Theses and dissertations (Health Sciences)
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Item A feasibility analysis of migrating emergency care providers to the new emergency care qualifications in the Capricorn District in Limpopo, South Africa(2024) Selahla, Lekgowana Philimon; Sobuwa, Simpiwe; Chule, Ntuthuko GiftIntroduction: Emergency care education and training has historically centred on short courses and on-the-job training, resulting in most emergency care providers lacking formal qualifications. The current legislative changes have restructured emergency care education, introducing a three-tiered qualification system, aligned with international and national standards. These encompass a one-year higher certificate, a two-year diploma, and a four-year professional degree in emergency medical care. Despite these changes, migration to formal emergency care qualifications has never been investigated. This study addresses this knowledge gap by evaluating the feasibility of migrating the existing emergency care providers in Limpopo emergency medical services to the new emergency care qualification structure. Methodology: This study employed a retrospective, quantitative, descriptive design to analyse the feasibility of migrating the existing emergency care providers to the new emergency care qualifications. The study population comprised emergency care providers working for the Limpopo emergency medical services. The total population sampling, a purposive non-probability technique, included all qualified emergency care providers in the Capricorn District in Limpopo. The data collection method used involved extracting relevant documents for the study from employees’ files in the archives storeroom. The data was analysed using the statistical package for social sciences® version 25. Results: A total of 356 (93.68%) participants from a target population of 380 emergency care providers in the Capricorn District, Limpopo emergency medical services, were included in the study. However, 36 participants were excluded due to invalid data as their files did not have matric, identity or emergency care qualification documents. Consequently, the final sample size was 320 (84.21%) participants. Of the 320 participants, two participants were without a matric qualification, bringing about 318 participants in the matric qualification analysis. The findings revealed that most emergency care providers were males 195 (60.94%), with Africans 319 (99.69%) being the predominant racial group. The age distribution revealed that 181 (56.56%) participants fell within the 40 to 49 age range, and the mean age was 45. Regarding emergency care qualifications, the study found that 180 (56.25%) participants held basic ambulance assistant qualification, and 318 (99.37%) participants completed matric. However, many participants lacked the performance levels and subject combinations to enter emergency medical care programmes. A mere 10 (3.14%) passed Mathematics, six (1.89%) passed Physical Science, and 36 (11.32%) participants passed Biology. None of the participants met the criteria for entry into diploma and bachelor's degree programmes. Only three participants met the entry criteria for the higher certificate programme. Conclusion: The study’s findings showed that most of the existing emergency care providers in the Capricorn District do not have the pre-requisite secondary school leaving subjects or the appropriate matric performance levels to enter various emergency medical care programmes. As a result, migration to formal emergency care qualifications through direct access will not be feasible for many of the emergency care providers. The matric results place a substantial number of them in a disadvantaged position.Item Preparing paramedic graduates for independent practice : an assessment of the effectiveness of a Paramedicine degree from a university in KwaZulu-Natal(2022-05-13) Mariano, Shaylee; Govender, Kevin; Naguran, SageshinIntroduction There have been major advances in prehospital emergency care policy, training and practice in South Africa (SA). One of the most notable changes is the transition of paramedic education from vocational technical training to university-based education. This change ultimately led to the development of the bachelor’s degree in Emergency Medical Care (BHSc: EMC) which is a four-year professional degree offered at only four accredited higher education institutions (HEIs) in SA. Since its inception, the degree itself has undergone many changes; however, despite these changes, its effectiveness in achieving its intended and espoused goal has never been investigated. Emerging from this knowledge gap is the purpose of this study – to investigate the effectiveness of the BHSc: EMC degree, specifically at an HEI in KwaZulu-Natal, SA, in preparing students for independent practice. Methodology The study commenced with a critical appraisal of a collection of documents that comprehensively described the version of the BHSc: EMC curriculum delivered during the years 2016 to 2018. The aim of this review was to specifically address objective 1 of the study, which was to examine the content, the instructional design and the minimum competencies that graduates needed to show on successful completion of the degree. This review was then followed by a sequential mixed method exploratory design, which was conducted in two distinct phases, and included the total population of all 45 individuals who identified as 2016–2018 