Department of Nursing Science

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Application of elements of the informed choice of modern contraceptives among reproductive aged women in the Khomas region of Namibia
(2016) Nelumbu, Petrina N.; Amakali, Kristofina; Hofnie-//Hoëbes, K
A gap still exists between the propositions of the policy and guidelines on the application of the elements of informed choice in family planning services and the reality in practice. This paper presents the findings of the study that was conducted to partially assess and describe the application of the elements of informed choice by the nurses in providing modern contraceptives at the health care facilities in Khomas region of Namibia. A quantitative descriptive study design was employed among the study populations of 7,401 women of reproductive age (15-49 years) who use family planning services at the four (4) urban and two (2) rural health care facilities in Khomas region. Systematic random sampling was done for the urban and rural health facilities, while a convenience sampling was employed to select a sample of 184 client participants from the total population using the computer probability of 95% and the confidence limit of 5%. The data were collected through exit interviews of the clients and analysed using EPI Info. The findings indicated a glaring lack of the provision of the information which can constitute the basis for an informed choice by the clients. Based on the findings, the study recommended among others the provision of in-service training in family planning and communication skills for nurses, development and dissemination of Information Education and Communication (IEC) materials for the clients and the availability of more family planning methods for the clients.
Assessment of knowledge, attitude and practices of male adults regarding the uptake of HIV counselling and testing in Opuwo district, Kunene region, Namibia
(University of Namibia, 2022) Tjipundi, Sewako Thekela
Human Immunodeficiency Virus (HIV) voluntary counselling and testing (VCT) are one among the different approaches implemented to curb the spread of HIV infections and minimise the impact on individuals and families. VCT are considered effective strategies in risk reduction among sexually active individuals, hence, the involvement of men in HIV services is critical to ensure the success of such services. Efforts by government and civil society organisations to get more men involved in HIV services in Namibia over the years have yielded little benefits. This research focused on determining the knowledge, attitudes, and practices of male adults regarding the use of VCT services in Opuwo District, Kunene Region, in Namibia. Data were collected in Opuwo town, Otuzemba and Katutura locations. The aim was to determine the role played by the male adults’ knowledge, attitudes, or practices in the uptake of HIV testing. The purpose of this research was to appraise the level of knowledge, attitude, and practice of VCT and to determine their association with demographic data on HIV uptake of the male adults in Opuwo district. The study employed a descriptive cross section study, method was used to select the respondents from a population which was done from September to November 2019. The simple random sampling of men aged between 15-50 years and above. The sampling formular used was EPI-INFO version 7 with a confidence interval of 95% and a power of 80%, which gave a sample of 113 participants. Data were gathered from 113 participants using a structured questionnaire that was distributed by the researcher and with the help of two people. The theoretical framework that was utilised in this study was the Health Belief Model, which submits the way beliefs guide individual actions and the process that people go through to change their behaviour The study was guided by ethical principles of beneficence, principle of respect for person and principle of justice. The research sought to determine the degree of knowledge regarding attitude and ii consumption of VCT services by male participants. The association between the data of the participants and other variables was tested using a Chi square. The participants in the study were men who had an average age of 30years. While 95.5% of the participants were knowledgeable about HIV/VCT, 60% had a negative attitude towards VCT, and 60% of the participants had never tested for HIV. The fear of positive results, stigma and discrimination, and confidentiality of test results if they were positive was reported as the main barrier for VCT uptake among men. Arguably, if male participation in accessing VCT services is to be enhanced, VCT programme should reduce, HIV stigma and improve access and trust towards VCT in the district. Other possible interventions are the setting up of regular home-based VCT programmes and the mainstreaming of HIV Testing Services in community development programmes. The chi-square test showed that the type of occupation has an influence on the knowledge of HIV. Finally, the study concluded that outreach programmes that target the testing of men should be encouraged or introduced by Community Based Organisations, and the Ministry of Health and Social Services.
