Research Articles (CHNS)

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Assessment of the needs of student nurses regarding critical thinking in nursing practice
(2016) Pretorius, Louise; Van Dyk, Agnes; Small, Louis F.; Amukugo, Hans J.
This study involved a quantitative, quasi-experimental and contextual design. The target population for this phase was senior student nurses registered at the University of Namibia, in their fourth year of nursing studies in the training hospitals of Windhoek and Oshakati. A total of 46 fourth-year nursing students, registered at the Faculty of Medical and Health Sciences in the Department of Nursing, were included for phase 1 except for the two students who took part in the pilot study. The students were from both campuses, namely the Windhoek and Oshakati campuses, doing the four-year Diploma in Comprehensive Nursing curriculum, which incorporates the principles of critical thinking. An imaginary case scenario was developed for students to analyse and answer some relevant questions to enable the researcher to determine the level of understanding and integration of critical thinking. In this study each student’s answers were deductively analysed by calculating central values, more specifically the mean for each question, to determine their application of critical thinking skills in the management of a nursing problem The researcher has, with literature support, arrived at “umbrella” concepts, namely the most important concepts that nurses in Namibia need and without which they cannot practice. These umbrella concepts are to be included in the educational programme.
A conceptual framework as basis for the development of a psychosocial educational programme to facilitate the reintegration of incarcerated women who had dumped babies and / or committed infanticide
(2016) Sumpi, Ndempavali; Amukugo, Hans J.
This paper focuses on the conceptualization the research findings and literature control with regard to the experiences of women who have dumped babies and / or committed infanticide. Eleven unstructured individual interviews were voice recorded and transcribed verbatim. The researcher used a systematic approach to analyse the transcripts and field notes using Tesch’s open qualitative data analysis method Based on the findings of the main themes of the study, four central concepts emerged from those themes; namely psychological factors, socioeconomic factors, the reintegration process, as well as a legal and ethical framework. Through consultation and member checking, it was concluded that an educational programme was suitable to prepare and support the women who had dumped babies and / or committed infanticide. The educational programme entailed the management and understanding of the psychosocial aspects, socioeconomic aspects, reintegration process, as well as the legal and ethical aspects of the women. These women are members of the society irrespective of the magnitude of the crime they had committed. The conceptual framework forms the basis of the development of the training programme for women who have dumped babies and / or committed infanticide. The description in this conceptual framework is in accordance with the reasoning map that is based on the survey list outline by Dickoff et al. (1968).
Deliverance of the adolescent friendly health service standards by nurses in Otjozondjupa region of Namibia
(2017) Muyenga, Marry L.; Amakali, Kristofina; Wilkinson, Wilma
Despite the implementation of the national standards for Adolescent Friendly Health Services (AFHS) towards the prevention among others teenage pregnancy the, problem continues to rise across the regions of Namibia. This article presents the findings of a quantitative, cross-sectional, descriptive, analytical study regarding the implementation of the components on Adolescent Friendly Health Care Providers and the Adolescent Friendly Environment of the Adolescent Friendly Health Services standards by nurses in Otjozondjupa Region of Namibia. Quantitative data were collected from 12 registered nurse midwives and 23 enrolled nurse-midwives who implement the AFHS at the health care facilities (through structured self-interview questionnaire) and 18 health care facilities that implement the AFHS in Otjozondjupa Region (through checklist) for triangulation of the data. The data were analysed using the SPSS Version 16 data base. Descriptive and inferential statistics were performed on selected variables to determine the relationship of variables. The findings indicated that only 30% of the registered nurse-midwives compared to 75% of the enrolled nurses who implement the AFHS were formally trained in adolescent reproductive and sexual health issues. The findings further indicated that although 75% and 87% of the respective categories of nurse respondents indicated that they conduct school outreach activities, the initiative seems not being implemented effectively as can be inferred from only 14% of the registered nurse who indicated that they do conduct health education at schools. In the same vein, 90% of the health facilities had no spaces that were designated for the adolescent health services. Therefore, the recommendations were made in respect of the implementation of these two components of the AFHS standards at the health care facilities in the region.
Description of a model to facilitate male involvement in the reproductive health context by the registered nurses
(2016) Amukugo, Hans J.; Jooste, Karen; Nangombe, Julia P.
