Theses and dissertations (Health Sciences)
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Item Knowledge and practices of radiographers when imaging children with non-accidental injuries at a public hospital in KwaZulu-Natal, South Africa(2020-11-30) Lekaota, Olehile Edward; Nkosi, P. B.Non-accidental injury (NAI) in children is defined as an abuse, where injury is inflicted intentionally. Radiographers are the first point of care to identify the area with injury and provide x-ray films to show that the injuries result from NAIs. The research shows a dearth of studies on knowledge and practice of radiographers when imaging children with NAIs. It is imperative to understand this information in order to provide training for radiographers, and ultimately improve the diagnosis of NAIs, so that children can be protected from the abuse. Aim of the study The purpose of the study was to explore radiographers’ knowledge and practice when imaging children with NAI in order to develop them in this aspect and ultimately recommend training required. Methodology An exploratory, qualitative research design using a case study approach was employed in this research. Criterion sampling was used to select a public hospital that treats children with injuries in KwaZulu-Natal. Homogenous sampling was used to select radiographers employed by this hospital to participate in the study and a sample size of 10 radiographers participated in this study. Semi-structured, face-to-face and one-on-one interviews utilising open-ended questions were used to collect data from the participants. Data collection stopped with the 8th participant when data became saturated. Data was transcribed verbatim before data analysis. Tesch’s method of data analysis was used in the analysis. Findings Collected raw data was transcribed and proceeded with thematic analysis where the following themes merged; knowledge of NAI in children, care of children with NAI, practice when imaging children with NAI, quality of images in children with NAI and acquiring knowledge of NAI in children. The study revealed that radiographers lack knowledge and practice on imaging children with NAI. The study findings also identified factors that compromise a lack of knowledge and practice. Conclusion It is vital for radiographers to attain knowledge and practice on imaging children with NAI so as to enable them to detect a suspected NAI case. The intervention of Government on the implementation of relevant policies pertaining NAI, will assist radiographer and other medical team to follow all required procedures elicit the evidence of NAI. The participants of the study insist they require training on how to treat and classify NAI cases, and the ultimately goal is to secure the safety and protection of children.Item A critical analysis of the implementation of obstetric management guidelines on common causes of maternal death, as applicable to midwives(2021-05-27) Sewnunan, Asha; Puckree, T.; Basson, Petro MagdalenaBackground Despite interventions by the United Nations which formulated the Sustainable Development Goals (SDGs), to replace the unmet targets of the Millennium Development Goals, the maternal mortality ratio (MMR) remains high in low-andmiddle income countries including South Africa (SA). The goal 3 of the SDG aims to achieve less than 70 maternal deaths per 100 000 live births by 2030, globally. The slow but steady decline in the number of maternal deaths in SA with 339 deaths over the last 2014-2016 triennium falls short of the SDG targets (National Department of Health, 2017). The institutional MMR for potentially preventable maternal deaths in South Africa was 83.3 over the last triennium. The management of obstetric emergencies in SA is based on the interventions laid out in the Essential Steps in Managing Obstetric Emergencies (ESMOE) which was adapted from internationally recognised obstetric management guidelines that have proven to reduce MMR’s if effectively implemented. The availability of a good clinical guideline is only part of the solution but ensuring effective implementation in the clinical environment is of greater significance to reduce preventable maternal deaths. Aim The aim of this study was to analyse the impact of the implementation of the ESMOE guidelines by midwives on the management of the common causes of maternal deaths. This included identifying gaps, challenges and successes of its implementation by the midwife at the different levels of health care facilities with the ultimate aim of developing a practice framework to implement the interventions into midwifery training, to improve relevant knowledge and skills in providing quality emergency obstetric care. Methodology A multi method data collection approach using quantitative and qualitative designs was implemented in four phases. This study was conducted in two of the eleven districts of KwaZulu-Natal. All level of hospitals and CHCs (eleven) in eThekwini (District A) and Ugu (District B) were chosen based on purposive sampling including the districts health system’s referral pattern. Data was collected by the researcher using self-designed data capturing sheets. Quantitative data was collected on resources and ESMOE training at all eleven selected facilities, as well as a retrospective chart