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Critical evaluation of the influence of ideal clinic status on the quality of primary care services provision in eThekwini District, South Africa
(2024-10-17) Mazibuko, Ntombifuthi Norah; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Introduction and background As the global world commits to achieving universal health coverage by 2030, there is a growing acknowledgement that optimal cannot be delivered by simply ensuring the coexistence of infrastructure, medical supplies and providers. Improvement in delivery requires deliberate focus on quality of health services that include providing effective, safe, people-centered care that is timely, equitable, integrated and efficient. Global quality reports note that billions of people will not gain from potential universal coverage benefits unless improvements in health system quality are realised. In South Africa, several quality improvement initiatives have been implemented, the Ideal Clinic Realisation and Maintenance initiative being the latest initiative aimed at improving quality services provision, especially at primary care level as the entrance point into the system. Research on improved quality provision in facilities with ideal status is thus crucial to providing quality health services for all South Africans based on their needs, irrespective of socio-economic status. Aim of the study The study aimed to critically evaluate the influence of Ideal Clinic status on the quality of primary health care service provision in eThekwini District, South Africa, thereby proposing an Ideal Clinic practice framework that will enhance an improved quality of healthcare service provision in primary health care facilities. Objectives of the study The objectives of the study were to determine the current practices of providers and the status of user records in ideal primary facilities; to explore the perspectives of healthcare providers regarding the influence of Ideal Clinic status on quality of patient care; to ascertain the perspectives of the health care users on the quality of care received in facilities with ideal status; and, to propose an Ideal Clinic prctice framework that can be used to enhance improved quality healthcare service provision in primary health care facilities irrespective of Ideal Clinic status. iii Methodology A convergent parallel design, where both qualitative and quantitative methods were used to collect data within a short period to avoid potential threats to validity. The quantitative data collection consisted of (n = 360; 88.8%) retrospective record reviews of adult clinical records and (n = 45; 11.1%) children’s records and a self administered questionnaire from (n = 54; 85.7%) professional nurses and (n = 9; 14.2%) facility operational managers. The qualitative data collection consisted of semi-structured interviews with (n = 8) healthcare providers to explore their perspectives regarding the influence of Ideal Clinic status on the quality of care provision to healthcare users and (n = 14) healthcare users. The perspectives of the healthcare users regarding the quality of care received in facilities with ideal status were ascertained. Data analysis of the quantitative data was via descriptive and inferential statistics, and the qualitative analysis was via thematic analysis. The two data strands were analysed independently and inferences made from each strand were synthesized to form conclusions about the findings. The results of the two separate analyses were mixed for an overall interpretation of the findings. Findings Although the PHC facilities included in the study had been awarded Ideal Clinic status, it was evident that Ideal status did not automatically translate to quality of care in most facilities. There were important care assessments that had been inadequately performed or not done at all. These included physical examinations that were not performed, poor or no documentation on clinical records, shortage of medical supplies, and lack of training and support for staff. Recommendations Recommendations are of a short-term nature and can be achieved with buy-in from the policy makers. Long-term recommendations include renovation of primary health care facilities to cater for the full package of primary health care services, human resources and medical equipment. Conclusion Based on the findings, a practice framework was developed to provide structure using evidence-based practices on interventions that would assist policy makers and implementers to engage in relevant actions for improving quality service provision irrespective of the Ideal Clinic status.
Guidelines to facilitate collaboration between midwives and traditional birth attendants in KwaZulu-Natal
(2025-01-29) Ndaba, Nompumelelo Pearl; Ngxongo, Thembelihle Sylvia Patience; Sokhela, Dudu Gloria
