilitate clinical nursing education of nursing students in the training health facilities of Oshana and Oshikoto regions, Namibia. A pragmatism perspective was adopted for this study. A convergent parallel mixed method approach was used to obtain data. The Practice Oriented Theory formed the conceptual framework that guided the study while the ADDIE Model and Ministry of Health and Social Services (MoHSS) framework guided the development of the guidelines. This research study was undertaken in the following three phases: Phase 1: To achieve objectives 1,2,3 and 4 of the situational analysis, a mixed methods research approach with descriptive and exploratory designs. Objective 1: A narrative type literature review was conducted to describe best practices in clinical nursing education. Sources published from 2010, were consulted. The said literature review revealed best practices in clinical nursing education as: effective communication, intersectoral collaboration, stakeholders’ involvement, clinical learning environment, qualities of a facilitator and shared vision. Objectives 2 and 3 aimed to explore and describe the experiences of registered nurses (n= 43), lecturers (n =5) and nursing students (n= 28) on facilitation of clinical nursing education. Data were collected through five (5) focus group discussions with registered nurses and three (3) focus group discussions with nursing students, and five (5) individual interviews with lecturers from the training institution. Participants were purposively selected for these two objectives. Data from focus group discussions and interviews were analysed according to Tesch’s steps of qualitative data analysis. Three themes and twenty sub-themes emerged. The findings revealed that participants (respectively) experienced nursing students’ challenges, registered nurses’ and lecturers’ challenges as well as support system challenges that affect facilitation of clinical nursing education. Objective 4: Focused on assessing the clinical environment where clinical nursing education takes place. For this objective a quantitative and descriptive design was used. Quantitative data were collected using self administered questionnaires from registered nurses (n=172) and nursing students (n=108) who were recruited through simple random sampling. A 5-point Likert scale was used to score various variables. The data were analysed using the Statistical Package for Social Sciences (SPSS) computer software version 25.0. The results showed that there were poor interpersonal relationships, support system challenges and a lack of continuing professional development. Phase 2, focused on the conceptual framework that guided the study. The conceptual framework according to Practice Oriented Theory as proposed by Dickoff et al., (1968) was used. The survey list of Dickoff et al., (1968) was used for this purpose. Thus, the agent was the (researcher, registered nurse, nurse educator), recipient (nursing), dynamic (best practices and challenges), procedure (process followed to develop guidelines) and terminus (developed guidelines). Phase 3, concentrated on the development of guidelines for registered nurses regarding the abovementioned aim. The development of the guidelines was based on research evidence from Phase 1 and guided by ADDIE model and MoHSS framework for guidelines development. Four guidelines were developed to strengthen best practices in clinical nursing education and address the identified challenges. In conclusion, clinical nursing education and facilitation are important components in preparing nursing students for the activities they will perform as registered nurses after graduation. However, this study has demonstrated that there are challenges in clinical practice that need to be addressed as they have the potential to negatively affect the facilitation of clinical nursing education. The study recommended that similar studies be conducted using a broader scope of training health facilities and training institutions in Namibia, to gather more information on clinical nursing education. It vii is further recommended that the facilitation of clinical knowledge and skills be based on theories and research to avoid transferring traditionally outdated nursing knowledge and skills to nursing students. The study also recommended that the developed guidelines be validated and operationalised in the practical setting.Item A model for midwives towards the facilitation of childbirth choices among women in selected public healthcare facilities in Namibia(University of Namibia, 2022) Mlambo, SarahThe facilitation of childbirth-choices is the epitome in rendering patient centred care to ensure that women make informed decisions regarding their care. The rights of women in ensuring decision making and affording women choices regarding childbirth types is critical for the emotional wellbeing of the women and positive birth experiences. In the public healthcare institutions in Namibia, women have no choices but rather have assumed choices and as such they receive no or little information on childbirth types. The objectives of the study were encapsulated in four phases which were: identification and analysis of concepts (Phase one); define, classify and conceptualise concepts as a basis of model development [Phase two]; developing, describing and evaluating the model (Phase three), and developing and describing the guidelines for the model (Phase four). A mixed method approach with a convergent parallel design was used in the study. In Phase one of the study a scoping review was adopted to identify the best practices in the facilitation of childbirth-choices, whereas the qualitative approach with purposive sampling was adopted for the experiences of midwives and women. In addition, a quantitative approach with stratification was applied to identify the different childbirth types in the selected healthcare facilities. Ethical clearance was accorded by the University of Namibia Research Ethics Committee, Ministry of Health and Social Services, the selected healthcare facilities and the sampled research participants. Four participating hospitals, 1446 maternal files, 10 midwives, 12 women and 30 articles formed the sample for the study. Qualitative data were analysed through the six steps proposed by Creswell, and quantitative data were analysed through Statistical Package for the Social Sciences (version 26). The study results were merged (Phase one and two) and they corroborated well together in the discussion