review on a total of 17 maternal deaths that occurred over a specified period to assess the implementation of ESMOE interventions. Face to face interviews were conducted by the researcher with 14 ESMOE trained midwives to determine the barriers and challenges they experience that impedes successful implementation of the ESMOE interventions. To test for significant trends in the quantitative data, inferential statistics was applied, including Pearson’s correlation, ttests, Mann Whitney U test, Kruskal Wallis Test and Chi-square tests. Descriptive statistics included means and standard deviation as applicable. Relevant frequencies were represented in tables and graphs. Chi-square test of independence were used on cross-tabulations to see the significant relationships in resources at the various health facilities. The Kruskal Wallis test was used to compare specific variables across the different types of health facilities. The qualitative data was analysed using thematic content analysis. Finally, a Delphi Technique using ESMOE experts was employed to validate a practice framework to implement relevant ESMOE modules into midwifery training to enhance competencies of midwives and implementation of the guidelines. Results The findings of this study indicated that many barriers and challenges exist that prevent successful implementation of ESMOE interventions which would further reduce maternal mortality rates in SA. Of the 11 facilities chosen 45.5% (n= 5) were community health centres, whilst 54.5% (n=6) were hospitals. In phase two the results revealed that the CHCs and DH did not meet the criteria of being fully BEmONC compliant, which resulted in increased referrals to regional and tertiary hospitals. This was evident by the significant difference in normal vaginal deliveries at combination hospitals as compared to CHC (p=.037). An average of 2505 deliveries were conducted at combination/regional hospitals over a four- month period with averages of 1247 at a DH and 957 at a RH as compared to only 224 deliveries at a CHC. A general shortage of essential equipment was found across facilities. The CHCs had significant shortages of CTG machines and intravenous regulators. Staff with ESMOE training were insufficient to staff all the maternity units across the facilities. District A, the bigger of the two districts with eight facilities had a significantly lower number of ESMOE trained advanced midwives (n=11) as compared to District B with three facilities (n=12). The number of maternal deaths that occurred over January 2016 to April 2016 at three combination hospital were 82% (n=14) as compared to 12% (n=2) at the regional hospitals and only 6% (n=1) that occurred at a District hospital and no deaths at a CHC. Deaths due directly to hypertension were 41% (n=7), HIV was 6% (n=1), whilst 53% (n=9) were from other causes not directly relevant to this study. A significant number of relevant maternal deaths 54.5% (n=6) were due to delays in seeking treatment and sub-standard care. Transport delays to the health facility contributed to 18.2% (n= 2) deaths, whilst non-compliance to treatment and poor record keeping were found in 27.3% (n=3) of the relevant maternal deaths. The interviews with the midwives in phase three yielded results that were suggestive of inadequate ESMOE training, lack of updates, lack of regular skills and drills exercises that contributed to lack of knowledge and skills in providing effective EmOC. Other challenges in effectively implementing emergency obstetric care included poor morale due to staff shortages, heavy burdens of workload, lack of motivation and support that contributes to sub-standard care. In the final phase the researcher took these findings and built on this by developing an algorithm that shows the need to improve midwifery clinical competencies. This algorithm was taken further to develop a practice framework that proposes to implement ESMOE interventions into the basic midwifery training to improve relevant knowledge and skills in managing obstetric emergencies effectively within a collaborative team approach. Conclusion This study has shown that gaps in the implementation of ESMOE guideline interventions in the selected facilities in KZN could have contributed to sustained high MMR in the province. The midwives expressed the need for regular training and updates to continuously improve and maintain their knowledge, skills and competencies in providing effective obstetric care. The data allowed the development of an algorithm for improved emergency obstetric patient care and a practice framework for training of midwives to ensure optimal implementation of the guidelines.Item Perceptions, expectations and experiences of first time chiropractic patients when consulting chiropractic students at a teaching clinic in KwaZulu-Natal(2018) Robbertze, Jamie Sarah; Kretzmann, Heidi; Skea, Denise AngelaThe focus of the chiropractic profession is to diagnose, treat and prevent mechanical disorders which affect the neuromusculoskeletal system of the body. Chiropractic is a young profession in South Africa as law only recognized chiropractors as recently as 1971. As a result, perceptions of chiropractic are continually evolving as it gains popularity among the public. Despite its growth to date, further