Introduction: Perinatal deaths are untimely deaths and are a major public health concern in many developing countries. They have enormous economic, social and health implications for families and society. Over 300 000 women die annually due to pregnancy-related and childbirth complications in sub-Saharan African countries including South Africa, and about 2.6 million babies are stillborn, particularly during the third trimester, with the majority of these deaths occurring in low-socioeconomic communities. Midwives, with their training, and traditional birth attendants (TBAs), with their cultural experience, play a pivotal role in maternal and newborn health, especially in the rural communities where they both bring their expertise to the care of women and newborn babies. There is evidence that in most stettings these two groups coexist but work independently with no form of formal collaboration. Collaboration between these two groups could bridge the gap between formal and traditional health systems and ensure that women and babies receive quality healthcare support throughout pregnancy, labour and post-delivery. Therefore, strengthening collaboration between midwives and TBAs is crucial to reduce maternal and neonatal mortality rates and improve overall health outcomes especially in the rural settings where the services of both TBAs and midwives coexist. AIM: This study aimed to develop practice guidelines to facilitate collaboration between midwives and TBAs in KwaZulu-Natal. Method: A qualitative research design using explorative, descriptive, case study approaches was employed at uThukela District Municipality in KwaZulu-Natal, South Africa, guided by the structural functionalism theory of Talcott Parsons following the adaptation, goal attainment, integration, and latency process. The sample comprised 38 midwives and 18 women who were purposively sampled and 10 TBAs who were sampled using the snowball method. Data were collected between April and August 2023 following ethics approval (IREC 307/220) from the Durban University of Techology. Data were collected using interviews and focus group discussions and thematically analysed guided by the six steps of qualitative data analysis as described by Creswell and Creswell (2023). v Findings: The study findings confirmed that midwifery and TBA sevices coexisted in uThukela District and that women were utilising services from both groups during pregnancy, childbirth and the postnatal period. The study also confirmed that there was no existing collaboration between the midwives and TBAs in this district thus resulting in no formal communication between the two groups regarding the care of women and children. This had negative implications for the care of women and children, particularly regarding the continuity of care. However, midwives and TBAs expressed a willingness to collaborate because of their shared goal of reducing maternal and neonatal mortality rates in the district. The women also expressed their support for collaboration between the midwives and TBAs which they stated would address a number of challenges that they face as they sought healthcare from the two groups. Recommendations: The study makes several recommendations mostly related to policy formulation/revision to incoperate TBAs, training and inservice education, midwifery, and TBA practices, as well as further research. Most importantly, guidelines to facilitate collaboration between the TBAs and midwives were developed as part of the study. Conclusion: The findings from the study highlight the negative influences of lack of collaboration on the management of women and children and several benefits that could be achieved through collaboration. Benefits include establishing a shared vision, team work, benchmarking and sharing of good practices, all of which could have positive outcomes on the care of women and children. This could also aid in achievement of Sustainable Development Goals of the country especially goal number number 3 related to ensuring healthy lives and promoting the well-being of mothers and children. These guidelines are expected to assist in bridging the gap between midwives and TBAs, fostering a collaborative environment that leverages the strengths of both groups. Furthermore, the guidelines aim to foster community unity by involving various stakeholders, ultimately enhancing maternal and neonatal healthcare outcomes
Student nurses and educators’ experiences of clinical teaching and learning during COVID-19 pandemic in selected campuses of Gauteng College of Nursing
(2024-10-13) Malindisa, Zandile Goodness; Sokhela, Dudu Gloria; Ngxongo, Thembelihle Sylvia Patience
Background The Corona virus disease (COVID-19) pandemic, which was first reported in Wuhan in December 2019, spread to other countries in the world, including South Africa. When the infections were very high, different stages of national lockdown were put in place, to curb the rapid spread of the infection. All education institutions were closed, including Nursing Education Institutions for both theory and clinical practice. Student nurses could not practice for three months of level five lockdown. Once the infections started to subside, student nurses went back to clinical areas and some students cared for patients with COVID-19 disease, with no knowledge or adequate protection from the disease. Aim The study aimed to explore student nurses’ and educators’ experiences of clinical teaching and learning during the COVID-19 pandemic in selected campuses of the Gauteng College of Nursing. Methods A descriptive qualitative design was used to conduct face-to-face individual interviews with 15 purposively selected student nurses who were in their fourth-year of the R425 training programme and four clinical educators. Findings Three themes and 16 subthemes emerged. The themes were: clinical experiences during the COVID-19 pandemic, clinical teaching and learning during COVID-19 pandemic, and coping strategies that can be used in future pandemics or similar crises. Conclusion The findings from this study indicate that teaching and learning were very challenging during the COVID-19 pandemic due to the restrictive policies that were imposed in the country affecting nurse training and education.