of the facilitation of childbirth-choices. In the study, the results showed that facilitation is a process to be done timely and women need to be accorded some reasonable time to decide. In the scoping review, results showed that the facilitation of childbirth-choices should include shared decision making, patient centred care, the implementation of protocols and guidelines at all levels, informed consent or choice and the giving of unbiased information. The experiences of midwives in this study echoed barriers in the facilitation of childbirth choices as they expressed the shortages of staff, timing of information, information sharing as well as cultural influences. Furthermore, midwives shared a lack of provision for childbirth choices as the rights of women were not observed and a lack of women centred care despite protocols and guidelines hence, they are not adhered to. In addition, women in this study iii affirmed that they have inadequate information of the childbirth types and they were unsure and or surprised that they had choices, and lacked shared decision making and childbirth choices. The women also indicated that the timing of the information was late or impromptu, thereby making informed decisions difficult. Moreover, antenatal attendance in this study was 96.7%, with childbirth distribution showcasing vaginal birth 76% and caesarean section 24%. Of the 24% of caesarean sections performed, 10.44% was attributed to repeat caesarean section and 4.77% to foetal distress. In conclusion, a model was developed and described (Phase three) based on the study findings to help in the facilitation of childbirth-choices among women. The developed model was evaluated following the considerations by Fawcett. Guidelines to operationalise the model (Phase four) were developed guided by the study results and best practices. Facilitation is of paramount importance in ensuring that women are involved in the decision making when they have accurate information and with that, they will be able to make informed choices. The right to information and the autonomy of women should not be infringed as this yields positive childbirth experiences. Midwives have the mandate to treat each woman individually hence woman centred care will be attained. Further studies need to be conducted in the private sector as well.Item A model for nurses to facilitate supportive care to men diagnosed with prostate cancer and their families in the intermediate hospital Oshakati: A hospital based approach(University of Namibia, 2022) Salomo, SalomoNamibia appears to have no existing guidelines to facilitate supportive care for men diagnosed with prostate cancer (PCa) in the oncology departments at the Intermediate Hospital Oshakati (IHO). In King et al.’s (2015) opinion it is crucial for healthcare workers involved in delivering care for men diagnosed with PCa and their families to maximise their quality of life through supportive care. The purpose of this study was to develop a model for nurses to facilitate supportive care for men diagnosed with PCa and their families at the IHO. The study adopted a pragmatic worldview to achieve its objectives. In applying a pragmatic paradigm, the researcher adopted a convergent, parallel, mixed methods study, employing both a quantitative, descriptive, cross-sectional and a qualitative, exploratory, descriptive and contextual design. The study was conducted in four phases of theory generation, as proposed by Chinn and Kramer (2018): Phase 1 comprised an analysis of concepts based on five research objectives that correspond with the five elements of the study population, namely, published research materials on PCa, nurses, men diagnosed with PCa, family members of men diagnosed with PCa, and oncology departments at the IHO. Qualitative data were collected by means of a scoping review and in depth, individual, face-to-face interviews with 11 men, 7 family members and 14 nurses in order to explore and describe (1) best practices for the supportive care provided by nurses in the oncology departments for men diagnosed with PCa and their families, (2) the experiences of men diagnosed with PCa of the supportive care received from nurses in oncology departments, (3) the experiences of the families of men diagnosed with PCa of supportive care received from nurses in oncology departments, and (4) the experiences of nurses in facilitating supportive care for men diagnosed with PCa and their families in the oncology departments. A non-probability purposive sampling method was used to select information rich participants. All responses were audio taped and transcribed verbatim. Qualitative data were manually analysed by means of content analysis, using the Tesch’s eight steps of open coding. The following themes and sub-themes were accordingly identified: two themes and eight sub-themes for objective 1, two themes and seven sub-themes for objective 2, two themes and four sub-themes for objective 3, and three themes and six sub-themes for objective 4. Each theme was discussed, verified with direct quotations from the interviews and supported by relevant and appropriate literature. Quantitative data were collected using a five-point Likert scale questionnaire to assess the oncology departments in terms of facilitating supportive care for men diagnosed with PCa and their families. Thirty-five registered nurses answered the questionnaires. Quantitative data were analysed using the Statistical Package for the Social Sciences, version 25 (SPSS-25). The study revealed that men diagnosed with PCa are rarely offered psychological and spiritual support to enable them to cope more successfully with the hardships they face after being diagnosed with the disease. Nurses, for their part, experience various interventions regarding supportive care, as well as a shortage of resources, the lack of a conducive environment and a lack of support, as well as barriers that hinder the facilitation of supportive care for men and family. On the other hand, family members of men with PCa felt devalued in the healthcare system, as they were often excluded from decision-making regarding treatment. The findings also reveal a lack of psychological and spiritual supportive care by nurses for families. In phase 2, a conceptual framework based on Dickoff et al.’s (1968) practice oriented theory and the four main concepts gleaned from the concept analysis (support, physical, social, psychological and spiritual support) was developed. In phase 3 of the study, the model