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Background: COVID‐19 necessitated emergency telepractice for student‐led speech‐language therapy clinical practicals in training institutions, with limited preparation and evidence‐based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. Aims: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student‐led telepractice sessions in a diverse, resource‐limited context. The broader goal of this project was to provide evidence‐based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. Methods & Procedures: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student‐led paediatric telepractice sessions from a South African university clinic as part of a pilot study. Outcomes & Results: We identified four overarching considerations for student‐led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face‐to‐face contact. Conclusions & Implications: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject: Many speech‐language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID‐19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non‐existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence‐based research which explores the mechanics of such sessions in real‐time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds: This pilot study examined video‐recorded, student‐led, paediatric, speech‐language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in‐person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work?: Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice. [ABSTRACT FROM AUTHOR]

Background: Globally, mothers have identified work as one of the main obstacles to exclusive and continued breastfeeding. The support a woman receives in her workplace in terms of workplace arrangements can be critical to enable women to continue breastfeeding. This study aimed to develop and assess the face validity of a practice model to support exclusive and continued breastfeeding in workplaces in the Western Cape, South Africa. Methods: An explanatory, sequential, mixed-method research design, was conducted (June 2017 to March 2019) in three distinct phases. Phase one employed a quantitative, descriptive, cross-sectional study design. Phase 2 used a qualitative, multiple case study. Phase three involved the development and face validity of a practice model to support exclusive breastfeeding in workplaces. The face validity included two Delphi rounds for experts to provide input on the draft practice model. This paper will only report on phase 3 of the study. The practice model was developed, drawing on the analysis of data from phases one and two and using programme theory approaches and a logic model. Results: The practice model was positively perceived. Participants viewed it as informative, well designed and easy to follow, even for those not knowledgeable about the subject. It was viewed as an ideal tool, if accompanied by some training. Participants were positive that the model would be feasible and most commended the tiered approach to implementation. They felt that workplaces would be more open to a step-by-step approach to implementation and if only a few activities are implemented it would be a start to make the work environment more conducive for breastfeeding employees. There were mixed opinions regarding commitment; a few participants mentioned commitment as a challenge they anticipated in the male-dominant environments in which they worked. The provision of space for breastfeeding at the workplace was also highlighted as a potential challenge. Conclusions: Advocacy around creating an enabling workplace environment for breastfeeding is needed. The practice model has the potential to be internationally relevant, locally applied and may be of particular use to workplaces that want to initiate and/or strengthen breastfeeding support. [ABSTRACT FROM AUTHOR]

Despite a sound policy framework, the right of learners with disabilities in South Africa to inclusive and equitable quality education is not being met. A key reason hindering the realisation of this right is that there are very few teacher education programs focused on supporting learners with disabilities. Acknowledging the urgency of teacher education, in this paper we draw on qualitative data from 109 teacher participants and 39 course facilitators of a series of disability inclusion-focused teacher education short courses in the Western Cape province of South Africa. Based on their experience of the courses, we consider how teachers can be empowered to meet the diverse needs of their learners within an inclusive framework. Findings highlight that professional and personal growth facilitated a more empathic understanding of learners and the opportunity to collaborate with others, enabling teachers to find creative ways of solving problems faced in their workplaces. To support teachers in meeting the needs of their learners, teacher training should facilitate active reflection on the role they play in shaping the lives of their learners, and prepare teachers to respond to challenges strategically, taking advantage of the resources available to them within and beyond their school environment. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. Methods: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Results: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Conclusion: Policymakers should consider PWCDs when responding to a public health concern in the future. Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs. [ABSTRACT FROM AUTHOR]