expansion of the profession may be limited due to its isolation from the public health care system of South Africa. This study aimed to determine the demographics, perceptions, expectations and experiences of first time chiropractic patients who consulted chiropractic students at a teaching clinic in KwaZulu-Natal. This information may allow identification of requirements for improved clinical outcomes of first time chiropractic patients and clinical practice of chiropractors and the chiropractic profession. This qualitative study utilized an exploratory and descriptive design. This methodology was chosen for its potential to reveal a deeper understanding of the fundamentals of chiropractic. Data collection involved semi-structured interviews with fourteen first time chiropractic patients who presented to the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Interviews were voice recorded, transcribed verbatim and analysed which resulted in eight themes with numerous subthemes. These were explored and demographic characteristics of participants were determined to fulfil the objectives of the study. Eight participants were male and six were female. Most were aged in their thirties, forties or fifties. With regards to population groups, six participants were Black/African, three were Indian, three were Coloured and two were White. Half the participants had medical aid and most were professionals, technicians and associate professionals and services and sales workers. The understanding of chiropractic and chiropractic care theme revealed a limited awareness and understanding of chiropractic, perceptions of the chiropractic scope of practice and beliefs regarding chiropractic care for special population groups. The care-seeking influential factors theme indicated that the reasons chiropractic care was sought were: soreness, trusted suggestions and unsuitable alternative care options. The experience anticipations theme showed that some participants had indistinct ideas prior to their experiences while others had conceived expectations for the chiropractic care. The consultation outcomes theme indicated expectations for improvement in presenting complaints as well as occurrence of adverse reactions. The origins of beliefs theme revealed that perceptions and expectations of chiropractic were formed from accessible information as well as the first time chiropractic consultation experience. Professional and unprofessional aspects of the DUT CDC environment were discussed in the first impressions theme. The chiropractic care theme explored experiences of the thorough and detailed examination, feelings of fear and apprehension and trust and comfort, patient centered care, effectiveness of the treatment and pain and adverse effects. The last theme, experience reflections, demonstrates the extent to which expectations were met, aspects of the experience which could be improved and desires to return to and recommend the DUT CDC to others.Item Clinical support to nursing community service practitioners in Ugu District, KwaZulu-Natal(2018) Malunga, Ignatia Tandiwe; Basson, Petro MagdalenaIntroduction: The shortage of skilled health professionals in public health care facilities is the main reason why compulsory community service was started by the South African government. The change in the disease pattern over the past two decades coupled with the mass exodus of health care professionals to overseas countries resulted in severe staff shortages especially in rural areas. Nursing community service practitioners (NCSPs) lack experience in dealing with complex clinical problems especially at primary health care level. They need experienced health professionals to offer clinical support to them. Aim of study: The aim of the study was to establish the degree of clinical support that is offered to NCSPs who are placed for compulsory community service within the Ugu district. Methodology: A qualitative study was conducted using an exploratory descriptive design. Purposive sampling was utilized to select eight NCSPs from a regional hospital and a community health centre. Semi-structured interviews were conducted and data was recorded verbatim for accurate analysis. Content analysis of data was employed where data was analyzed into meaningful themes. Results: The study revealed gaps in the clinical support offered to NCSPs. Lack of clinical support was reported more in the hospital than at the community health centre.·organizational problems such as lack of orientation, absence of in-service education and lack of proper rotation to different departments were some of the main concerns that were reported. Conclusion: Nursing community service practitioners need clinical support from experienced health professional to guide and teach them until they develop confidence.Item Clinical experiences of first-time registered Master's chiropractic students during their clinical practicum(2017) Ganesh, Nivida; Varatharajullu, Desiree; Sibiya, Maureen NokuthulaBackground The imperative of clinical education in chiropractic is to endow students with the clinical competencies and professional attributes necessary for independent practice. The clinical practicum exposes chiropractic students to the realities, demands and expectations of patient care through