for nurses to facilitate supportive care for men diagnosed with PCa and their families in IHO was developed. The model was developed based on four theories, namely: practice oriented theory, systems theory, holistic theory and the nursing process theory. The model was described in line with the five descriptive components, as proposed by Chinn and Kramer (2018), namely, purpose, concepts, definitions, relationships, structure and assumptions. Each component of the model was described in terms of the way it contributes to the purpose of the model. The model was evaluated in accordance with the criteria for evaluating the nursing model, as proposed by Fawcett (2005) and Parse (2005). In phase 4, guidelines for operationalising the model were developed to provide direction for nurses and members of the multidisciplinary team involved in the model facilitation process. The guidelines were developed in terms of aims and activities to address the challenges and barriers that hinder the facilitation of supportive care for men diagnosed with PCa in health facilities. Based on the study findings, recommendations are made in terms of nursing practice, nursing education, and nursing research.Item Development of strategies for registered nurses to facilitate services rendered by community health workers in Hardap, Kavango east and Khomas regions, Namibia(University of Namibia, 2022) Black, Sofia HansteinWith the adoption of the community health worker programme, the primary health care directorate of the ministry of health aimed at delivering family and community-centred promotive, preventive, rehabilitative and basic curative services to all citizens of Namibia. The programme’s services focused on preventive and promotive infant and under-five-year-olds’ health care, maternal and neonatal health care, adolescent and youth-friendly health services, human immunodeficiency virus and acquired immunodeficiency syndrome and tuberculosis prevention, social welfare and disability prevention. However, no functional unit with its own ideal structure for monitoring and facilitation of community health workers’ services was established. The latter resulted in the programme experiencing challenges with the planning of facilitation strategies that would enhance the programme’s effects. The overall purpose of the study was to investigate the effectiveness and functionality of facilitation (mentoring, supervision, monitoring, evaluation and training) by the registered nurses to the community health workers deployed by the ministry in the Hardap, Kavango East and Khomas regions of Namibia. It was also to develop strategies for registered nurses to facilitate services rendered by CHWs based on Standard Operating Procedures Guidelines of primary health care. This study was conducted in a quantitative and qualitative nature, thus a mixed methods approach in five phases. Phase1 being a situational analysis, phase 2 conceptual framework development, phase 3 strategy development and phases 4 and 5 comprising testing the implementability and preliminary evaluation of the developed strategies in the Khomas region. The study was conducted within a pragmatist paradigm, which employed the quantitative research approach, exploratory, descriptive, and non experimental designs. At the same time, it was interpretive, employing a qualitative phenomenological, exploratory, contextual and descriptive research approach to understand recipients’ experiences. Four groups of respondents (138 community health workers for the quantitative design, three primary health care supervisors, 10 registered nurses and 64 community health workers for the qualitative design) were used to learn their responses and experiences. Structured questionnaires were completed for the quantitative part, while eight focus group discussions were performed with community health workers. Unstructured in-depth interviews were conducted with registered nurses and primary health care supervisors until data saturation. The main challenges that were identified from the situational analysis include, inadequate and infrequent facilitation of community health workers’ services, negative perceptions on facilitation of community health workers’ services and insufficient communication among implementers. Furthermore, the findings indicated lack of feedback and training, lack of supportive supervision, monitoring and evaluation and poor management of the community health worker programme. The findings shaped the basis for the conceptualisation in phase 2. Key findings from the mixed methods research were linked to the practice-oriented theory of Dickoff, James and Wiedenbach (as cited in Chinn & Kramer, 2015). The practice-oriented theory consists of concepts such as agent (the researcher), the recipient (registered nurse who will primarily be introduced to the developed strategies and community health workers who will benefit from registered nurse knowledge on strategies) as well as the context (health facilities where the developed strategies are to be used and communities where community health workers are deployed and where facilitation will take place). In this study, dynamics refer to the challenges that registered nurses experience in facilitating services rendered by community health workers. Procedure refers to the process followed by the agent in the development of strategies for effective implementation of the community health worker programme. The terminus refers to facilitators and supervisors who utilise the developed strategies to facilitate the services rendered by community health workers, ensure the community health worker programme is managed appropriately and functioning optimally, and that community health workers are receiving in-service training and are satisfied with the facilitation of their services. Phase 3 dealt with the development of the strategies for facilitators of the community health workers. The researcher used the findings from the situational analysis (phase 1) and the survey list of Dickoff et al. (as cited in Chinn & Kramer, 2015) as the reasoning map. The Standard Operating Procedure Guidelines of the ministry of health (Ministry of Health and Social Services, 2014) supplemented the information of the five strategies. Phase 4 aimed at determining implementability of developed strategies in the Khomas region, as there were limitations to determining implementability in the Hardap and Kavango East regions. This was done to authenticate and ensure accessibility of developed