Factors influencing work-related relationships between nurses and their line managers in public hospitals, Ugu District, KwaZulu-Natal
(2025-03-23) Mkhize, Sindisiwe Emgard; Sokhela, Dudu Gloria; Ngxongo, Thembelihle Sylvia Patience
Introduction Work-related relationships are unique interpersonal connections that hold significant implications for individuals and the organizations in which they exist. Employees often engage in various types of formal and informal relationships at work, such as those with peers, managers, subordinates, friends, and advisors. These relationships are crucial for fostering individual commitment to the organization, promoting positive attitudes toward work, and enhancing organizational outcomes. Aim of the study The aim of this study was to identify the factors influencing the work-related relationships between nurses and their line managers. Methodology A descriptive, quantitative, cross-sectional survey design was employed to investigate the factors that influence the work-related relationships between nurses and their line managers. Data were collected using a self-administered questionnaire from 406 nurses and managers, who were sampled through simple random sampling. The data were analyzed using SPSS version 29. Results The study achieved a 100% response rate. The majority of nurse respondents showed significant agreement with 21 out of 27 statements in the questionnaire (78%), with scores greater than 3 (p < 0.001). The highest levels of agreement were for statements regarding having individual discussions with managers (mean [SD] = 3.90 [0.45]), the ability to communicate problems affecting their duties with managers (mean [SD] = 3.83 [0.625]), efforts to establish working relationships with managers (mean [SD] = 3.78 [0.625]), and the perception of an open-door policy from managers (mean [SD] = 3.78 [0.686]). Nurse respondents showed significant disagreement with three (11%) of the 27 statements. Managers expressed concerns that nurses required additional training and skills to improve their performance and noted that some nurses exhibited rude behaviour. Conclusion Nurses enter the workplace with the intent to perform, earn, learn, and grow professionally. When these objectives are not met, frustration may arise. It is recommended that, upon assuming duties, managers should communicate their expectations clearly, including processes, procedures, and performance standards. Managers should also identify appropriate skills for the job, mentor nurses for professional growth, and address deviations from expected behavior to achieve the institution's goals. Ultimately, the relationships between nurses and their managers significantly impact patient outcomes
Experiences of KwaZulu-Natal diagnostic radiographers’ engagement in continuing professional development activities during the COVID-19 pandemic
(2024-05-07) Ogile, Yonela; Nkosi, Pauline Busisiwe
Introduction Continuing professional development remains a keystone for developing and maintaining professionalism of radiographers and other healthcare professionals throughout their career lifetime. It ensures that professionals retain their capacity to practice safely, effectively, and legally, within their evolving and advancing professional fields. Technological advancements and changes in the medical imaging field, necessitate and justify the need for diagnostic radiographers to engage in continuing professional development activities. The Corona Virus Disease of 2019 (Covid-19) has significantly disrupted all aspects of life globally. The Covid-19 pandemic transformed the way in which diagnostic radiographers engaged in continuing professional development activities. Many educational activities that have been traditionally designed for live interaction and in-person settings were moved to online platforms. However, in the South African context, no studies have been conducted to detail the effects of the Covid-19 pandemic on diagnostic radiographers’ engagement in continuing professional development activities. The current study filled this gap. Aim This study aimed to explore the experiences of KwaZulu-Natal (KZN) province diagnostic radiographers’ engagement in continuing professional development activities during the Covid-19 pandemic and to understand what could have been done to improve their engagement in continuing professional development activities . Methodology A qualitative descriptive phenomenological design was employed to conduct this study. A criterion sampling was used to select three public hospitals, within the eThekwini district in KZN. A sample size of 20 diagnostic radiographers selected using purposive homogenous sampling, participated in this study. Ethical approval to conduct the study was obtained from the Institutional Research Ethics Committee (IREC) at the Durban University of Technology (DUT). All participants participated voluntarily and gave their written consent. Data were collected using face-to-face, one-on-one, semi-structured v in-depth interviews using open-ended questions which were related to engagement in continuing professional development activities during Covid-19 pandemic. Interviews were transcribed verbatim before data analysis. Data were analysed using thematic data analysis method. Data were stored on a password-protected computer which can only be accessed by the researcher. The audio tape recorder was kept in the lockable storage that can only be accessed by the researcher. The data would be stored in this manner for 5 years. Findings The themes that emerged as findings in this study of radiographers’ experiences when engaging in continuing professional development activities during Covid-19 pandemic included: effects of this pandemic; barriers; facilitators; and recommendations on support needed to improve the engagement or in similar situations. These findings revealed that diagnostic radiographers’ engagement in continuing professional development activities was affected during the Covid-19 pandemic. One of the changes that the pandemic brought was the transition from face-to-face to virtual formats of engagement in continuing professional development activities. There was participation as well as lack of participation in continuing professional development activities during the Covid-19 pandemic. Either of the findings was linked to preferences in continuing professional development activities formats, barriers, and enablers for participants' engagement in continuing professional development activities. There was a general acknowledgment of the value of engaging in continuing professional development activities. Furthermore, participants recognised the obligation to fulfil the regulatory requirements of engaging in continuing professional development activities to remain registered as healthcare professionals. Participants in the current study highly recommended support for including time allocation, hosting of inhouse activities, and guidance from the Health Professions Council of South Africa (HPCSA) and accredited providers on how to engage in online activities. Conclusion and recommendations Continuing professional development remains important for diagnostic radiographers to professionally update their knowledge and skills so that they keep up with evidence-based practice and technological changes in their profession. The Covid-19 pandemic affected the diagnostic radiographers’ engagement in continuing professional development activities. In the current study this effect was noted through the transition of the continuing professional development formats which was followed by a lack of engagement by some participants. Support in the form of time allocation for continuing professional development activities and in-house continuing professional development activities is strongly recommended to facilitate better radiographer’s engagement. Employers, HPCSA, and accredited continuing professional development providers should take an active role in supporting diagnostic radiographers, so that they may better engage in continuing professional development activities.