immersion into the clinical learning environment. Various authors emphasise the importance of obtaining a student’s perspective of their experiences within this environment as it is essential to curriculum development and improvement, delivery of quality clinical education, and student satisfaction with their standard of education. Interestingly, unlike in other health professions’ disciplines, the clinical experiences of chiropractic students who have commenced their clinical practicum have scarcely been described in international literature. This study is the first of its kind to record the clinical experiences of chiropractic students during their clinical practicum in South Africa. Aim The aim of this study was to explore and describe the clinical experiences of first-time registered Master’s chiropractic students during their clinical practicum component at the Durban University of Technology Chiropractic Day Clinic in 2016. Method A qualitative, exploratory, descriptive approach was utilised. A purposive sample of 15 first-time registered Master’s chiropractic students was interviewed. Their clinical experiences during the clinical practicum were obtained through semi-structured interviews. Seven key questions, each relating to a specific aspect of the clinical practicum, were used to stimulate discussion. The data were recorded electronically and thereafter transcribed. Thematic analysis was used to interpret the data. Results Four main themes were identified, viz. undergraduate education and pre-clinical preparation; experiences within the clinical learning environment; inter-personal relationships in a clinical learning environment, and appraisal of the clinical practicum. Participants reported that the undergraduate and pre-clinical preparatory phase needed to be more practically orientated in order to provide relevance and cohesion to clinical learning. Significant experiences in the clinical learning environment included personal and professional growth and development, perceptions of preparedness for independent practice, perceptions of patient responses to chiropractic care, administrative duties and clinic infrastructure. The interpersonal relationships that contributed to the overall clinical experience were between students and their clinical supervisors, and students and the administrative staff. The appraisal of the clinical practicum included highlights and positive aspects that shaped the attitudes, values and philosophies of students, as well as the challenges and obstacles they encountered within the clinical learning environment. Conclusion This is the first South African study to document the clinical experiences of first-time registered Master’s chiropractic students. These clinical experiences were based on a variety of organisational and curriculum-orientated factors, as well as interpersonal dynamics. While students acknowledged and appreciated the critical importance of clinical education, and valued the learning opportunities within the clinical setting, they also provided constructive feedback on matters needing improvement to enhance the overall clinical experience. The lack of exposure to patient care prior to the commencement of the clinical practicum negatively impacted the clinical experiences. It is recommended that the findings of this study be utilised by the key stakeholders within chiropractic education to enhance chiropractic clinical education in South Africa.Item Knowledge, clinical competencies and medico legal responsibilities required for the administration of intravenous contrast media by radiographers(2017) Koch, Gerhardus George Visser; Swindon, Lynda; Pillay, Julian DavidBackground The current scope of practice for diagnostic radiographers, does not allow them to administer intravenous contrast media (IVCM) since there are no formal training guidelines accredited by the Health Professions Council of South Africa (HPCSA) (Koch 2014: 26). In selected countries abroad, radiographers are allowed to administer IVCM and have thus received the necessary and accredited training to do so. In view of this, the South African radiographer’s scope of practice is not on par with the selected countries. The radiologists in South Africa (SA) who are currently responsible for the administration of IVCM have issued a position statement which supports, in principle, the idea of radiographers administering IVCM should they receive the necessary and appropriate training to do so (RSSA 2011: 1-2). The aim of this research study was, therefore, to investigate the radiologists’ perspectives regarding the theoretical knowledge, clinical competencies and medico legal responsibilities required by radiographers in order to effectively administer IVCM. This research study provides input for the development of national training guidelines for radiographers to administer IVCM. Research Methodology A quantitative, descriptive study was conducted by targeting qualified radiologists residing and practicing within the province of KwaZulu Natal (KZN). Ethical approval was obtained from the Durban University of Technology’s (DUT) Institutional Research and Ethics Committee (IREC). All the participants were contacted in their personal capacity. The research tool was an online survey administered through SurveyMonkey