The aim of this article is to describe a model to facilitate male partner involvement in the RH context. The findings in chapter 3, step1 – concept analysis – which comprised the identification, definition and classification of concepts and the construction of an interrelationship between concepts and statements (chapter 4), formed the basis for the development of this model. This model to facilitate male partner involvement in RH is based on the theory generation of Chinn and Kramer (1991). The central concepts are defined by using the rules described by Rossouw (2000/1,) and Copi and Cohen (1996). Lastly, the model evaluation has been done in accordance with the method of Chinn and Kramer (1991).
Description of a quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia
(2016) Nangombe, Julia P.; Amukugo, Hans J.
The aim of this paper is to describe the quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia. The Practice Oriented Theory of Dickoff (1968) was used as practical guidelines to develop the conceptual framework. This framework was employed during the research and the educational programme development process. During the research process, the agent was the researcher; recipients (Managers/leadership and health professionals); the context (MoHSS head office and healthcare facilities); dynamics (findings for objective one and two); Procedure (research process) and terminus (foundations for development of educational programme). For the educational programme developing process, agent (quality specialist), recipients (health professional), context (health facilities), procedure (training programme for health professionals), dynamics, (challenges hampering successful implementation of the programme) and the terminus (knowledge, skills and abilities acquired through the training programme). During the development of the quality improvement training programme, two main theories were adapted. The most prominent one was a model by Meyer and Van Niekerk (2008), which was adapted to guide the process of developing the training programme. Kolb’s experiential learning theory was used to explain the learning process and styles of developing knowledge through experiences. The content of the training programme was derived from five main themes, 17 sub-themes and the conceptual framework based on the situation analysis about challenges faced by the health care facilities. The five themes were lack of implementation of policies and guidelines; inadequate resources; lack of interpersonal relationships; inadequate understanding of quality assurance and quality improvement; and inadequate research to provide evidence-based information during treatment and patient care. The educational programme consisted of the purpose / aim, objectives, structure / design, facilitation process, implementation process, and evaluation of the programme.
Description of an educational programme developed to support registered nurses during clinical supervision of student nurses in medical and surgical wards in a training health facility: Namibia
(2016) Neshuku, Hanna; Amukugo, Hans J.
This paper describes an educational programme interventions developed to support registered nurses during the clinical supervision of student nurses in the medical and surgical wards of a training hospital in the Oshana region, Namibia. The programme developed contained the purpose and goals of the programme, programme objectives, programme structure, processes and approaches. The programme catered for the following themes: Managerial challenges, educational challenges and non-conducive environment as was experienced by registered nurses and student nurses in order to support them during clinical supervision. It includes the activities to address managerial challenges as identified to be affecting the clinical supervision of student nurses; this is to address educational challenges identified during clinical supervision of student nurses. Furthermore, the programme contains activities focused on providing registered nurses with knowledge and skills on clinical supervision, in order to increase their understanding and competence about the clinical supervision of student nurses. Another activity included interventions for enhancing positive interpersonal relationships and good communication skills to improve effective interactions between registered nurses and student nurses. This study made it possible for the development of an educational programme that enable the registered nurses to receive the much needed information pertaining to the clinical supervision of student nurses, and served as a guide and support tool when carrying out clinical supervision of student nurses. In conclusion the study was justified as an original contribution to the existing body of knowledge in general health nursing science.
Development for a quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia
(2016) Nangombe, Julia P.; Amukugo, Hans J.
The paper describes the steps followed in the development of a quality improvement training programme for health professionals. This was echoed by the facts that the health professionals are facing in their quest for quality health care delivery. In Namibia, most health care facilities have not been yielding good results in response to patients’ health care needs. Health care dynamics are complex and inundated with several factors; among others new methods, speed of improving medical science and technology, as well as increasing demands of the clients to address emerging and re-emerging diseases. In order to achieved that the five phases of programme development by Meyer and Van Niekerk (2008) were modified to facilitate the programme development. Quality improvement training for health professionals. Those five phases were situational analysis; conceptual framework; developing of the training programme; development of the guidelines for the implementation; and Evaluation of training programme.
The development of a psychosocial educational programme to facilitate the reintegration of incarcerated women who had dumped babies and / or committed infanticide
(2016) Sumpi, Ndempavali; Amukugo, Hans J.