graduates. Phase 1 consisted of interviews designed to specifically elicit the emic views of a purposefully targeted and informationrich sub-group of individuals (n = 18) also from within the total population. The goal of this phase was to use the elicited information to develop a contextually valid, relevant and bespoke questionnaire that was to be used in phase 2, where quantifiable participant responses from the entire population (n = 45) were then collected. Data from phase 1 was qualitatively and thematically analysed and phase 2 data was descriptively and inferentially analysed. Significant results at p < 0.05 are reported. Results The critical appraisal of the curriculum revealed that there was an obvious lack in an espoused consensus on the minimum standards for the degree. There was also notable misalignment between content and modules across subsequent and articulating years of the degree. A closer examination of learning outcomes revealed that they very rarely aligned with principles that ensured consistent clear and specific direction for what students could expect to learn at the end of the respective modules. The survey used to address objectives 2 and 3 achieved a 63% response rate. In relation to graduates’ work readiness, described as students being equipped with the foundational entry-level skills and resources needed to be minimally qualified for a specific occupation as specified by a job description or occupational profile employability, graduates revealed that their paediatric and neonatal assessment and management skills, and their rescue abilities, were not at the level that rendered them adequately prepared for even entry-level jobs. With regard to graduates’ employability, which while closely related to work readiness is defined as having the necessary skills and abilities that render candidates eligible for employment, graduates felt that while they met minimum job requirements, they lacked practical experience as well as confidence. They also alluded to the suggestion that certain aspects of the degree are not aligned with industry needs. Conclusion There is no doubt that the development of and compliance with minimum competency standards which are a result of national consensus will be the cornerstone for a more effective and efficient paramedicine degree. How those minimum standards are achieved and how and when content is delivered to achieve those minimal standards should also be a result of national consensus. In the absence of these standards, there exists the possibility that learning outcomes, content, learning and teaching strategies, assessments, alignment, educational philosophy and standardisation of the BHSc: EMC, which are core constructs for effective teaching and learning in SA paramedics, will continue to receive criticism as highlighted in this study.Item A model for the prevention of work-place violence towards public service emergency care providers in Gauteng province(2021-12-01) Khoza, Tshikani Lewis; Sibiya, M. N.; Mshunqane, N.Background Workplace violence is an alarming world-wide phenomenon that also affects healthcare providers. However, among healthcare providers, Prehospital Emergency Care Providers (PECPs) are particularly at risk of workplace violence as they provide direct patient care in often hostile and undefined public areas whilst interacting with the patient, their family members and bystanders. Gauteng Province is South Africa’s economic hub and the most populous province. In Gauteng Province, workplace violence towards public service PECPs persists, producing a negative impact on the effectiveness of the public healthcare system, despite the measures that have been put in place. Aim The aim of this study was to develop a model to prevent of workplace violence against public service PECPs in Gauteng Province. Methodology The study was conducted using a non-experimental, cross sectional and mixed methods design guided by a social constructivism/ interpretivism paradigm with an interpretative framework founded on pragmatism. Overall, 413 questionnaires were administered in the quantitative subphase. The qualitative subphase the study included seven (7) face to face semi-structured interviews from the management cohort and focus group discussions comprised of 35 PECPs. Parallel mixed methods analysis was used to analyze the data. Findings The findings of this study revealed that even with the current preventative measures in place, there is a high incidence of workplace violence towards public sector emergency care providers within low and middle income communities of Gauteng who rely on state funded healthcare. The risk factors to workplace violence included service delivery frustrations and protests, high crime rates, a lack of reliable backup and emergency care providers being perceived as easy targets. Workplace violence results in a lack of job satisfaction and a poor perception of workplace safety culture amongst PECPs and a decreased quality of and limited access to emergency medical care amongst the low and middle income communities in Gauteng. The findings and meta-inferences generated by the mixed results informed the development of a proposed model for the prevention of workplace violence towards public service PECPs in Gauteng Province.Item An investigation into occupational blood and body fluid exposure among emergency medical care providers within the public sector emergency medical service in eThekwini(2020-11-30) Chetty, Melvin; Govender, Kevin; Sobuwa, SimpiweIntroduction