Assessment of management of newborn babies with neonatal asphyxia at maternity units of a state hospital in Windhoek
(University of Namibia, 2018) Hanyanya, Johanna
Despite guidelines on essential and obstetric emergency care devised by the Ministry of Health and Social Services to address obstetric and neonatal related challenges in Namibia, the report on perinatal and neonatal death review of April 2010 - March 2012, indicated that birth asphyxia is in first position contributing 49.4 % to neonatal deaths. This reflects the severity of asphyxia as a public health concern in Namibia (MoHSS, 2014). The aim of the study was to assess the management of newborn babies with neonatal asphyxia at maternity units of a hospital in Windhoek. A quantitative, descriptive and retrospective study was used on a total population of 90 patients’ files who died due to asphyxia. The sample and the population were the same (90 numbers of patients’ files). Data were collected by means of a structured checklist, analyzed with Epi info 7, as software computer package for statistical analysis purpose and presented as descriptive statistics. The results of the study showed that there was a delay with early recognition and timely decision-making on the safer method of delivery especially for cases of breech presentations, cephalopelvic disproportion (CPD) and prolonged first stage of labour. Referral of patients from district and regional hospitals to a national referral hospital takes too long. The results of the study further showed that many deliveries were conducted by registered midwives in the absence of a pediatrician or medical doctor. Recommendations were made with regard to improvement of knowledge and skills on maternal and neonatal care by health care providers in order to provide quality antenatal care to pregnant women, conduction of safe deliveries and provision of efficient care to the new-born babies who are at risk of asphyxia. Deliveries of cases at risk to be conducted with the presence of a paediatrician for expert resuscitation. Regulations of the referral system on maternal care should strictly be put in place regarding the hours mothers have to stay in labour after complications have been detected to prevent avoidable neonatal deaths especially due to asphyxia
Assessment of quality of midwifery care during labour at maternity departments of intermediate and refferral hospitals in Namibia
(University of Namibia, 2021) Nghifikwa, Jonia
Quality of midwifery care can be defined as care delivered by midwives, which is safe, effective, efficient, accessible, acceptable, patient-centred, equitable, and results in a positive pregnancy outcome. This research aims to assess the quality of midwifery care rendered during labour at the intermediate and referral hospital in Namibia. In Namibia, the Ministry of Health and Social Services (MoHSS) in particular, has come up with many interventions aiming to reduce maternal and neonatal mortality and morbidity. Even though these programmes were implemented, the programme reviews conducted by MoHSS in 2016 identified some gaps in the quality of midwifery care and recommended the conduct of a second nationwide Emergency Obstetric and Neonatal Care (EmONC) assessment. The main objectives of this study therefore were to describe the demographic profile, conclude the standard of midwifery care rendered during the first, second, third and fourth stages of labour by reviewing maternity records and analysing the standard of midwifery care rendered during the first, second, third and fourth stages of labour of the women who gave birth at intermediate and referral hospital from 01 January to 31 March 2018. The study was a retrospective study with a descriptive quantitative design conducted on 653 maternity records at the above mentioned hospitals. The findings revealed the age group from twenty to thirty-five to be the highest age group that gave birth i.e. (78.6%), while (10.7%) were adolescents and (10.7%) of the women aged above 36 years of age. This study indicated that (95%) of these women attended antenatal care. However, obstetric history indicates that the majority of the women who had delivered 391 (59.9 %), had two to four children, followed by those who gave birth for the first time 197 (30.2 %), while the lowest were those who had five or more children 65 (10.0%). Early opening of a partograph could lead to early identification of problems and plans for interventions. This study further shows that 402 (61.6%) partographs were mostly opened with women in the active phase of labour. Few partographs 33 (5.1%) were opened in the latent phase of labour. However, partographs that were opened, the study results revealed that not all were managed according to the WHO guidelines. Poor documentation of midwifery interventions and care was noted, suggesting poor midwifery care. Most of the deliveries 499 (76.4%) were normal vaginal deliveries, followed by 151 (23.1%) who had caesarean section deliveries. The rest had assisted deliveries with one breech delivery. According to the findings of this study it can be concluded that midwifery care rendered during labour at the studied hospitals was of substandard.