Background: Speech–language therapists and audiologists (SLT&As) may encounter difficulties when confronted with patient death and dying, which may conflict with their moral beliefs and result in moral injury. Furthermore, South African SLT&As practice in a country with a high mortality rate, which may add to the complexity of their experience. Moreover, they may be influenced by African philosophies promoting care, which might conflict with their experiences of patient death and dying. Aims: To explore the moral injury experienced by South African SLT&As in patient death and dying, and how they overcame the injury. Methods & Procedures: This article forms part of a larger qualitative study that explored SLT&As' experiences of patient death and dying in South Africa. Thematic analysis was conducted on the transcripts of 25 episodic narrative interviews conducted with South African SLT&As on their experiences of patient death and dying. Outcomes & Results: Findings suggest that South African SLT&As experienced helplessness, guilt and anger in patient death and dying. However, with support from the allied team, engaging in self‐reflection and religious practices, they reported alleviation of moral injury. Conclusions & Implications: In order to mitigate moral injury in South African SLT&As, they require professional education, self‐care strategies, guidelines and support from the teams in which they work and their supervisors. Research is needed that explores how SLT&As' biographical characteristics and interactions with significant others of dying and deceased patients, may result in moral injury. What this paper adds?: What is already known on this subject?: Moral injury and measures used to overcome the injury have been explored in military personnel, doctors and nurses, but not in SLT&As. However, studies that explored the perceptions of SLTs and/or audiologists regarding providing palliative care and of death and dying, particularly that by Rivers et al. in 2009, suggested that these professionals may be at risk of experiencing emotional trauma due to patient death, particularly when not receiving undergraduate education on this subject. However, the extent of this trauma and the support needed to overcome it is unknown because the participants in these studies may have not experienced patient death, and were only students or just SLTs. What this article adds?: This article highlights the complexity of speech–language therapy and audiology practice when confronted with patient death and dying. South African SLT&As may have to make decisions that conflict with their morals and professional practice standards, especially as the helping nature of their profession is characterized by African philosophies that promote care, which may result in moral injury. Clinical implications of this article: This article indicates that in addition to undergraduate education on patient death and dying, SLTs and audiologists require continuous professional education on this topic, self‐care strategies, support from the teams in which they work, and their supervisors and guidelines for when they encounter patient death and dying. [ABSTRACT FROM AUTHOR]

Background: This paper provides an overview of a series of studies undertaken to assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–5 years. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: Qualitative methods were used to collect data from 38 focus-group discussions (isiXhosa = 11, Afrikaans = 11, English = 10 and siSwati = 6) resulting in 268 participants. Setting: Breede Valley sub-district (Worcester), Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) and Northern Metropole (Atlantis, Witsand, Du Noon and Blouberg), City of Cape Town, Western Cape province, as well as Ehlanzeni District (Kabokweni) in Mpumalanga province. Subjects: Mothers/caregivers older than 18 years who provided informed consent to participate. Results: The majority of participants had previous exposure to guidelines with similar messages to the SA-PFBDGs. Information sources included nurses, local clinics, family, friends and media. Possible barriers to following the guidelines included limited physical and financial access to resources; cultural/family practices, poor social support and time constraints. Outdated information, misconceptions, inconsistent messages and contrasting beliefs were evident. The vocabulary of some messages was not well understood. Education on infant and young child feeding and visual portrayal of the guidelines could aid understanding. Conclusion: A degree of rewording should be considered for improved understanding of the revised, draft SA-PFBDGs. Once adopted, the guidelines can be used to educate various stakeholders, including parents, caregivers, healthcare providers and educators, on the correct nutritional advice for children aged 0–5 years ensuring the healthy growth and development of young children in South Africa. [ABSTRACT FROM AUTHOR]

This paper challenges the view that, in the context of the HIV/AIDS pandemic, the African extended family is no longer able to care for and support orphaned children. The paper is based on a qualitative case study conducted in a South African urban area on the lived experiences of orphaned children aged 9–14. Data were collected from the children, their teachers as well as their main caregivers. The study found that, despite the poverty facing the extended family, emotional support, family cohesion and support for learning can serve to meet the educational needs of orphaned children. [ABSTRACT FROM AUTHOR]

Pre‐abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre‐abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative‐discursive lens, the analysis revealed four micro‐narratives in which participants appreciated non‐directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti‐abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client‐centred pre‐abortion counselling are discussed. [ABSTRACT FROM AUTHOR]

The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa. [ABSTRACT FROM AUTHOR]

This paper presents findings of a constructivist grounded theory study conducted within the Western Cape Province of South Africa. The study explored how family caregivers respond to sexuality issues of their young adults with intellectual disabilities (ID). Indepth interviews and focus group discussions were used as methods of data collection. Twenty-five family caregivers participated in the study. The family caregivers' perceptions highlight how the lifelong care relationship and the living arrangements attached to it may become a hindrance to people with ID exercising sexual autonomy. The family caregivers felt responsible for the young adults' behavior and determined what was appropriate or not with regards to the young adults' sexuality. Concerns about the young adults' future care were central in the family caregivers' responses. We conclude that without the appropriate forms of support for both the young adults and their caregivers, the young adults will continue to be policed by the family caregivers and not have choices and opportunities to enjoy and express their sexuality. The support interventions needed should alleviate the burden of care from the family caregivers and also ensure independent living and more choices for the young adults with ID. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the topic?: Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments.Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. What the paper adds to existing knowledge?: Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety.Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. What are the implications for practice?: Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses.Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not "go the wrong way" and decrease confidence levels. Introduction: Much has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities. Aim: To explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa. Method: Following a qualitative descriptive design, 11 newly qualified nurses in their first 6–18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed. Results: Four themes emerged from the analysis: fear related to the mental healthcare environment; self‐doubt upon meeting the expectations of the inter‐professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals. Discussion: During the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self‐confidence in both managerial and therapeutic realms. Implications for practice: Management of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation. [ABSTRACT FROM AUTHOR]