strategies. The researcher made use of national and international professionals who were experts in the field of community health workers. During phase 5, a preliminary evaluation of the strategies was done in accordance with the criteria proposed by Chinn and Kramer (2011), namely clarity, simplicity, generality, accessibility and importance. The researcher achieved this by conducting a two-day discussion workshop during which attendees gave their comments and inputs. The study recommends that districts construct a supervision structure and deploy a knowledgeable enrolled nurse to provide frequent, supportive supervision to community health workers. Furthermore, the researcher recommends compulsory attachment of community health workers to outreach teams. Another recommendation proposed is the strengthening of advocacy within the community.Item An educational programme to support the caregivers of adolescents living with HIV regarding disclosure in Oshikoto region, Namibia(University of Namibia, 2021) Ikeakanam, Ottilie Tangeni Omuwaln 20 l 7 about 1.8 million adolescents, between the ages of 10 and 19, were living with human immunodeficiency virus (HIV) worldwide, acco unting for about 5% of all people living with HIV and about 16% of new adult HIV infections. Adolescents living with HIV (ALHIV) present a significant proportion of new infections of HIV in Namibia as well. The caregivers of ALHJV are faced will the difficult decision of when, and how to inform their children of their HIV status. The purpose of this study was to explore and describe the experiences of caregivers of ALHIV regarding disclosure in Oshikoto region, Namibia. The study included the development of an educational programme to support such caregivers and to facilitate their disclosure practices. This was a qualitative, descriptive study with an explorative and contextual design. The findings were that caregivers of ALHIV experienced barriers to disclose HIV status to ALHIV; they experienced emotional trauma, and experienced mixed fee lings related to adolescents ' diagnosis with HIV. Caregivers experienced resistance from ALHIV to take antiretroviral therapy (ART). However, the study found that non- biological parents are at ease to care for ALHIV, because they are probably less emotionally attached to the child. The findings were used to develop an educational programme to support the caregivers of ALHIV regarding disclosure. The educational programme was implemented and evaluated in the final phase of the study and indicated that the educational programme has a potential to help caregivers of ALHIV regarding disclosure of their status. Recommendations from the findings are that there are needs for a more large scale introduction of healthcare workers to support caregivers regarding disclosure of HIV status to ALHIV for healthy living of adolescents concerned. Additionally, the study recommended further studies on evaluation of the effectiveness of the educational programme and the role of the family characteristics in disclosure practices.Item An Employee Assistance Programme (EAP) to support midwives affected by maternal deaths and stillbirths in Khomas region, Namibia(University of Namibia, 2022) Endjala, TuwilikaGlobally, Employee Assistance Programme (EAP) has become a vital workplace programme that assists employees in managing personal and work-related problems. EAP aims to provide midwives with the ability to cope with the demands of their professional and private lives through various mechanisms. EAPs can play an essential role in helping midwives and their family members balance work and personal life demands whilst supporting employers' goals towards improved and continuing levels of workplace productivity. Since midwives work autonomously, they are inherently exposed to traumatic situations, such as Maternal Deaths (MD) and Fresh Still Births (FSB), which may occur daily due to the nature of their work. However, this programme is considered a neglected component in attempts to uphold and improve midwives' wellbeing in the midwifery profession as there is limited literature for Namibia. Therefore, this study targeted the Khomas Region because it has the highest MD and Stillbirths (SBs) in Namibia. The study aimed to develop an EAP that supports midwives affected by maternal deaths and stillbirths in the Khomas Region. The study was conducted with a pragmatic worldview at two public referral hospitals in the Khomas Region. The study was based on a mixed method approach that includes a convergent parallel design in which the qualitative part used a descriptive, exploratory and contextual design. In addition, the quantitative part used cross sectional design. The study was conducted in three phases: Phase 1 comprised of situational analysis based on the four objectives that correspond with the study population: midwives. Qualitative data was collected to explore and describe midwives' experiences affected by MD and FSB using Focus Group Discussions (FGDs) and individual interviews. Four FGDs and four individual interviews were conducted with midwives from two state hospitals. Midwives were purposively sampled, and a total of 29 midwives participated in the qualitative part of the study. FGDs and individual interviews were audiotaped and transcribed verbatim. Qualitative data was analysed using content analysis and coded using Tech's steps of open-coding. Five themes and 21 sub-themes were identified. In addition, quantitative data was collected using a questionnaire to determine the occupational exposure of midwives to MD and FSB, evaluate the self-reported level of stress among midwives due to exposure to MD and FSB, and to determine the coping mechanism used by midwives to cope with MD and FSB in the absence of EAP. Since the population was small, a total population sampling was used (n=140). Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 27 and SPSS AMOS version 23. The study showed that the midwives experienced varied challenges such as MD and FSB effects on midwives, high exposure to MD and FSB with inadequate professional and environmental support, death distress among midwives, and difficulties related to the emotional versus problem focused coping mechanism. The study’s phase 2 conceptualised the findings from phase 1 and led to the development of the study's conceptual framework based on the Practice Theory by Dickoff, James and Wiedenbach (1968) survey list components such as agent (the researcher, counsellor and management), recipient (midwives), context (health facilities), dynamics (challenges hampering the successful development of an EAP), procedure (EAP and implementation strategies developed) and terminus (the ability of midwives to cope with MDs and FSBs). In addition, Phase 3 of the study developed an EAP to support midwives affected by MDs and SBs in the Khomas Region. The EAP was developed according to Lokanadha and Mohan (2010) Quality of Work Life Model. The programme description includes a philosophical basis, aim, principles, objectives, approach, the content of EAP/activities, expected outcome and evaluation of the process. The implementation strategies for the programme were also developed according to Howe's (2011) Compass Aligned Performance System (C@PS) model which is a strategic management tool simplify the strategies and plan to implement designed strategies. Four strategies were developed, and these are the provision of support services to midwives through EAP at the workplace, training of midwives on how to deal with MD and FSB, motivation of midwives through a visible support system from management and training of supervisors on the EAP, and how to make referrals. A team of experts verified the EAP and implementation strategies after development. Based on the findings, it is concluded that MD and FSB affect midwives, high exposure, high death distress, and midwives use various coping mechanisms, hence the need to address these challenges. The study made recommendations based on the study findings for practice, education and future research. It is further recommended that hospitals in the Khomas Region implement the EAP to support midwives on how to cope with MD and FSB.Item A transition support programme to facilitate the competencies of newly qualified registered nurses at public hospitals in Namibia(University of Namibia, 2021) Emvula, OliviaGlobally, competencies among newly qualified registered nurses (NQRNs) during transition have been described as a worldwide concern. Health care systems are becoming more demanding with patients and communities becoming more aware of their rights to health care. Therefore, NQRNs are expected to be competent to deliver quality and safe care. It is, therefore, important that transition support programmes are put in place to provide a baseline for the guidance and support of newly graduated nurses. The study was aimed at determining the competence of NQRNs and to develop a transition support programme to facilitate their competencies at public hospitals in Namibia. The objectives of the study were: to determine and describe the self-reported competence of newly qualified registered nurses, determine and describe the views of newly qualified registered nurses competence as rated by their unit managers, to develop a conceptual framework that informs the development of the programme, to develop the transition support programme to facilitate the competencies of newly qualified registered nurses, and to propose guidelines regarding the implementation of the programme. The study was conducted in three phases. Phase one was a situational analysis, followed by the development of a conceptual framework in phase two, and the development of the transition support programme in phase three. A quantitative approach with descriptive, analytic survey design was followed. Data were collected from the two study populations by means of questionnaires. Data were analysed using the Statistical Package for the Social Sciences software, version 24. The study findings were as follows: In relation to professional, ethical and legal competencies (domain 1) of NQRNs, the different items reviewed on the NQRNs indicated that they were not completely competent in this domain. Similarly, the responses from unit managers supported these responses, with the unit managers indicating that NQRNs were not completely competent in the professional, legal and ethical domain, but rather possess basic competencies. Findings on domain 2: Knowledge-based practice This domain summarised the clinical competencies of NQRNs in relation to the provision of nursing care based on knowledge base practice. This study revealed that NQRNs are not completely competent in most clinical areas, but rather possess basic or adequate knowledge. Findings on Domain 3: This domain reviewed the NQRNs competencies in management and leadership. The findings reveal that NQRNs are not completely competent, but rather possess either basic or little knowledge. Recommendations were made to the Ministry of Health and Social Services (MoHSS), education institutions, and suggestions for further research were made based on the study findings.Item Optimizing Tuberculosis treatment success rates in Namibia(2019) Kibuule, DanTuberculosis (TB) is a leading cause of mortality globally, leading to an annual death rate of 1.8 million. In 2017, over 700 people died from TB in Namibia. Moreover, despite the scale-up of high-quality Directly Observed Treatment Short Course strategy (DOTS) to control TB in Namibia, treatment success rates (TSR) fall short of the global target of 90%. Unsuccessful treatment outcomes are a risk drug resistant TB. Consequently, the study aimed to model the population, patient and drug (pharmacokinetics and pharmacovigilance) level predictors of treatment success, cure and completion rates under the DOTS programme in Namibia. The study was designed in four phases, population, and patient and drug level models, and an overall conceptual model to optimize TSR. Population-level modeling of the effectiveness of the community based-DOTS on TSR, cure and completion was done using interrupted time-series analysis. Three patient level models of TSR, loss to-folow-up (LTFU) and case fatality rates for a 10-year nationwide cohort, 2004-2016 were conducted using multivariate regression in R. Two drug level studies, i.e. a meta-analysis of the impact of HIV/TB co-infection on serum concentrations (Cmax) of rifampicin, isoniazid, pyrazinamide and ethambutol, as well as a systematic review on the burden of adverse effects were modeled. First, the CB-DOTS intervention in 2005, immediately increased annual TSR by 12.9% (p <0.001) and then by 1.1%/year thereafter, but stagnated at ~85% by 2015. Secondly, the independent predictors for TSR were region of DOTS implementation (p=0.001); type of Workbased DOT supporter (p<0.001), sputum conversion at 2 months (p=0.013); cotrimoxazole prophylaxis OR= 0.4(95%CI: 0.2, 0.7, p=0.002); HIV co-infection OR=0.2(95%CI: 