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Article History

Received: 1 August 2025

Accepted: 6 March 2026

First Online: 14 May 2026

Declarations

:

: The study received ethical approval from the Stellenbosch University Health Research Ethics Committee (approval number S22/10/216) on 21 November 2022. The study was conducted in accordance with the Declaration of Helsinki’s ethical principles. Managers from the private and state-subsidised LTCFs provided written institutional permission for the study.

: Not applicable.

: Unlicensed lay workers who are not nurses but work in formal sectors, such as LTCFs. Caregivers assist residents with their activities of daily living, such as bathing, turning bedridden residents, and feeding [ , ].

: Enrolled nursing assistants who provide basic nursing care, such as providing residents with psychosocial and physical support in their activities of daily living under the supervision of an RN [ ]. ENAs receive one year of training to obtain a higher certificate (120 credits) [ ].

: Enrolled nurses – ENs provide basic nursing care, such as implementing residents’ nursing care plans and observing residents’ reactions to medication and treatment, under the supervision of an RN [ ]. ENs receive two years of training. This is a legacy qualification, and no new graduates have been trained since the last enrollment for this category on 31 December 2019 [ ].

: Registered nurses - RNs consist of registered professional nurses who provide comprehensive care and registered general nurses who provide general nursing [ ]. RNs have either a three-year diploma or a four-year degree-level training.

: The authors declare no competing interests.