This paper focused process followed 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 development of the educational programme established was based on the survey guide suggested by Dickoff et al. (1968) namely agent, recipient, dynamic and terminus. According to the data analysis, the women who had dumped babies and / or committed infanticides were experiencing psychological and socioeconomic challenges, as well as reintegration, legal, and ethical challenges. The researcher decided to develop a psychosocial educational programme to address those challenges. The educational programme was also designed to meet the needs of women who had dumped babies and / or committed infanticide and to equip them with competencies; such as skills, knowledge, attitudes, and values to manage the psycho-social aspects and to facilitate their reintegration. The educational programme comprises, the aim of educational, objectives, contents of an educational programme educational approaches, programme development process, evaluation of an educational programme.
Development of an educational programme to facilitate critical thinking of student nurses in Namibia
(2016) Pretorius, Louise; Van Dyk, Agnes; Amukugo, Hans J.
The article focused on the development process of an educational programme to facilitate the development of critical thinking in the students. The study was conducted in four phases, beginning with the needs assessment in phase 1 through which the researcher determine the need of the students in terms of critical thinking. The deductive data analysis of phase 1 served as basis of the conceptual framework for the development of an educational programme. Phase 2 focused on the development of the conceptual framework and it was achieved by utilized a specific educational approaches and philosophical framework were employed. Phase 3 and 4 were conducted simultaneously. Phase 3 focuses on implementation while phase 4 focuses on evaluation. A quasi – experimental design was implemented which focused on active participation by the participants in the programme.
Development of model to facilitate male involvement in the reproductive health context by the registered nurses
(2015) Amukugo, Hans J.; Jooste, Karen; Mitonga, Kabwebwe H.
The purpose of this article is to describe the process followed in the development of the model of facilitating male partner involvement in reproductive health (RH) context by the nurses. Namibia is one of the African countries affected by cultural and socio-economic influences that have persuaded gender roles in a way that hinders male-partner involvement in RH context. This phenomenon make difficult for the nurses to facilitate their involvement. The research methods were done in four phases. Phase 1 entitled concepts analysis. Phase one was done into two steps namely step1 - concepts identification and step 2 - concepts definition. During concept identification, qualitative, exploratory, descriptive design was followed. The target population included male and female partners attending health facilities and all nurse managers (registered nurses in charge) that provided RH services in the health facility in a northern region in Namibia. Individual interviews and focus were conducted until data saturation occurred. During the research three fundamental principles such as respect person, beneficence and justice were adhered. Tech’s eight steps of descriptive data analysis were used. Three (3) main categories, six (6) categories and twelve (12) subcategories were identified using open coding and conceptualization. The main concepts of the model were identified and classified using a survey list of Dickoff, James, Wiedenba (Dickoff,James, Wiedenbach, 1968; Mckenna, 2006). Phase 2 dealt with the creation of interrelationship statements between concepts identified in step 1. In phase 3 focuses with the description of the model using strategies proposed by (Chinn & Kramer, 1991). In phase 4, the description of guidelines and evaluation for the model was also done. The applied the principle of trustworthiness through developing dependability, credibility, transferability and confirmability in all four phases. A model was developed based on a theory generated approach. The model consist of five phase namely, situational analysis in the external environment (community) and internal environment (health facilities); establishment of partnership (male and female partner and Nurses), management process, maintaining the conducive environment and control & terminus/ outcome phase. It was concluded that facilitation of Male involvement in RH care context is needed. Further the recommendations were made to implement a model within the current health care framework in which reproductive health is provided.
Development of the conceptual framework for a quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia
(2016) Nangombe, Julia P.; Amukugo, Hans J.
This article describe the process followed by the researcher in the development of the conceptual framework for a quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia. The conceptual framework of this study was based on the Practice Orientated Theory of Dickoff (1968) that assisted with explaining the concepts used in developing the quality improvement training programme for health professionals at the health facilities. Dickoff’ s (1968) practice orientated theory consists of the agent, recipients, context, procedure, dynamics, and the terminus. In this study, the agent was a quality specialist, the recipients were health professionals, the context was the health facilities, the dynamics were challenges that health professionals were experiencing; the procedure was the training programme, while the terminus was knowledgeable and skillful health professionals in quality health care delivery.