0.1, 0.5, p=0.001) and the DOT regimen (p<0.001). Thirdly, the annual decline in cases LTFU was significant between the first (2005-2010) and second (2010-2015) medium term plan periods for TB programme implementation (p=0.002).The independent predictors of LTFU were male sex (p=0.004), 15-24 age group (p=0.03), provider of treatment (p<0.001), intensive phase (p=0.047) and living in border/transit regions (p<0.001). Fourthly, the independent predictors of TB case-fatality under the DOTS programme were HIV coinfection OR=0.2 (95%CI: 0.1, 0.4, p=0.001) and the non-assessment of drug resistant testing using a GeneXpert, OR=3.4 (95%CI: 1.6, 7.5, p=0.003), region of DOTS implementation (p<0.001), patients age (p<0.001) and cotrimoxazole prophylaxis (p=0.013). Fifthly, the meta-analysis showed that HIV/AIDS significantly lowered Cmax of rifampicin -1.11μg/mL (95%CI: -2.18, -0.04, p=0.04, I2=0%) and ethambutol -0.75 μg/mL (95%CI: -1.38, -0.13, p=0.02, I2=0%) in the African population. Lastly, upto 69% of hospitalized patients experienced at least one adverse events, mainly of Type-A (i.e. predictable adverse drug reactions, range 9% to 69%). The frequency of adverse reactions was higher among TB patients with; HIV co-infection (78.5%, p=0.003), low baseline body weight (p=0.002), ART (76.2%, p=0.012) or cotrimoxazole prophylaxis (78%, p=0.005). A conceptual model for optimizing TSR was developed. We conclude, current DOTS programme though effective, is inadequate to optimize TSR and end TB by 2035. HIV/TB co-infection is main predictor of poor TSR at population, patient and drug level. Programmatic (i.e. access to bacteriological and drug resistance testing, quality of DOTS services by region), clinical (HIV/TB coinfection) and social-economic (quality of DOT supporter and young/middle aged males). The comprehensive integration of TB/HIV services as well as targeted programmatic, clinical and treatment interventions are required to enhance DOTS treatment success in Namibia. Further efforts are needed to individualize dosage regimens with rifampicin and ethambutol, and monitor Cmax in HIV co-infected patients in Africa to improve treatment outcomes.Item A psychosocial educational programme to facilitate the reintegration of incarcerated women who had dumped babies and/ or committed infanticide in Namibia(University of Namibia, 2015) Ndempavali, SumpiBaby dumping and infanticide have become a social phenomenon with severe consequences that are drawing nationwide attention and condemnation in Namibia. Those women who are perpetrating these heinous acts provide numerous motives; such as fathers denying paternity, unemployment, young mothers who still want to continue with school, as well as a lack of awareness about institutional care, foster homes, and formal adoption. These young incarcerated women before and after having dumped their babies and / or committed infanticide, are psychologically and emotionally traumatised. That left them fearful to be reintegrated into the society upon release, hence the need for a psychosocial educational programme to facilitate their reintegration. In this study, the researcher explored and described the views of women who had dumped babies and / or committed infanticide with regard to their experiences with the purpose of developing, implementing, and evaluating an educational programme to facilitate their reintegration upon release with their families and with society in general in the Oshana Region, Namibia. The study was qualitative, explorative, descriptive, and contextual in nature and was conducted in four phases, namely: Phase 1: This phase comprised a situational analysis. It was carried out to explore and describe the lived experiences of women who had dumped and / or committed infanticide. The researcher used in-depth unstructured individual interviews for data collection and data was analysed by using Tech’s method of qualitative data analysis. The findings of this study identified psychological challenges, fear for reintegration, socio-economic challenges, as well as legal and ethical challenges that were encountered by women who had dumped babies and / or committed infanticide. These findings led to the development of the psychosocial educational programme to address those challenges. Phase 2: During this phase, the conceptualisation framework guided the development of a psychosocial educational programme that facilitated the reintegration process of women who had dumped and / or committed infanticide. Dickoff, James and Wiedenbach (1968) identify the following three essential ingredients of a conceptual framework; namely, goal content, which is specified as the aim of the activity, prescription of the activity for goal realisation, and a survey list that accompanies the presentation of the prescription for the activity in terms of the goal realisation. The educational programme included the activities suggested in the survey list of Dickoff et al. (1968); namely, agent, recipient, context, dynamics, procedures, and terminus. Phase 3: This phase focused on the development of a psychosocial educational programme to facilitate the reintegration process of women who had dumped their babies and / or committed infanticide. The survey list of Dickoff et al. (1968) was adopted as a reasoning map in the construction of the development of a psychosocial educational programme, as well as the findings of the situational analysis of this study. Phase 4: This phase focused on the implementation and evaluation of the psychosocial educational programme that was developed to facilitate the reintegration of incarcerated women who had dumped babies and / or committed infanticide. A three-day training workshop was held at the Oluno Correctional Facility to conduct the educational programme. The educational programme was evaluated in order to validate whether the programme interventions were likely to bring about the desired change among the participants. The evaluation of the programme was conducted immediately after every session and at the end of the training programme. The programme outcomes evaluation was carried out three months after the educational programme had been implemented. The programme participants commented that the programme implementation was useful, as well as informative and educative. Conclusion: The study contributes to the body of knowledge in public health. This study emphasises that the young women who commit heinous crimes of baby dumping and infanticide are often immature and