scholarly journals Preparing Graduates for Interprofessional Practice in South Africa: The Dissonance Between Learning and Practice

2021 ◽  
Vol 9 ◽  
Author(s):  
Jana Müller ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
Health Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Clinical Training ◽  
Patient Management ◽  
Secondary Data ◽  
Team Approach ◽  
Workplace Issues ◽  
Comprehensive Primary Health Care

With South Africa's tumultuous history and resulting burden of disease and disability persisting post-democracy in 1994, a proposed decentralization of heath care with an urgent focus on disease prevention strategies ensued in 2010. Subsequently a nationwide call by students to adapt teaching and learning to an African context spoke to the need for responsive health professions training. Institutions of higher education are therefore encouraged to commit to person-centered comprehensive primary health care (PHC) education which equates to distributed training along the continuum of care. To cope with the complexity of patient care and health care systems, interprofessional education and collaborative practice has been recommended in undergraduate clinical training. Stellenbosch University, South Africa, introduced interprofessional home visits as part of the students' contextual PHC exposure in a rural community in 2012. This interprofessional approach to patient assessment and management in an under-resourced setting challenges students to collaboratively find local solutions to the complex problems identified. This paper reports on an explorative pilot study investigating students' and graduates' perceived value of their interprofessional home visit exposure in preparing them for working in South Africa. Qualitative semi-structured individual and focus group interviews with students and graduates from five different health sciences programmes were conducted. Primary and secondary data sources were analyzed using an inductive approach. Thematic analysis was conducted independently by two researchers and revealed insights into effective patient management requiring an interprofessional team approach. Understanding social determinants of health, other professions' roles, as well as scope and limitations of practice in a resource constrained environment can act as a precursor for collaborative patient care. The continuity of an interprofessional approach to patient care after graduation was perceived to be largely dependent on relationships and professional hierarchy in the workplace. Issues of hierarchy, which are often systemic, affect a sense of professional value, efficacy in patient management and job satisfaction. Limitations to using secondary data for analysis are discussed, noting the need for a larger more comprehensive study. Recommendations for rural training pathways include interprofessional teamwork and health care worker advocacy to facilitate collaborative care in practice.

A Preliminary Study of Nursing Practice Patterns Concerning Dysphagia Diet Modification: Implications for Interprofessional Education With SLPs

2021 ◽  
pp. 1-15
Author(s):  
Naomi Gurevich ◽  
Danielle R. Osmelak ◽  
Sydney Osentoski
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Practice Patterns ◽  
Improve Patient Care ◽  
Treatment Method ◽  
The United States ◽  
Diet Modification ◽  
Work Settings ◽  
Swallowing Dysfunction

Purpose Speech-language pathologists (SLPs) are trained to evaluate and treat dysphagia. One treatment method is to modify diet consistency or viscosity to compensate for swallowing dysfunction and promote a safer intake; this typically involves softening solids and thickening liquids. Thickening liquids is not safer for all patients, and modification of dysphagia diets without adequate training may reduce the quality of dysphagia patient care. Over 90% of SLPs working in health care report exposure to nurses who regularly downgrade dysphagia diets without an SLP consult. This study explores dysphagia diet modification practices of nursing staff with and without dysphagia training. Method Practicing nurses and student nurses ( N = 298) in the United States were surveyed regarding their dysphagia diet modification training and practice patterns. Additionally, a pre-/posttest design was used to determine the efficacy of a short general tutorial on willingness to modify diets without an SLP consult. Results Downgrading diets without an SLP consult is a common practice. Fewer than one third of nurses (31.41%) would avoid it, whereas 73.65% would avoid upgrading without SLP consult. Formal dysphagia training made little difference to this practice. The short general tutorial also had no beneficial effect, in fact slightly reducing the willingness to consult SLPs. Conclusions Dysphagia diet modification practice by nurses is pervasive in U.S. health care. This is a previously unexplored but common issue SLPs face in work settings. This study identifies a need to clarify guidelines and increase interprofessional education between both professions to improve patient care.

scholarly journals Reasons for students’ poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme

2010 ◽  
Vol 15 (1) ◽  
Author(s):  
Nomasonto B. Magobe ◽  
Sonya Beukes ◽  
Ann Müller
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Care Service ◽  
Health Care Service ◽  
Health Staff ◽  
Care Programme ◽  
Clinical Competencies ◽  
Primary Health ◽  
Comprehensive Primary Health Care