Assessment of the practices and experiences on mentorship and mentoring of nurse educators in the school of nursing, University of Namibia
(University of Namibia, 2023) Tjiurutue, Ingenesia Popii Vekuminina
Mentoring in nursing academia is receiving more attention as many senior academics are retiring and new nurse educators are joining nursing education. Mentoring is an important tool for clinical practice, nursing education, administration, and research that contributes to the competencies of many new nurse educators, who are recruited with a clinical background and little or no experience in an academic environment. It is expected for an expert nurse to become a novice in a new environment or role and needs mentoring to become an expert nurse educator. Despite the emphasis on the mentoring relationship among nursing academics, there is no established standard practice and nurse educators experience difficulty in their new role in the absence of mentoring. This study aimed to assess and describe the practices and experiences of nurse educators in the School of Nursing1 at the University of Namibia on mentorship and mentoring. The study adopted a comparative descriptive convergent parallel mixed method where quantitative and qualitative data were collected at the same time, analyzed separately, and merging occurred by comparing the two data sets and representing the merging results in a narrative discussion. The target population was nurse educators who were registered nurses by profession, teaching at the four campuses of the University of Namibia where the School of Nursing was established among the 12 campuses. The researcher opted for the same individuals in both quantitative and qualitative objectives that help to minimize threats during data collection and allowed the results to be compared. Likewise, both strands focused on the same study concepts of mentorship and mentoring to allow interpretation and comparison. For objective one, which was quantitative and focused on the practices, due to small population of nurse educators employed in the School of Nursing the total target population of 74 was included in the study as it was small and feasible for the researcher to contact everyone using a self-administered questionnaire. The target population was stratified as per campus and various teaching ranks. The mentees were nurse educators who were registered nurses by profession who had worked for less than five years at the School of Nursing while mentors should have worked for five years or more at the same school. The response rate for the quantitative strand was 82% (n= 40 questionnaires received out of 49 for the mentees and 96 % for the mentors (n=24 questionnaires received out of 25). Purposive sampling was done for objective two, which was qualitative to select the participants who participated in the semi-structured interviews at each campus as per respective study groups. For the qualitative strand, data saturation was determined per campus due to the different settings and heterogenous teaching ranks that had different experiences. A total of 36 mentees and 16 mentors participated across the different campuses. The interpretation of data sets shows convergent and discordant results in the quantitative data between the mentees and mentors in mentorship and mentoring practices. Likewise, similar four main themes emerged from both groups, with some variants of unique sub-themes across the groups. The quantitative results show that mentees and mentors agreed on mentorship practices but had discordant results on mentoring aspects as mentees disagreed with mentors’ positive ratings. Variables with significant p-values were identified and compared first within each group of mentees and mentors first and then finally with the finding from the qualitative data set. Equally, the qualitative results also had convergent and discordant results between mentees and mentors as well within each group supported by various sub-themes. The common approach of primary data analysis integration procedure was used. The representation of merging integration results was done by a side-by-side comparison of significant p- values of quantitative and main themes and sub-themes of the qualitative results through a narrative discussion. The discussion narrated how qualitative themes and sub-themes either confirm, disconfirm, or complemented the quantitative results or vice versa. This study concluded that mentoring and mentorship practices were described differently by mentors and mentees as well that positive and negative experiences emerged in both groups. Recommendations included the facilitation of good relationships as well as establishing trust, respect, and healthy communication between mentors and mentees. It was also recommended for the School of Nursing to have a school-specific orientation for nurse educators and develop a formal mentoring programme. Finally, there was a need to revisit the workload of nurse educators and develop a guideline for virtual mentoring of mentees
Beyond routine care for children with heart diseases from the vulnerable context: A clinical practice perspective
(2014) Amakali, Kristofina; Small, Louis F.
