Table 1 A descriptive summary of the salient contextual factors of the study setting in accordance with good practice reporting guidelines [18]

Staffing

The ward is managed by a nurse manager who is a registered nurse, with an additional specialist qualification in paediatric nursing.

There was an average of five nurses on each observed shift.

Language

The majority of the population living in the Umkhanyakude health district speak isiZulu as a first language.

Nursing staff speak isiZulu and English with one another, and often speak isiZulu with patients. Written records are maintained in English.

Service capacity

The 22-bedded ward admits patients for a variety of medical and surgical conditions ranging in acuity with two high-care beds and a 5-bedded isolation facility.

Reasons for admissions include: burns; gastroenteritis; snake bites; poisoning; pneumonia; traffic accidents; seizures; malnutrition, and social admissions (children who have been abandoned).

Ward environment

The main part of the ward is open-plan with full-sized beds in rows along each side.

The 18 full-sized adult beds with cot sides allow the mother to share a bed with her hospitalised child.

There are four small cot beds for children who are receiving orthopaedic traction or who do not have a mother staying with them.

Each bed is separated from the next by a locker and curtains that are rarely drawn by mothers or staff.