‘No member of [health] staff should undertake tasks unless they are competent to do so’ is stated in the Comprehensive Primary Health Care Service Package for South Africa (Department of Health 2001)document. In South Africa, primary clinical nurses (PCNs), traditionally known as primary health care nurses (PHCNs), function as ‘frontline providers’ of clinical primary health care (PHC) services within public PHC facilities, which is their extended role. This extended role of registered nurses(set out in section 38A of the Nursing Act 50 of 1978, as amended) demands high clinical competency training by nursing schools and universities.The objectives of the study were to explore and describe the perceptions of both clinical instructors and students, in terms of the reasons for poor clinical competencies. Results established that two main challenges contributed to students’ poor clinical competencies: challenges within the PHC clinical field and challenges within the learning programme (University).OpsommingDie primêre kliniese verpleegkundiges, tradisioneel bekend as primêre gesondheidsorg verpleegkundiges, funksioneer in Suid-Afrika as eerste-linie verskaffers van kliniese primêre gesondheidsorg (PGS) dienste binne die publieke PGS fasiliteite. Dit is hulle uitgebreide rol. Hierdie uitgebreide rol van die verpleegkundige (soos deur Wet op Verpleging,No 50 van 1978, artikel 38A voorgeskryf), vereis opleiding in kliniese vaardighede van hoë gehalte deur verpleegskole en universiteite.Die doelwitte van die navorsing was om die persepsies van beide kliniese dosente en leerders,met betrekking tot die redes vir swak kliniese vaardighede, repektiewelik te verken en te beskryf.Twee temas is deur die resultate as uitdagings (hoof redes) vir die swak vaardighede van leerders aangetoon, naamlik uitdagings in die PGS kliniese praktyk en die uitdagings in die leerprogram (universiteit).

Access to cataract services in selected rural communities in South Africa

2019 ◽  
Author(s):  
Lunic Base Khoza ◽  
Wilfred Njabulo Nunu ◽  
Bumani Solomon Manganye ◽  
Pfungwa Mambanga ◽  
Shonisani Tshivhase ◽  
...  
Keyword(s):  
South Africa ◽  
Health Care ◽  
Rural Communities ◽  
Rural Areas ◽  
Access To Health Care ◽  
Health Care Services ◽  
Secondary Data ◽  
Demographic Characteristics ◽  
Outcome Variable ◽  
Patient Records

Abstract Background Despite government efforts to improve access to health care services through the re-engineered Primary Health Care and National Health insurance platform, access still remain a challenge particularly in rural areas. The aim of this study was to analyse secondary data on cataract patients who were attended to in selected hospitals in rural Limpopo of South Africa. Methodology A cross section survey was conducted on 411 patient records from five selected hospitals in Vhembe district. A pre tested structured checklist was used to guide retrieval of variables from patient records. The collected data was entered into excel spreadsheet, cleaned and imported into Statistical Package for Social Sciences version 26 for analysis. Proportions of demographic characteristics were presented and these were cross tabulated with the outcome variable “success of operation” using Chi Squared tests. Results Findings point out that majority of patients who attended hospital for eye services were aged 65 years above and females (63%). There was no association between the tested demographic characteristics and the outcome variable. Most patients were diagnosed in the period 2015-2018 (60%). Over 90% of those that were operated had successful operations. Of the remaining 10% that had unsuccessful operations, 30% cited complications as being the reason why these operations were unsuccessful. Conclusions It is evident from the findings that cataract services offered in rural areas have low impact as they are not accessible to the patient. It is critical to have a worker retention strategy to retain experts.

scholarly journals The perspective of optometry students of the Phelophepa train regarding its role in developing experiential skills

2009 ◽  
Vol 68 (2) ◽  
Author(s):  
R. Hansraj
Keyword(s):  
South Africa ◽  
Health Care ◽  
Clinical Training ◽  
Clinical Skills ◽  
Low Vision ◽  
Learning Experience ◽  
Diagnostic Techniques ◽  
South Wales ◽  
Good Learning ◽  
Optometry Students