inexperienced leading to situations that force them to make decisions that are not often the best ones. The general insight includes the realisation that most of these young women commit these crimes at the spur of the moment and the root causes are well-known. These root causes include such factors or reason as tradition because some young women fear rejection by their communities or family if they are found to have had a baby outside of marriage. The economic state of the young mothers and their male partners who are denying paternity also contribute to baby dumping cases, since they are not able to raise a baby on their own. As a matter of fact, women who have dumped babies and / committing infanticide are subjected to physical, social and psychological wretchedness, and socio-economic destitutions. These women find themselves incarcerated as a consequence of the atrocious acts they have committed while they are fearing the reintegration with their families and communities as result of rejection. However, an educational programme can be effective to facilitate the reintegration of the incarcerated women with the purpose of overcoming their feelings of fear and rejection. In conclusion, the study also highlights the need for research about the challenges of male partners’ responsibilities to accept paternity, since these challenges are one of the major reasons why women dump babies and / or commit infanticide. Recommendations: The study recommends that the findings of the study be used or be incorporated in the curricula for training purposes. The main objective of the Namibian Correctional Services (NCS) is to rehabilitate offenders, and a competent staff complement is a key factor to achieving this objective. Therefore, it is recommended that the Ministry of Safety Security invests more in staff training and development in order to effectively impact the education and the training in the prison system. Another recommendation was for the upgrading of the knowledge of the correctional officers to keep themselves abreast with all correctional educational programmes. Furthermore, these recommendations might decrease recidivism of women who dump babies and / or commit infanticide after they have been released to be reintegrated into the society.Item An educational programme to support registered nurses during clinical supervision of student nurses in medical and surgical wards at a training health facility in the Oshana region, Namibia(University of Namibia, 2015) Neshuku, HannaThe provision of appropriate clinical supervision to nursing students is acknowledged to be problematic for a variety of reasons; i.e. inadequate staffing levels, heavy workloads, poor communication, and a shortage of materials. Furthermore, the need to initiate and assess a more suitable supervision programme to support supervisors is imperative. In this study, the researcher explored and described the views of registered nurses and nursing students about their experiences of clinical supervision of nursing students in medical and surgical wards with the purpose of developing, implementing, and evaluating an educational programme to support clinical supervision of nursing students in the medical and surgical wards at a training health facility in the Oshana region, Namibia. The study had been designed to be qualitative, explorative, descriptive, and contextual in nature and was conducted in four phases. Phase 1 comprised a situational analysis and was carried out to explore and describe the lived experiences of registered nurses and nursing students about the clinical supervision of nursing students in medical and surgical wards. Data was collected through in-depth individual interviews. Data was analysed according to Tech’s method of qualitative data analysis. The findings revealed the managerial and educational challenges that registered nurses and nursing students encountered; hence the need for registered nurses to support the facilitation of effective clinical supervision for nursing students Phase 2 dealt with the conceptualisation of a framework to guide the development of an educational programme to support registered nurses during the clinical supervision of nursing students. Phase 3 focused on the development of an educational programme to support registered nurses during clinical supervision of nursing students. The development of the programme had been guided by the findings of the situation analysis of this study, as well as by the survey list as suggested by Dickoff and Wiedenbach (1968). Phase 4 comprised the implementation and evaluation of an educational programme that had been developed to support registered nurses during clinical supervision. A two-day training workshop was facilitated at a training institution (UNAM Oshakati Campus) to support registered nurses who were supervising nursing students in medical and surgical wards at health facilities of the Oshana region during their course of study. The workshop was attended by registered nurses (registered nurses at a training health facility (UNAM Oshakati Campus) and a training hospital (Oshakati Intermediate Hospital) in the Oshana region). The evaluation of the programme was conducted immediately after the implementation of sessions with the aim of assessing the feasibility of the programme implementation. The programme outcome evaluation was conducted three months after the implementation of the programme. The programme implementation was recommended as useful and supportive by the participants while the programme outcome evaluation revealed that as a result of the programme intervention there was a marked positive change in clinical supervision of nursing students.Item Investigating the need for a home-based health care programme in support of the parents/ caregivers of children diagnosed with heart disease in the rural areas of Namibia(2013) Amakali, KristofinaThe incidence of congenital heart disease (CHD) has been reported to be 8 out of 1000 live born infants worldwide. Accordingly, congenital heart defects and rheumatic heart diseases contribute to approximately ten percent (10%) of all paediatric admissions to health care facilities in Namibia as compared to the proportion of diarrheal (3%) and acute respiratory infection (3%). Congenital heart diseases account for 9% of neonatal deaths in Namibia (WHO 2006; WHO 2009). Clearly, the situation in Namibia is grave as regard to profile of heart diseases among children. The majority of children with heart disease are from the