Faculty of Health Sciences
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Item 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.Item 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, PadminiThe 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.Item Experiences of nurses regarding the implementation of an ideal clinic project in eThekwini district, KwaZulu-Natal(2022-09-29) Zulu, Mthokozisi; Ngxongo, Thembelihle Sylvia PatienceIntroduction 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.Item Experiences and views of the pregnant women regarding the Basic Antenatal Care approach to health care services provision in eThekwini district, KwaZulu-Natal(Research and Reviews, 2016-12-23) Ngxongo, Thembelihle Sylvia Patience; Sibiya, Maureen Nokuthula; Gwele, Nomthandazo S.Purpose: The purpose of the study was to describe the experiences and views of the pregnant women regarding the antenatal care services received in the Primary Health Care clinics that were implementing the Basic Antenatal Care (BANC) approach. The BANC approach is listed as one of the priority interventions for reducing maternal and child mortality in South Africa and is used in the public health institutions to provide health care services to the pregnant women. Methods: A descriptive qualitative design was used to conduct the study in the 12 primary health care clinics that were providing antenatal care services and implementing the BANC approach in eThekwini district, KwaZulu-Natal The study took place seven years following the introduction of the BANC approach. Data were collected using semi-structured interviews conducted with 54 pregnant women from October 2014 to March 2015. Data were analysed using Tesch’s method of data analysis. Findings: Although some participants highlighted how the BANC approach had brought about improvement in the quality of care, other participants were concerned regarding the waiting times, the intervals between antenatal care visits, integration of antenatal care with other primary health care services, limited space at the clinics and attitudes and performance of clinic staff. Conclusion: In the current study, the participants shared their experiences and views regarding the antenatal care services that were provided using the BANC approach. Most of the situations that the participants had encountered and their views regarding Antenatal care services highlighted specific areas of the BANC approach that needed attention. Guided by this, the researchers were able to provide the recommendations from the study that would assist to improve implementation of the BANC approach. These included special emphasis on compliance to service delivery guidelines and protocols by antenatal health care providers, availability of the clinic staff members who had been trained and oriented towards the implementation of the BANC approach, integration of services and reviewing human and material resources for adequacy when new programs are introduced.Item A desktop evaluation of the potential impact of nanotechnology applications in the field of environmental health in a developing country(Science and Education Publishing, 2015) Naidoo, Levani; Kistnasamy, Emilie JoyNanotechnology is the latest addition to enhancing lifestyles of the human population. It also has an impact on the core parts that are vital to the well-being of humanity and its’ sustainability. Nanotechnology has been researched and is implemented in a number of countries at a commercialized level. However, in South Africa, nanotechnology is still being explored at grassroots with a few private industries implementing it. Based on research, the public health sector is expected to benefit the most from the application of nanotechnology. An environmental health practitioner plays a key role in ensuring the health and sustainability of the human population. The purpose of this desktop study is to generally explore the uses of nanotechnology in the Public Health sector with specificity to food, health and water remediation in the context of environmental health in South Africa and evaluate the possible impacts nanotechnology will have in the South African society. Proposed recommendations to be considered on how to address the use of nanotechnology in the current state of South Africa are made along with identifying the gaps in research in nanotechnology pertaining to South Africa.Item A study of the perceptions and experiences of patients receiving homoeopathic care in the context of primary healthcare services within the public sector(2016) Love, Kirsty Jane; Hall, Cornelia Maria; Crankshaw, Tamaryn L.Introduction Homoeopathy is recognised as a well established form of alternative medicine in the private healthcare sector of South Africa (Caldis, McLeod, Smith, 2001). Whilst local research supports the viability of homoeopathy as a primary healthcare resource; patient perception and experience with the homoeopathic service remain largely unknown (Smillie, 2010). The study addresses shortfalls in existing literature on homoeopathy, providing a qualitative evaluation of the homoeopathic healthcare service in the context of public healthcare in South