Purpose: The optometry degree programme in South Africa currently includes a combination of both theoretical and clinical modules.  The optometric skills required by graduates are often achieved by students’ involvement in clinical training at both in-house clinics, as well as external clinics.   One of the external clinic sites for all institutions in South Africa currently offering the Optometry degree is the Phelophepa Health Care train.  This study set out to investigate, from a student’s perspective, the effectiveness of experiential learning at this clinical site.Setting: The study was carried out aboard the Ph-elophepa Health Care train.Method:  A questionnaire survey was completed by a saturated sample of 177 optometry students having completed at least a two week clinical rotation aboard Phelophepa.  The sample comprised students from all four optometry programmes in South Africa, as well as, exchange optometry students from the University of New South Wales and Melbourne University.  The questionnaire was divided into five sections that dealt with demographics, equipment and facilities, profile of refractive and pathologycases encountered, additional skills and general perceptions. The self-administered questionnaire was in English and Afrikaans, as these are the twolanguage mediums in which optometric education,in South Africa, is currently delivered.Results: A response rate of 57% was obtained.  Theequipment and facilities aboard Phelophepa were found to be adequate.  Just over half of all the respondents had consulted with over 50 patients onPhelophepa during their two week rotation.  Communication was not reported as being a barrier to consulting with patients on Phelophepa.  Respondents reported the clinical cases as being mainly interesting and ‘good learning’ cases.  The majority of respondents (71%) felt that the general clinical skills they obtained on Phelophepa were better than those developed in their institutional clinics.  Not all refractions and ophthalmoscopy on patients aresupervised aboard Phelophepa.  There appears to be a need for the delivery of specialized optometry skills like binocular vision, paediatric vision, low vision and diagnostic techniques on Phelophepa.   All the respondents agreed that Phelophepa was a useful learning site, and 99% agreed that optometry departments should continue using it as an externalclinic site.Conclusion:  Despite certain shortcomings, under-graduate students perceive Phelophepa to be a useful learning experience that optometry schools in South Africa should continue to utilize.  

scholarly journals A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

2018 ◽  
Vol 6 (37) ◽  
pp. 1-260 ◽  
Author(s):  
Jill Maben ◽  
Cath Taylor ◽  
Jeremy Dawson ◽  
Mary Leamy ◽  
Imelda McCarthy ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Secondary Data ◽  
Well Being ◽  
Care Staff ◽  
Alternative Interventions ◽  
Steering Group ◽  
Study Sites ◽  
The Impact

BackgroundSchwartz Center Rounds®(Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R.Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.ObjectivesHow, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.Design(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).Setting(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).Participants(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.Results(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.LimitationsRounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.ConclusionRounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.Future workThe adaptation of Rounds to new contexts and to increase reach needs evaluation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Flow experiences improve mindfulness of educational emotions during interprofessional training. Meta-analysis of a pilot study

2017 ◽  
Vol 41 (S1) ◽  
pp. s897-s897
Author(s):  
C. Lazzari ◽  
I. Masiello
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Interprofessional Education ◽  
Channel Model ◽  
Meta Analysis ◽  
Flow Experience ◽  
Health Care Students ◽  
Interprofessional Training ◽  
Image Position ◽  
Flow Experiences

IntroductionCsikszentmihalyi defines “flow experience” as the state of mind students experience when the average skills and challenges while learning are above their own average.ObjectivesDelle Fave, Massimi, & Bassi optimal experiences are used to assess students’ flow experience during interprofessional education (IPE).AimsTo use the emotions comprising the Milan school eight-channel model [“afraid, concerned, bored, relaxed, in control, excited, happy (‘flow’), and glad”] to assess flow experiences of undergraduate health care students during interprofessional training.MethodsTwenty-seven undergraduate health care students undergoing IPE training recoded their flow emotions during discussion of a clinical case in ward rounds, patient care in interprofessional teams, self-reflective practice at the end of each day of training and supervision of teachers. Statistical evaluation using meta-analysis with Tau squared (t2), Cochrane's Q and I2 provided the results (Table 1).ResultsAs reported in Table 1, interactions with teachers (I2 = 60.98%), patient care (I2 = 58.87%) and discussion of clinical cases (I2 = 63.31%) reported higher variability, significant at P < 0.05. The most frequent emotions were “relaxed” (> 66%) and “in control” (> 66%) but not “flow” (> 20%).ConclusionsResults show that challenges were below the skills possessed, which can slow down the learning process.Table 1Results for flow experiences in interprofessional education.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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