Occupational exposure to blood and body fluid (BBF) is an issue of serious concern for health care workers (HCWs) and presents a major risk factor for the transmission of infectious diseases such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV). Emergency medical care (EMC) providers, particularly those working in the developing countries, appear to be at even greater risk due to nature of their prehospital work and the environment in which this work is undertaken. Purpose To investigate the knowledge, practices and exposure to BBF among public sector EMC providers in the eThekwini metropole, as part of a process of informing contextually relevant recommendations for the mitigation and management of BBF exposure in the prehospital environment. Methodology The study used a mixed methodological approach and was conducted in two phases. During the first phase quantitative data was collected using a questionnaire which was distributed to a randomly selected and representative sample of EMC providers employed by the Emergency Medical Rescue Services (EMRS) in eThekwini. Phase two included the collection of qualitative data through structured interviews which were conducted with the information-rich respondents who had participated in phase one. Through methodological triangulation, the data from Phase one and Phase two were integrated to obtain an in-depth understanding of the knowledge, practices and exposure to BBF among public sector EMC providers in the eThekwini metropole. Results A total of 41 (43%) of the 96 participants indicated that they had been exposed to BBF at some point in their careers. The majority (n = 26, 63%) of such BBF exposures was due to needlestick injuries (NSI) with the procedure involved in gaining intravenous (IV) access accounting for most (n = 14, 34%) of the BBF exposures. The main contributing factor in relation to most (n = 25, 61%) of the exposures was combative patients. There was a significant relationship between the qualifications of the EMS providers and the type of BBF exposure (p = .016). It was found that a higher proportion of intermediate life support (ILS) providers sustained NSI compared to advanced life support (ALS) and basic life support (BLS) providers, whilst a higher percentage of ALS providers sustained BBF exposure to their eyes, while basic life support providers sustained more BBF exposures to broken skin as compared to ALS and ILS providers. Seventy nine percent (n = 76) of the respondents were unable to identify all of the presented risks of their BBF exposure, while 80.2% (n = 77) did not know where their organisation’s BBF exposure guideline was kept. There was a significant relationship between the EMC providers’ qualification and their knowledge of the risks of BBF exposure (p = .01), with ILS providers identifying more risks associated with BBF exposures compared to ALS and BLS providers. Half of the respondents (n = 48) were unable to identify all the presented examples of universal precautions. The association between qualifications and knowledge of universal precautions was significant (p= .002). Advanced life support and ILS providers demonstrated greater knowledge of BBF exposure compared to BLS providers. Inadequate BBF exposure training and a lack of clear direction regarding BBF exposure protocols were identified as possible reasons for the inadequate knowledge of both the risks of BBF exposure and universal precautions. Most (n = 87, 90.6%) of the respondents indicated that they always used gloves when there was a perceived risk of BBF exposure, while 27.1% (n = 26) and 15.6% (n = 15) indicated that they never used eye protection and facemasks respectively. Possible reasons for the infrequent use of personal protective equipment (PPE) include the unavailability of PPE, and EMC providers not anticipating the BBF exposure. The majority of the respondents (n = 74, 77.1%) indicated that they always recapped needles, 95.8% (n = 92) removed needles from syringes and 46.9% (n = 45) disposed of sharps containers when completely full. Conclusion The study found that the EMC providers employed by the EMRS in eThekwini do not possess adequate knowledge of either BBF exposure or universal precautions, which may be one of the contributing factors to the high prevalence of BBF exposures revealed in this study. As the burden of disease continues to grow, urgent intervention is required to mitigate BBF exposure in all HCWs, but particularly in the case of EMC providers who are frontline staff who often have no prior knowledge of the patients they may see before the initial contact. As informed by this study interventions may include the provision of BBF exposure training, the circulation of effective BBF exposure guidelines and the adequate availability of PPE.Item Preparedness of emergency care providers to deal with death, dying and bereavement in the prehospital setting(2018) Conning, Reon Johnathan; Naidoo, Raveen; Bhagwan, Raisuyah; Ahmad, Sami ManaIntroduction: Emergency care providers are exposed to events involving suffering and tragedy as part of their routine work in the field. They are accordingly expected to deal with death, dying and bereavement in a safe, sensitive, efficient manner, showing empathy and compassion while managing their own emotions. This can be stressful and lead to trauma symptoms, anxiety and depression. Purpose: To investigate how prepared emergency care providers are to deal with death, dying and bereavement in the