The statistics of children with heart diseases are notable in Namibia many of whom are from the rural area. While waiting for surgical corrections or when the child is a case for palliative care, these children have to be cared for at home, a task that can be doubtful for a rural caregiver. A qualitative, exploratory, phenomenological and contextual study was conducted to describe the experiences of rural caregivers regarding provision of home care for children with heart disease. The children’s experiences of living with the disease at home were also assessed because the burden of the diseases intensifies the demands for care. The findings revealed that both the caregivers and the children experience challenged emotions, disruptive social functioning, lacking of support from the family, lack of support from societal organisations as well as experiences of low vitality among the children. These experiences together, signify the overall poor coping by the caregivers and the children. Therefore, caring for a child with a heart disease at home requires a plan of individualized care which considers the context and the socio-economic status of the caregivers as the determinants for coping with providing care at home. Based on the findings, key recommendations were made among others to the clinical practice setting as an entry point to the care provided to these children. This paper provides a detailed description of the proposed health care intervention in the clinical setting to facilitate effective home care to children with heart diseases from the rural context.
Clinical care for the patient with heart failure: A nursing care perspective
(2015) Amakali, Kristofina
Providing clinical nursing care to a patient with a heart disease requires the application of the knowledge of disease process which informs the nursing intervention. This paper presents a discussion on some priority aspects of clinical care for the patient with heart failure from the perspective of nursing care as summarized in the figure below. A brief summative overview of the disease process and the central concept in heart failure as fundamental to the conceptualization of clinical care needs for a patient with heart failure was presented. Application of the framework of the nursing process in providing clinical nursing care for a patient with a heart disease and the application of ethical principles were discussed. Thus, competent and therefore safe clinical care for a patient with heart failure requires comprehensive nursing care which embraces both the scientific approach and ethics of care
Clinical learning experiences of nursing degree students at public training hospitals in the Khomas region, Namibia
(University of Namibia, 2023) Kadhila, Joseph Galukeni
Clinical placement provides an opportunity for students to be socialised into the health system, achieve clinical skills in a real-life setting and observe the delivery of care by other healthcare professionals. Despite the obvious benefits of placements for students, poor relationships with the supervising nurse, environments that fail to promote belongingness and a lack of supervision hinder learning in the clinical setting. The purpose of the study was to assess the clinical learning experiences of nursing degree students practising in general wards at public training hospitals in the Khomas region of Namibia. The objective of the study was to explore and describe the clinical learning experiences of nursing degree students in general wards at public training hospitals in the Khomas region. The study aimed at answering the following central question: “What are your experiences during placement in general wards of the training hospitals in the Khomas region? The researcher selected a qualitative, explorative, descriptive and contextual design. Fifty-one participants from the undergraduate second, third and fourth years were recruited. Data collection included eleven (11) individual face-to face interviews and eight (8) Focus Group Discussions. Data was coded and analysed using Tesch’s method of data analysis. Four themes emerged from the exploration and description of nursing students ‘clinical learning experiences, namely, a non-conducive learning environment, negative staff attitude, communication barriers and shortage of staff. The results show that there were indeed constraints to learning in the clinical setting across all the years of study. Recommendations were made to the Nursing Education Institution, the training hospitals and the Ministry of Health and Social Services. Further research is needed on the clinical learning experiences of nursing students in other regions, the clinical learning experiences of male nurses and the lecturers’ experiences on clinical accompaniments.
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, Epafras
The 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 women
The development of nursing care standards by means of peergroup consensus for selected critical and high care situations in Namibia and the implementation thereof by means of selfstudy learning packages: An experimental study
(1995) Small, Louis F.
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 Hanstein
With 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.
An educational programme to facilitate critical thinking by the student nurse in Namibia
(2008) Pretorius, Louise
Summary provided by author
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.
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, Hanna
The 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.
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 Omuwa
ln 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.