An educational programme to facilitate critical thinking within the nursing perspective
(2016) Pretorius, Louise; Van Dyk, Agnes; Small, Louis F.; Amukugo, Hans J.
This article is focuses on an educational programme to facilitate critical thinking within the nursing perspective. For the purpose of developing an educational programme; the study was conducted in four phases, beginning with a needs assessment in Phase 1 through which the researcher determined the need of student nurses in terms of critical thinking. The deductive data analysis of phase 1 served as conceptual framework for the development of education programme in phase 2. Phase 2 consisted of the development of educational framework to facilitate critical thinking in student nurses. Specific educational approaches and a philosophical framework were employed during the development of the programme. An expert opinion on the programme was obtained before the implementation could be concluded in phase 3. Phase 3 and 3 of the study were conducted simultaneously. Phase 3 covered the implementation of the educational programme and Phase 4 the evaluation. The process itself includes, the purpose of the development of the programme, conducting a situational analysis; utilization of philosophical approaches, developing the educational programme; content of the programme; educational and curriculum approaches integrated into the development of an educational programme and strategies to overcome obstacles during the implementation of an educational programme.
Emergency trolley’s contents and records: Audit study at maternity sections, state hospitals, Windhoek, Namibia
(2018) Manetti, Benjamin Klass Sebulon; Amukugo, Hans J.; Shilunga, Anna Panduleni
The purpose of the study sought to assess and evaluate the contents and records of the emergency trolley in the maternity section of the state hospitals in Windhoek, Namibia. A quantitative and descriptive research design was used for the study to investigate emergency equipment, essential drugs and emergency trolleys. A convenient sample of 10 emergency trolleys in the Windhoek Central Hospital (Hospital A) and Katutura Intermediate Hospital (Hospital B) in Windhoek, Namibia were used. Data was collected using a checklist adapted and edited from the EMSSA. Data were analysed using Microsoft excel 2013. Essential paediatric equipment including bag valve mask devices, Magill’s forceps, oxygen masks were absent in many of the units and wards. Data described that checking of defibrillators, monitors and suction devices still remained a major problem in the units/wards that were fortunate enough to have the aforementioned equipment. A conclusion was that generally the units/wards performed well during the assessments and evaluations. There were still units without emergency trolleys, trolleys that were poorly assessed, and those that were obstructed and registered nurses that had a negative perception to the audit of the emergency trolley. Specialized units such as NICU and Hi-Care Hospital A and Prem Unit Hospital B performed very well in their assessments. Development of policy with regards to assessing, restocking and maintenance of emergency supplies can be used to guide the nurses on what to do. Resuscitation morbidity and mortality meetings in order to identify issues and outcomes surround resuscitation incidences within the unit or ward.
Evaluation of an educational programme to facilitate critical thinking of student nurses
(2016) Pretorius, Louise; Amukugo, Hans J.; Van Dyk, Agnes; Small, Louis F.
This article deals with phase 4 of the study, namely the evaluation of the educational programme developed in phase 2. The development of the educational programme was aimed at the facilitation of the development of critical thinking in the student nurse. The purpose of phase four (4) was to evaluate whether the researcher had achieved the objective of the educational programme, namely to facilitate the development of critical thinking skills of the final year student nurse. Specific objectives were therefore set for phase 4. Further, hypotheses were formulated and tested during this phase of the study. The aim of formulating a hypothesis was to determine whether any development had taken place in the experimental group who participated in the educational programme. All fourth-year nursing students (47) who complied with the inclusion criteria participated in the educational programme. Each participant consented in writing to be part of the programme—including the pretest and posttest. A total of 53 students participated as the control group in the pretest and posttest. All the participants in the experimental and control groups of the study were registered for the Comprehensive Diploma in Nursing at the University of Namibia. Reasons were advanced in chapter 3 for the fact that the participants in the study were final-year students at the Windhoek and Oshakati campuses of the Faculty of Medical and Health Sciences. It was concluded that the implementation and evaluation of a three-day educational programme on the facilitation of the development of critical thinking within a quasi-experimental design had desired results. Students from both the main campus (Windhoek) and the Northern Campus (Oshakati) of the Department of Nursing at the Faculty of Medical and Health Sciences of the University of Namibia were included in the quasi-experiment. Internal validity of the design was ensured by eliminating the threats to an experimental design
Experience of students Nurses regarding caring of mothers’ undergone Caesarean section at postnatal ward at Katutura State Hospital
(2018) Shikalepo, Fransina Ndapewa; Amukugo, Hans J.