Africa. The task of the study was to develop substantive theory with the aim to better understand health behaviour of patient’s utilising homoeopathic and allopathic healthcare services. Methods The study employed a qualitative study design, and explored the perceptions and experiences of patients receiving homoeopathic care at the Kenneth Gardens Homoeopathy Clinic, within the context of primary healthcare services and public sector healthcare. Data was generated through in-depth, semi-structured interviews conducted with 14 participants. Data was systematically analysed using grounded theory methods to generate substantive theory (Glaser and Strauss, 1967; Schreiber and Stern, 2001; Holloway and Wheeler, 2010). Results Data analysis revealed five main themes of influences affecting the utilisation of homoeopathic services at the Kenneth Gardens Clinic; these include context specific factors to healthcare utilisation, factors influencing healthcare utilisation, health beliefs and practices, health outcome factors and trust. The study results illustrate that participants trusted their homoeopathic provider and homoeopathic treatment outcomes; and subsequently demonstrate the direct positive influence which trust had on the utilisation of homoeopathic services in the study population. Discussion The discussion explores the significance of influences, barriers and discerning factors identified in the study on decision-making pathways in healthcare utilisation behaviour of homoeopathic and allopathic healthcare services. The significance of trust in healthcare utilisation behaviour is explored as the principle finding of the study. The study’s conceptual model is based on Anderson’s (2005) behavioural model of health service utilisation and has been adapted to demonstrate the relationship in health seeking behaviours between homoeopathic and allopathic care modalities. Recommendations The relationship between the variables illustrated in the study’s proposed adapted model need to be further tested using quantitative research methods. Trust in healthcare, and in particular with homoeopathy, is a subject which merits further exploration.Item Work integrated learning experiences of primary health care post basic nursing students in clinical settings(2014-05-28) Sibiya, Nontuthuzelo Elizabeth; Sibiya, Maureen NokuthulaBackground : Work Integrated Learning is an educational approach that aligns academic and workplace practices for the mutual benefit of students and workplaces. Work Integrated Learning like in any other nursing course is essential in primary health care as required by the South African Nursing Council. In the clinical setting, students develop clinical and diagnostic reasoning; they also learn how to make the appropriate clinical decisions which they need as qualified primary health care practitioners. This is achieved through instruction and guidance by lecturers, mentors and clinical staff. However it has been noted that the clinical learning environment confronts students with challenges that are absent from the classroom situation. So this study seeks to explore and describe the experiences of post basic nursing students in primary health care clinics so as to address the challenges that are faced within the clinical settings. Aim of the study The aim of the study was to explore and describe primary health care post basic nursing students’ experiences during clinical placements. Methodology : A descriptive exploratory qualitative approach was used to guide the study. In-depth interviews were conducted with ten primary health care post basic nursing students who were allocated for Work Integrated Learning at the clinics in District A and District B in 2011. The main research question for this study was asked: ‘What are the experiences of primary health care post basic nursing students regarding Work Integrated Learning?’ Results : The findings of this study revealed that Work Integrated Learning is vital for the development of clinical skills amongst primary health care post basic nursing students. However, shortage of staff, inadequate material/ non-human resources, lack of supervision in the clinical facilities, distant clinical facilities and insufficient practice in the clinical skills laboratory were identified as challenges that students experience during Work Integrated Learning placement.Item Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa(AOSIS, 2013-07-05) Sokhela, Dudu Gloria; Makhanya, Jabulile Nonhlanhla; Sibiya, Maureen Nokuthula; Nokes, Kathleen M.Background: Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Conclusion: Effective health communication strategies contribute to positive experiences by health care users and these can be effected by: (1) involvement of health care providers in planning the construction of health facilities to give input about patient flow, infection prevention and control and provision of privacy, (2) effective complaints mechanisms for users to ensure that complaints are followed up and (3)encouraging users to arrive at the facility throughout the day, rather than the present practice where all users arrive at the clinic early in the morning.