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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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Start date: 2020Subject: search.filters.subject.Primary health care

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    Exploring factors influencing patient safety incident reporting by nurses in primary health care facilities in King Sabata Dalindyebo sub-district, Eastern Cape
    (2024) Tolobisa, Patiswa; Naranjee, N.; Moonsamy, S.
    Patient incident reporting is a crucial activity for enhancing healthcare standards and ensuring patient safety. Reporting patient safety incidents offers a comprehensive overview of incidents, detailing what occurred and how it happened, thereby facilitating learning and improvement. The study identified several factors influencing patient safety incident reporting, including a lack of understanding of incident reporting, a blame culture, minimal support by managers, a lack of training, inadequate facilities, a lack of feedback and debriefing, and the absence of rewards and punishment system. A necessary positive activity to improve health care standards and patient safety is patient incident reporting. Patient safety incidents provides a broad picture of what has happened, how it happened and facilitates learning. AIMS AND OBJECTIVES OF THE STUDY The aim of the study was to explore and describe factors influencing the reporting of patient safety incidents in primary health care facilities from nurses’ viewpoints. The objectives were to explore factors influencing PSI reporting behaviours in primary health care facilities in King Sabata Dalindyebo sub-district, OR Tambo District, Eastern Cape, to explore nurses’ knowledge and understanding of PSI reporting, and to provide recommendations for improving PSI reporting. METHOD In this study, a qualitative, exploratory, descriptive design assisted the researcher in exploring the factors influencing reporting of patient safety incidents by nurses in primary health care facilities. The target population was all 48 nurses permanently employed in the primary health care facilities in Mqanduli cluster, King Sabata Dalindyebo. A non probability, purposive sampling method was used to select the participants for the study, where 10 nurses were interviewed as determined by data saturation. Individual interviews were conducted using semi-structured interviews in English based on an interview guide which lasted for 15-20 minutes for each participant. The data was analysed using the thematic data analysis method. FINDINGS Five themes emerged from the thematic analysis, with 19 subthemes. Themes were: (1) Experiences of patient safety incident reporting, (2) contributory factors to patient safety incidents, (3) importance of patient safety incident reporting (4) barriers to PSI reporting, and (5) recommendations by participants.The reporting process for patient safety is influenced by a number of factors, such as nurses' reluctance to report for fear of punishment, the emphasis placed on unclear reporting systems, management behaviour, lack of training and education, and fear of lawsuits. The experience of implementing patient safety incident reporting necessitates support from management in the form of training and provision of resources, creating a positive work environment and safety culture by not punishing those who make errors, and rewarding those who report patient safety incidents. CONCLUSION The nurses at Mqanduli cluster, King Sabata Dalindyebo Sub-District had challenges regarding the reporting of patient safety incidents due to a number of issues tabled by the participants that were influencing factors to patient safety incidents that should have been prevented such as negligence. The participants proposed recommendations such as development through training of the nursing staff regarding how to report patient safety incidents and provision of resources.