rural areas. If they are not acute sick, the majority of these children often receive treatment as outpatients and their parents/caregivers are expected to cope with the demands of caring for these children at home. Taking care of a child with a heart disease at home is daunting task for the parents and the caregivers as extreme vigilance on their part is required. However, this degree of vigilance cannot be realized by the parents of children with heart diseases who are from the rural areas in Namibia, because there is no support system in place to enable them to cope with the demands of caring at home. The aim of this study was to explore and describe the lived experiences of their parents/caregivers as regard caring for a child with a heart disease at home and the experience of living with heart diseases by the children with the purpose to identify the needs for facilitation of coping with the demands of caring and to develop a home-based health care programme to facilitate coping with such a situation. A qualitative, exploratory, descriptive, contextual and phenomenological study was conducted to describe the participants’ experiences, identify need for assistance and assess the possibility of remedial actions to help parents and caregivers cope with caring at home. The study was performed in three sequential research phases. Phase I involved the situational analysis through the description of the participants experiences of caring for a child with a heart disease and of living with a heart disease respectively. Phenomenological data was collected from a purposefully selected sample of 5 multiple cases of parents/caregivers and children with heart disease from the rural areas in Namibia. The data was collected by means of in-depth interviews, field note and the pictorial naïve drawings by the child participants until data saturation was reached. The data were analysed using the Tesch method of qualitative data analysis. The findings revealed that the parents/caregivers were struggling to cope with the demands of care and, hence, there was a clear need to empower them so as to facilitate their coping. Phase II involved the conceptualisation of the research and the development of a homebased health care programme. Accordingly, a home-based, health care programme, which encompassed multi-component interventions to facilitate coping, was developed for the parents/caregivers and the children concerned. Phase III involved the implementation and evaluation of the programme at the households of the study participants. A two-day workshop was facilitated at each household in order to implement the programme interventions. The programme outcome evaluation was conducted three months after the programme implementation with the findings of the evaluation indicating that the programme interventions has, indeed, empowered the parents/caregivers to cope with the demands of care. In conclusion, the experiences of poor coping on the part of the caregivers of children with heart diseases from the rural areas in Namibia calls for innovations from both health care providers and other social systems to support the caregivers and enable them to cope in providing home acre to their children with heart disease. In this regard, the recommendations were made with regard to health care providers to implement contextualised health education to the parents/caregivers of children with heart disease to enable parents/caregivers to continue with palliative care at home, the inclusion of interventions contained in this programme in the health care programmes at the district level of health care delivery and the provision of social grant to children diagnosed with heart diseases whose parents/caregivers are economically vulnerable.Item An educational programme to facilitate reflective practice for registered nurses in training hospitals in Windhoek(2013) Nelumbu, Lucia N.Illness is an evitable part of life for the vast majority of people. The nurses’ reactions to people who are ill or who are in need of health care are influenced and shaped by their own personal qualities, such as sensitivity, understanding and honesty as well as the professional attributes, skills, competencies, attitudes and cognitive abilities necessary for effective practice. Problems or incidents occurring in clinical settings are often seen as indicators of poor nursing care and even indicators of a lack of reflective practice skills. The purpose of the study was to explore and describe how reflection is practised by registered nurses. The objectives of the study were to explore and describe how reflection is practiced and conceptualised by registered nurses in Namibia. A qualitative, explorative, phenomenological, descriptive and contextual approach was used. Data were collected from the population, including all registered nurses purposively selected from different disciplines in training hospitals, through in-depth interviews. The data were analysed according to themes based on the ideas of Tesch’s model, and revealed inadequate knowledge of reflective practice among registered nurses as they only expressed the execution of their daily activities without paying attention to how they reflect in daily practice Hence the reflective practice programme was developed and implemented to offer knowledge and skills to effectively address the clinical challenges which registered nurses may encounter in terms of reflection. The evaluation of the programme was conducted sixteen weeks (4 months) after the programme implementation, with the overall results showing that reflective practice would assist registered nurses to think critically and to engage in reflection upon professional practice activities that would lead to the improvement of their performances. The main recommendations made were among others, that nursing education in Namibia must make reflective practice a compulsory competency of registered nurses and all health care providers, and should be included in the curriculum of all student nurses.Item Self-assessment programme for operating room professional nursing practice in Namibia(2008) Kloppers, Alfreda R.Abstract provided by authorItem Strategies to facilitate application of sociology of development to nursing practice(2008) Shikongo, Katrina-KaunaNursing practice is a living body of knowledge derived from different disciplines, i.e. biological, psychological and social. From the social sciences, Sociology of Development is one of the sources of knowledge used in nursing practice