prehospital setting in order to recommend strategies that will diminish the emotional strain they experience, as well as decrease the trauma of sudden death and the number of abnormal grief reactions for the bereft. Methods: The study used a quantitative descriptive prospective design. Data was collected using an online self-report questionnaire that was sent to all operational emergency care providers in the Dubai Corporation of Ambulance Services (DCAS). The data from consenting participants (n = 496) was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 25.0. Inferential statistical techniques such as correlations and chi-square test values were used and interpreted using the p-values. Factor analysis was also conducted for the purpose of data reduction. Results: The majority of respondents (n = 316; 64.4%) reported that they had not received any formal education or training on death, dying and bereavement. Those that had received formal education or training reported that this training was conducted mainly by nursing (n = 124; 25.9%) and paramedic (n = 65; 13.6%) instructors. A quarter of the respondents (n = 126; 25.4%) reported experiencing intrusive symptoms such as loss of sleep, missing work and nightmares as a result of a work-related death or dying incident, but only a few (n = 20; 4.1%) had received professional counselling. Conclusion: This study found that emergency care providers are underprepared to deal with death, dying and bereavement and reported discomfort and anxiety associated with this aspect of their job. A comprehensive death education programme that encompasses the diversity of death and the unique challenges that the emergency and prehospital setting presents should be implemented to reduce emotional anxiety, help emergency care providers cope better with death and decrease the number of abnormal grief reactions on the part of the bereft.Item Preparedness required for ensuring best coordinated use of international urban search and rescue assistance by earthquake affected countries(2007) Morris, Brendon; Grainger, Linda D.; Owen, R. C.Strong earthquakes are frequent catastrophic disasters occurring worldwide and often lead to structural collapse of buildings. Urban Search and Rescue (USAR) is the specialised process of locating, extricating and providing immediate medical treatment to victims trapped in collapsed structures. This research project aimed to identify the key preparedness efforts necessary by an earthquake affected country to ensure best coordinated use of international USAR assistance.Item Development of a tool to define the population of emergency medical care users in South Africa(2008) Bowen, James MarcusPrehospital emergency medical service (EMS) data is essential for understanding the functioning of the services as well as the community's health. Being able to clearly and accurately define the patient population in terms of demographics and clinical condition may guide the EMS in resource management, clinical governance, research, education and political decisions. However, such data is limited in South Africa. This research, therefore, aimed to develop a data collection tool to determine the population of prehospital emergency medical care patients in South Africa. The objectives were: (i) determination of what data needed to be collected, (ii) development of a tool to collect the data, and (iii) testing the tool for ease and appropriateness of use and completeness of data collection in an authentic environment. A mixed-method, predominantly qualitative methodological design was used, with some elements of grounded theory. There were three phases corresponding to the objectives. The first two were qualitative and the third was both qualitative and quantitative. In the first phase expert consensus was sought, using a focus group discussion and Delphi study, to develop a minimum data set (MDS) to describe the patient population. The resultant MDS consisted of 18 data elements which could be categorised into demographics, time and location of EMS use, the clinical reasons for EMS use, and the actual use of the EMS. A tool and associated user instructions, based on the findings of Phase One, were developed and refined during Phase Two. Phase Three was used for testing the tool in an authentic environment. The tool was found to be acceptable and user-friendly. Further testing of the tool for accuracy and reliability is recommended.Item An assessment of ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal(2008) Naguran, SageshinThe purpose of the study was to assess ambulance infection control in an emergency medical service in the Ilembe District of KwaZulu-Natal, by determining the prevalence of bacteria and fungi in ambulances, including those that are potentially pathogenic, and evaluating the knowledge and practices of staff in infection control.Item Preparedness required for ensuring best coordinated use of international urban search and rescue assistance by earthquake affected countries(2007) Morris, BrendonStrong earthquakes are frequent catastrophic disasters occurring worldwide and often lead to structural collapse of buildings. Urban Search and Rescue (USAR) is the specialised process of locating, extricating and providing immediate medical treatment to victims trapped in collapsed structures. This research project aimed to identify the key preparedness efforts necessary by an earthquake affected country to ensure best coordinated use of international USAR assistance.