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    An evaluation of the knowledge and practices of primary health care nurses in the collection of clinical specimens at the King Cetshwayo District, KwaZulu-Natal, South Africa
    (2023-05-31) Mthethwa, Bhekisiwe Thobekile; Razak, Ayisha; Pillay, Padmini
    The burden of diseases in South Africa (SA) increases the demand for several clinical specimens to be collected and analysed at the clinic level and to provide an initial diagnosis of diseases. The primary purpose of the clinical specimen collection is to conclude on the clinical diagnosis, give proper clinical management, and monitor disease progression of patients. In 2019, the South African National Health Laboratory Services reported an increasing rate of specimen rejection due to pre-analytic errors for Primary Health Care (PHC) clinics. The insufficient knowledge and incorrect practices by nurses during specimen collection resulted in specimens being deemed unsuitable for analysis thus were rejected by the laboratory services, leading to delayed patient diagnosis and treatment. Aim of the study The study aims to evaluate the knowledge and practices of nurses in the collection of clinical specimens that may lead to rejections in Primary Health Care clinics. Method Quantitative, non-experimental, cross-sectional descriptive survey design was used to conduct the study. Consecutive sampling method used to select the 22 fixed primary health care (PHC) clinics and one CHC under King Cetshwayo Health District. The target population consisted of professional and enrolled nurses from the selected clinics. Sample size was 352 respondents. A checklist and a self administered questionnaire was used to gather information on specimen collection. Data was analysed using SPSS version 27 and descriptive statistics was used to describe the data graphically and in frequency distribution tables Results The study results on knowledge and practices of nurses in specimen collection, showed that the majority of respondents (97%) n=326 displayed necessary knowledge on four main areas of specimen collection which are: preparation and identification; collection and handling; courier and results handling and the availability of specimen collection material. The respondents also displayed significant knowledge in the specimen collection and handling section with an 89% (n=299) response to colour coding for specimens and 81% (n=272) for the volume of the specimen in the container. Conclusion The study showed that three phases of specimen collection which are: specimen and patient preparation (pre-analytical), collection and analysis (analytical) as well as results handling (post-analytical) can influence each other negatively or positively. The positive influence is when the availability of all specimen collection consumables, proper nurses training (structure) and use of correct procedures (process) enables nurses to collect the specimens correctly so that accurate results will be produced (outcome). The negative influence is when the unavailability of some specimen collection consumables and inadequate training results in nurses using incorrect procedures to collect specimens; therefore, inaccurate results will be produced by the laboratory delaying patients’ diagnosis and treatment.
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    Experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal
    (2022-09-29) Zulu, Mthokozisi; Ngxongo, Thembelihle Sylvia Patience
    Introduction and background: The key outcome of the vision of the government of South Africa is the attainment of a long and healthy life for all of its citizens. In view of this, the government of South Africa has embarked on a phased implementation of the National Health Insurance (NHI) scheme in order to achieve universal health coverage so that there is access to appropriate, affordable efficient quality health care services for all. The South African National Department of Health introduced the ideal clinic realisation and maintenance programme in response to the current shortages of primary health care (PHC) services and to lay a strong foundation for the implementation of NHI. The programme includes an algorithmic approach to change all the PHC clinics to adhere to the NHI standards. An ideal clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies. Nevertheless, reports indicated that the target of achieving the 50% mark in selected vital areas such as staffing, resource allocation and utilisation, by 2019, has not been achieved. Aim and objectives of the study: The aim of the study was to explore and describe the experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal. The objectives of the study were to: explore and describe the experiences of nurses regarding the implementation of an ideal clinic project; determine the perception of nurses regarding the implementation of an ideal clinic project, describe the support, if any, received by the nurses during the implementation of the ideal clinic project; determine the challenges if any experienced by nurses during the implementation of an ideal clinic, and to determine the strategies that can be instituted to facilitate successful implementation of an ideal clinic project. Method: A qualitative research design which using an explorative and descriptive approaches was employed with Donabedian’s structure, process and outcome model used as a theoretical framework to guide the study. Data were collected through one-on-one semi-structured interviews with the nurses who were involved in the implementation of ideal clinic projects in the 18 PHC clinics under Prince Mshiyeni Memorial Hospital between the 16th September 2020 and the 26th October 2020. Findings: The six major themes that emerged from the interviews included structural limitations, processes involved in the running of the clinic, support offered to the PHC clinics, communications and staff involvements, staff training and administration of an ideal clinic project all of which interfered with successful implementation of this project. Conclusion: The findings of the study confirmed that the nurses who are the drivers of this ideal clinic project have many negative experiences and perceptions which make it difficult to fulfil the ideal clinic project standards. It was evident from the study that there was little support offered to them when it came to ideal clinic implementation. However, the study also revealed that there are a number of actions that could be instituted in order to bring the ideal clinic status to fruition such as improvement of infrastructure, training of staff and addition of more staff and instituting staff involvement in the ideal clinic project as a whole. Recommendations: Recommendations are made in relation to policy formulation and implementation, service delivery, nursing education and research. The recommendations made from this study were based on the strategies that can be instituted to improve the ideal clinic implementation. The recommendations were made with special reference to the employment of more trained staff, improvement of infrastructure of the facilities, staff involvement in the implementation of any programmes and adequate support of staff members regarding the implementation of the ideal clinic project.