The purpose of this study was to explore and describe the experiences of second year University of Namibia nursing students regarding caring of mothers’ undergone caesarean section at postnatal ward at Katutura state hospital. Participants were purposively sampled and unstructured individual interviews were used to collect the data amongst eleven students. This was done after permission was granted by the Ministry of Health and Social Services and from the University of Namibia. Informed consent was obtained and the re-searcher ensured the ethical principle of justice, autonomy, beneficence and respect. Data was analysed using TESCH’S method of data analysis that merged to the formation of five (5) themes and eight (8) subthemes. The results indicated that participants experience challenges during the care of mother’s undergone caesarean section. Participants expressed patient factors that are hindering the caring of mothers. Participants also expressed different experiences regarding learning opportunities and different emotions regarding caring of mother’s undergone caesarean section. Recommendations were made regarding reinforcement of guidelines and policies which govern health care personnel and introduction of new policies which will promote the health and wellbeing of mothers who have undergone caesarean section, and also improve health education on wound care and aseptic techniques within service training programs.
Experiences of men diagnosed with prostate cancer in the four northern regions Namibia
(2016) Salomo, Salomo; Amukugo, Hans J.; Pretorius, Louise
This article is aimed at describing the lived experiences of men diagnosed and living with prostate cancer in the four northern regions. A phenomenological, explorative and descriptive design was followed as the basis for conducting the study. The above mentioned research design was achieved through individual in-depth interviews conducted with men diagnosed and living with prostate cancer in the Intermediate Hospital that serves as a referral hospital for cancer patients from all the four northern regions. A sample of ten (10) men, diagnosed and living with prostate cancer, from a population comprised of men between the ages of 39 - 95 was selected using a non-probability purposive sampling technique. This sample size was determined by saturation of data as reflected in repeating themes. Ethical clearance was received from an ethical review committee prior to the conduct of the study. Individual in-depth interviews and field notes were used as a method of data collection. During the interviews, participants were asked one question namely; “What is your experience after being diagnosed with prostate cancer?” Communication skills were employed to encourage participants to verbalize their lived experiences after being diagnosed with prostate cancer. A tape recorder was used to collect data and was transcribed verbatim. Data collected was analyzed in line with Tesch’s eight steps in the coding process. The researcher and an independent qualitative research expert carried out coding. Four themes emerged from the results of the study. It became evident that men diagnosed and living with prostate cancer had different experiences after being diagnosed that resulted in physical discomfort and psychological changes in their bodies. It was recommended that more emphasis should be put on supportive care towards men diagnosed with the disease. Individualized approaches to help men address their thoughts and feelings after being diagnosed with prostate cancer should be considered, as well as the incorporation of strategies that help men to be more effective at obtaining social support.
The experiences of mothers and caregivers on feeding practices of children under the age of five years with undernutrition in Oshikoto region, Namibia
(2018) Amukugo, Hans J.; Shilunga, Anna Panduleni
Background: Undernutrition in children under the age of five years is prevalent in the developing countries which increase the risk of morbidity and mortality among such age group. Lack of information related to nutrition and feeding practices as well as other factors such as employment and pressure from family and community members cause mothers and caregivers of children under the age of five years to use inappropriate methods of feeding which contribute to undernutrition. Purpose: The aim of this article is to relate the experiences of mothers and caregivers on feeding practices of children under the age of five years in Oshikoto region, Namibia. Methods: A qualitative study design was utilized to explore and describe the experiences of mothers and caregivers on feeding practices of children under the age of five years. The study population comprised of mothers and caregivers of children diagnosed with undernutrition either severe or moderate, admitted in pediatric units or registered on Nutritional Assessment Counseling and Support programme. A purposive sampling was used to select participants and a total number of fifteen mothers/caregivers were interviewed. The data were transcribed verbatim and analysed using Tesch steps. Results: The study revealed that mothers and caregivers experienced lack of information related to nutrition and feeding practices and other contextual constraints which resulted in the utilization of suboptimal feeding practices of children under the age of five years. Conclusions: Due to challenges experienced by mothers and caregivers, they need to be empowered with knowledge on nutrition and feeding practices of children under the age of five years.