which included questions and statements relating to the administration of IVCM and was structured so as to meet the study objectives. The research tool was evaluated and amended by an expert focus group to ensure reliability and validity. Confidentiality was maintained and all the data obtained during this research study was password protected. Results and discussion Fifty-nine radiologists (60.8 percent) participated in this study. Twelve respondents, however, were excluded due to incomplete surveys. The final response rate, therefore, was 48.5 percent (n=47) of which 72.3 percent of the respondents were from the private sector. Results illustrated the radiologists’ agreement regarding the theoretical, clinical/practical and medico legal training components for inclusion in the further training of radiographers to administer IVCM. Most respondents supported the inclusion of three assessments: theoretical (87.2 percent), clinical (93.6 percent) and a record of clinical competencies (95.7 percent). The assessments were considered equally important in terms of percentage weighting. The overall results compared favorably to the current international trends and practice standards of radiographers administering IVCM. Conclusion and Recommendations The study, in providing key data for the development of training guidelines for radiographers to administer IVCM, has demonstrated the importance of higher education (HE) and training in addressing transformation in health services with particular reference to professional scopes of practice. Furthermore, it reinforces the need for local research that will inform HE and training and hence a scope of practice that meets local needs. It was recommended that future studies should include those HE institutions offering training in Radiography as well as their stakeholders for the design and transformation of a national curriculum for radiographers to administer IVCM.Item An investigation into the clinical practicum experience of als paramedic students and their preparedness for professional practice(2016) Moodley, Kubendhren; Bhagwan, Raisuyah; Naidoo, RaveenClinical practicum remains an integral part of training and a vital component of the emergency medical care curriculum that takes place in a realistic and complex emergency care environment. Clinical practicum should provide students with the opportunity to combine cognitive, psychomotor and affective skills to develop competencies to prepare the qualifying practitioner for demands of pre-hospital emergency care in the real world. The aim of this study was to explore the multidimensional aspects of the clinical practicum experience of ALS paramedic students in the Western Cape through the lens of a qualitative research design. The study involved exploring the experience of paramedic students in the clinical practice placement. In addition, the views of paramedic graduates were also explored, to ascertain whether the placement experience adequately prepared them for practice. An analysis of the clinical practice documents utilised in the training of ALS paramedic students was conducted with particular reference to identify correlations with relevant literature. In addition, it was necessary to identify how clinical practice manifested itself, not only in what students and graduates express but also how it was coordinated and conveyed in a professional work related context, against the backdrop of the work integrated learning framework. Using a case study design, focus group interviews were conducted with final year EMC students from CPUT and CCA students from the Western Cape CEC. This was followed with one on one interview with paramedic graduates. Further to this, clinical practice documents were analysed to triangulate the data. This study revealed that the clinical practice learning objectives for paramedic students were not adequately achieved and paramedic graduates felt ill prepared for independent practice. These discrepancies were attributed to the complex issues both in theory and practice. The study provided a number of recommendations for improving the clinical training experience, such that paramedic graduates who enter the complex and challenging world of EMC are better prepared.Item The assessment of the facilitation of the clinical training component of an undergraduate nursing programme at a University of Technology(2015) Xaba, Nompumelelo Pearl; Mkhize, B.T.; Adam, Jamila KhatoonBackground All nursing students need to undergo clinical training for them to be competent practitioners when they qualify. According to the South African Nursing Council (SANC) training facilities are accredited only if the clinical training component is effective. Therefore, it is important that students are accompanied in order for them to grow professionally and have values as future health care professionals. In nursing education, a student throughout the nursing training course receives instruction both theoretically and clinically in the subjects prescribed in the curriculum by the SANC. Clinical instruction is effected through clinical teaching and learning, which is a requirement by the nursing regulatory body, the SANC. For an undergraduate programme a student has to spend a minimum of 1000 hours per year in clinical placement to