Effects of the shortage of midwives on performance and quality of care, in maternity ward, Rundu Intermediate hospital and Nyangana district hospital, Kavango East region
(University of Namibia, 2021) Kandjimi, Emilie
Midwives play a vital role in improving maternal and neonatal health. An adequate number of professional midwives is associated with improved quality of care and decreased maternal and newborn mortality. An increased workload due to the shortage of staff exposes midwives to unnecessary pressure, which might affect the quality of care they provide to patients. Addressing barriers that hinder midwives from providing quality care is a step towards improving the health care deliverance and hence, a step towards achieving the Millennium Developmental Goal (MDG) 5 and the Standard Developments Goal (SDG) 3. The aim of this study was to assess the effects of the shortage of midwives on their performance and quality of care, in the maternity ward of Rundu Intermediate Hospital and Nyangana District Hospital, Kavango East Region, Namibia. A quantitative analytic descriptive cross-sectional study was conducted using a purposive, non-random sampling method on fourty (40) midwives, in which thirty-one (31) were from Rundu Intermediate Hospital and nine (9) from Nyangana District Hospital. A self-administered questionnaire was used. The results revealed that the major effects of the shortage of midwives on their performance were as follow: increases workload (100%), feelings of fatigue and emotional exhaustion (97.5%), increases stress levels (95%), causes burnout and moral distress (87.5%), increases job dissatisfaction (87.5%), decreases willingness to work (70%), causes high staff turnover (65%), decreases the ability to work (65%) and increases medical errors committed among midwives (60%). Moreover, late attendance to patients (95%), poor monitoring of patients’ conditions (92.5%), inadequate or poor patient care (90%), delay in treatment of patients (87.5%), delay in initiating emergency interventions (82.5%) and lack of performance in the implementation of the EmOC (Emergency Obstetric Care) guideline (82.5%), were among the effects of the shortage of midwives on the quality of care. Other effects on the quality of care included increase in mortality rate (i.e. still birth, neonatal and maternal death) (77.5%), unnecessary complications that delay recovery (75%), negative attitude of health workers towards patients (67.5%) and medical errors committed by midwives (67.5%). The study concluded that the shortage of midwives has negative effects on both midwives’ performances and quality of care. The study recommended the followings: the MoHSS and the professional councils to come up with proper midwife-to-patient ratio to reduce workload pressure; the human resource of the MoHSS to make provision of recruiting adequate staff in maternity sections; and provide adequate equipment to enhance performance of few staff. In addition, the obstetric care trainings need to be provided to all midwife staff prior to allocation to maternity sections. The MoHSS should make provision of a service that provides the midwives with emotional and psychological support, to assist them on coping with stress from work-related pressures and help them deal with their emotions. The MoHSS should also create a conducive working environment to attract more staff, therefore, overcome staff shortage, and eventually, minimise effects of the shortage of midwives.
An Employee Assistance Programme (EAP) to support midwives affected by maternal deaths and stillbirths in Khomas region, Namibia
(University of Namibia, 2022) Endjala, Tuwilika
Globally, 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.
Empowerment of nurse managers to facilitate change management during Namibian health sector reforms
(2005) Hofnie-//Hoëbes, K
Empowerment of the rural parents/caregivers of children with heart diseases in Namibia to facilitate coping with the demands of caring at home
(2013) Amakali, Kristofina; Small, Louis F.
Aim: The purpose of this study was to describe how the parents/caregivers of children with heart diseases cope with the demands of caring for these children at home, with the purpose to develop a home-based health care programme to facilitate the parents/caregivers’ coping with the demands of care. Methods: A qualitative, exploratory, descriptive, and contextual study was conducted. Phenomenological data on the lived experiences of coping with the demands to care by the parents/caregivers and of living with the burden of the disease by the children were gathered and interpreted from a purposefully selected sample of 5 multiple cases of parents/caregivers and children with heart disease from the rural areas. Results: The findings have revealed poor coping with the demands of caring among the parents/caregivers, as characterized by the experiences of emotional challenges, disruptive social functioning and social relations, lack of support from the family and societal organizations, financial difficulties and of course the experiences of decreased vitality by the children. As a result, the need to empower the parents/caregivers for them to cope with providing a continuum care to their children who have heart disease was identified. The dynamics to mitigate the negative experiences were conceptualized. Therefore, the interventions of a home-based health care programme as an interface to facilitate the parents/caregivers to cope with the challenges caused by the demands to care were developed. Conclusions: The need for empowerment of these parents/caregivers can be met through the implementation of multi-component interventions, which draw together all the possible determinants factors and the coping methods to facilitate coping.
An evaluation of the follow-up nursing care of adult cancer patients in the Windhoek area- a general nursing perspective
(1995) Katjire, Marjorie M.

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