The experiences of mothers and caregivers on feeding practices of children under the age of five years with undernutrition in Oshikoto region, Namibia
(2018) Mulenga, Ester; Amukugo, Hans J.; Shilunga, Anna Panduleni
Background: Undernutrition in children under the age of five years is prevalent in the developing countries which increase the risk of morbidity and mortality among such age group. Lack of information related to nutrition and feeding practices as well as other factors such as employment and pressure from family and community members cause mothers and caregivers of children under the age of five years to use inappropriate methods of feeding which contribute to undernutrition. Purpose: The aim of this article is to relate the experiences of mothers and caregivers on feeding practices of children under the age of five years in Oshikoto region, Namibia. Methods: A qualitative study design was utilized to explore and describe the experiences of mothers and caregivers on feeding practices of children under the age of five years. The study population comprised of mothers and caregivers of children diagnosed with undernutrition either severe or moderate, admitted in pediatric units or registered on Nutritional Assessment Counseling and Support programme. A purposive sampling was used to select participants and a total number of fifteen mothers/caregivers were interviewed. The data were transcribed verbatim and analysed using Tesch steps. Results: The study revealed that mothers and caregivers experienced lack of information related to nutrition and feeding practices and other contextual constraints which resulted in the utilization of suboptimal feeding practices of children under the age of five years. Conclusions: Due to challenges experienced by mothers and caregivers, they need to be empowered with knowledge on nutrition and feeding practices of children under the age of five years.
The experiences of mothers during the hospitalisation of their low birth weight babies in Neonatal unit at Windhoek Central Hospital Windhoek Khomas region Namibia
(2018) Shiweda, Ndahafa Annashitasia; Amukugo, Hans J.
The purpose of this study was to explore and describe the experience of mothers during the hospitalisation of their low birth weight (LBW) babies in neonatal unit Windhoek Central Hospital, Khomas region, Namibia. A qua-litative, explorative, descriptive and contextual design was employed. The data was collected through in-depth interviews conducted at neonatal unit of Windhoek Central Hospital, with the permission from the Ministry of Health and Social Services (MOHSS). A sample of ten (10) mothers was selected with the means of purposive sampling. Informed consent was obtained from the participants and interviews were tape recorded, with the permission from the participants. Different communication skills were used to encourage partici-pants to verbalize their experiences. Data was transcribed verbatim and was analyzed according to Tesch’s eight steps of analyzing qualitative data that led to the formation of themes and sub-themes. The study results gave insight in-to emotional reactions, various supports, challenges experienced by the mothers and also the wishes they expressed. Based on the study finding, the researcher recommended an establishment of a rooming-in space for the mothers, establishment of high care neonatal units in hospitals outside Windhoek, implementation of improved breastfeeding programme, psy-chosocial care and lastly further research.
Experiences of registered and student nurses regarding the clinical supervision in medical and surgical wards: Develop an educational programme to support registered nurses
(2015) Neshuku, Hanna; Amukugo, Hans J.
The purpose of the study was to explore and describe the lived experiences of registered nurses and student nurses regarding the clinical supervision of student nurses in medical and surgical wards. The findings will be a basis to develop an educational programme to support registered nurses during clinical supervision in the same context. The study was a qualitative, explorative, descriptive and contextual in nature. This paper describes Phase 1, of the study aimed to explore and describe the experiences of registered nurses and student nurses regarding clinical supervision of student nurses. Data was collected through in-depth individual face to face interviews thereafter data were analysed based on the Tesch’s method of qualitative data analysis. The numbers of interviews conducted were 35 in total, made up of 27 interviews with student nurses and 8 interviews with registered nurses. The numbers were determined based on the subject who availed themselves for the study as well as data saturation. Study revealed managerial, educational as well as non-conducive environment challenges experiences by registered nurses and student nurses during clinical supervision of student nurses. It was concluded that educational programme should be developed in order to support registered to manage those challenges. The development of the programme is outlined in article part 2.

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