meet programme outcomes. It is the responsibility of all nursing schools, colleges and universities to ensure that each student meets these requirements. For this to be effective it has to be facilitated by lecturers and clinical instructors, through teaching and learning strategies to enable students to perform the clinical skill with knowledge and eventual competence. Therefore, clinical instructors are there to ensure that the students are competent in all skills, such as cognitive, affective as well as psychomotor skills. This will be beneficial to the programme in reduction of rates of failure and dropout and again by producing competent practitioners. A positive relationship and collaboration between the clinical training institutions and clinical placement facilities is vital for student achievement, especially because the clinical instructors assist students in correlating theory and practice. This study sought to assess the clinical training component of an undergraduate programme at this UoT in KwaZulu Natal. Findings may inform an improved clinical instruction programme as no such study had been undertaken. Methods A qualitative and quantitative design was used to explore feelings, perceptions as well as experiences of staff and student nurses with regard to clinical training component. Stratified random sampling was used to select student nurses according to levels of training and questionnaires were used to collect data. All permanently employed staff who had been working over six months were selected since they were directly or indirectly involved in the clinical facilitation. A focus group interview was conducted for the clinical instructors and questionnaires were used for the lecturers to collect data. Themes and sub-themes emerged and on analysis they were compared to the findings from the quantitative survey. Results and discussion The results revealed that collaboration of clinical placement facilities and training institutions is important for student’s support since all parties are able to communicate freely and students benefit. Students stated that they did not get enough support since the clinical facilitators were short staffed and they were also allocated to facilities that were far from the campus. The respondents cited problems during clinical accompaniments as there were very high expectations by staff members in the placement areas regarding student support. Lecturers were also expected to involve themselves in clinical accompaniment to bridge theory-practice gap. The employment of mentors will assist in student support as the mentors will be at placement areas and the staff and students easily contact them. Conclusion From the interviews the researcher managed to come up with important aspects that should be included in an accompaniment tool when developed, which should be user friendly to both lecturers and clinical facilitators. It will thus assist students with critical skills including critical thinking when performing any patient related nursing skill. It was recommended that the UoT management support staff by attending to their concerns including finding more clinical placement facilities close to the campus.Item Evaluation of the use of guided reflective journals during clinical learning and practice by undergraduate nursing students at the Durban University of Technology(2015-03-05) Mahlanze, Hazel Thokozani; Govender, S.; Sibiya, Maureen NokuthulaBackground The Council for Higher Education and the South African Nursing Council accredit institutions with learning and assessment practices which aim to develop and prepare graduates to be critical thinkers. The undergraduate nursing programme at the Durban University of Technology introduced the writing of reflective journals by their students in 2011. Students submitted journals of poor quality which lacked reflection. Aim of the study The purpose of this study was to evaluate the use of guided reflective journals by assessing the levels of reflection of the undergraduate nursing students during clinical learning and practice. Methodology An exploratory sequential mixed methods design, using quantitative and qualitative paradigm, was used for this study. A purposive sample of 40 participants was used to collect data. A perceptions questionnaire was administered to the 40 participants to determine their perceptions on how they experienced writing of the reflective journals. Content analysis was used to analyse the written content of the reflective journals. Descriptive statistics such a Chi-square goodness of fit and Wilcoxon Signed Ranks test were used determine levels of reflections and the differences in the first and second journals. Lincoln and Guba’s 1985 criteria for trustworthiness were applied to the study. Results Analysis of the journals revealed lower levels of reflection in the first reflective journal compared to improved levels in the second journal. Furthermore, the participants generally expressed writing of reflective journals as a valuable tool in professional, personal development as well as clinical learning. Levels of reflection and development of reflective practice will be greatly enhanced if all involved in nurse education will actively participate in encouraging writing of reflective journals by student nurses.