Abstract Youth gang involvement is a serious public health challenge and there is limited research with adolescents on their understandings of adolescent gang involvement, particularly in low-and middle-income countries (LMICs). This paper reports on the key theme of adolescents' experiences of youth gangs which emerged from qualitative research exploring adolescents' experiences of daily life. Six focus groups and 10 individual interviews were conducted with adolescents aged 13–14 years. Four factors were identified as protective against gang involvement; access to resources, school achievement, positive peer influences and supportive adult relationships. These findings illustrate the multiple factors which contribute to youth gang involvement and highlight the need for interventions to take an integrated and uniform approach to reduce risk factors and increase protective factors at the individual, family, school and community level. [ABSTRACT FROM AUTHOR]

Worldwide, researchers routinely study children indirectly through adults who act as proxies for such children. The call for researchers to rather study children directly and adopt less intrusive child-friendly methodologies has become louder. The draw-and-write technique is regarded as a less intrusive child-friendly method of collecting data that can be used for this purpose. This paper reports the findings of a qualitative study that sought to establish the feasibility of the draw-and-write technique in exploring the resilience of children orphaned by AIDS. This study involved a convenience sample of 23 IsiXhosa-speaking orphaned children aged from 13 to 17. The participants were in grades 6 to 10 and they resided in two child and youth care centres in the Eastern Cape province of South Africa. As part of the draw-and-write technique the participants were asked to make drawings of what enabled them to cope with their lives and to write short narratives in which they explained their drawings. Inductive content analysis was used to analyse the data and this process yielded two main themes, namely: personal protective resources and socio-ecological protective resources. The findings show that complex combinations of personal and socio-ecological resilience resources enabled the resilience of the orphaned children. The findings challenge researchers not to be oblivious to alternative child-friendly methods of research such as the draw-and-write technique when young people are the unit of analysis. The findings of this study have implications for research as well as practice in the field of education and psychology. [ABSTRACT FROM AUTHOR]

This paper focuses on the role of 'social support' in the experience of fibromyalgia (a musculoskeletal pain disorder) in South Africa. In-depth semi-structured interviews were used to collect narratives from 15 participants. Sources of social support constitute important mechanisms for coping with the illness experience of fibromyalgia. In providing a space for consultation and validation of the diagnosis of fibromyalgia, and the person living with the condition, people giving support fulfil a critical role in shaping the experience. The findings show how support from family, partners, and peers plays an integral role in the process of accepting fibromyalgia diagnosis, adapting to the demands of the condition, and seeking help from healthcare providers. The findings also show the ways in which people with fibromyalgia provide support for others with the condition, and the importance of this peer network in shaping the paths and outcomes of this illness experience. The findings of this study corroborate existing evidence that show fibromyalgia to be a complex condition to manage, due to the multiplicity, uncertainty and contestation that feature in the experience of the illness. Additionally, this study presents the challenges related to the limitations of access to healthcare in the South African context, and the utility of narrative approaches in garnering insight into the ways in which social support is harnessed in this environment. [ABSTRACT FROM AUTHOR]

Teaching is one of the most stressful occupations, with high stress and burnout levels of teachers necessitating intervention. This is especially relevant for South African teachers tasked with additional responsibilities of dealing with HIV/AIDS issues, as well as attending to normal curricula duties. A burnout prevention intervention, based on Paulo Freire’s adult educational approach, using transpersonal psychology techniques, was introduced to HIV/AIDS coordinator teachers (n = 27) at high-risk schools in the Western Cape, South Africa, who attended six three-hour weekly workshops. This paper presents the bottom-up thematic analyses of the group, as well as individual global analysis (n = 10) of the qualitative data, derived from focus group interviews and workshop evaluations after the intervention, providing insights into the experiences of workshop participants and their teaching contexts. The mind map of one participant is illustrated. The findings of the study confirmed that transpersonal practices (TP) presented in psychoeducation workshops were helpful in mediating stress and burnout in the work and personal contexts of teachers dealing with HIV/AIDS. TP offer practical applications of right brain emotional and social intelligence practices that could be incorporated into care and wellness school programmes for teachers vulnerable to stressors related to HIV/AIDS. [ABSTRACT FROM PUBLISHER]