scholarly journals An exploratory study of the experiences and challenges faced by advanced life support paramedics in the milieu of neonatal transfers

2021 ◽  
Vol 26 ◽  
Author(s):  
Raisuyah Bhagwan ◽  
Pradeep Ashokcoomar
Keyword(s):  
Critically Ill ◽  
Rural Areas ◽  
Life Support ◽  
Advanced Life Support ◽  
Healthcare Facility ◽  
Research Approach ◽  
Structured Interviews ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Critically Ill Neonates

Background: The safe transfer of critically ill neonates is important for their survival. This calls for greater preparedness on the part of paramedics to effect these transfers safely.Aim: To understand the experiences and the challenges faced by advanced life support (ALS) paramedics during neonatal transfers.Setting: The study setting consisted of advanced life support paramedics from urban and rural areas in KwaZulu-Natal. It comprised of a network of district hospitals as well air and ground transfer facilities, both public and private.Method: Using a qualitative research approach, the study sought the views of ALS paramedics who were involved in neonatal transfers in KwaZulu-Natal. A purposive sample of n = 8 ALS paramedics was selected. Data were collected using in-depth semi-structured interviews. The data were analysed through the process of thematic analysis.Results: The study found that paramedics faced multiple complex challenges related to neonatal transfers. Poor pre-transfer preparation of the neonate, equipment related challenges, lack of clinical support available during transfers and pressure to effect inappropriate transfers were some of the challenges they faced. These challenges coupled with insufficient education and the lack of sub-speciality programmes to capacitate, rendered them unprepared to deal with neonatal transfers effectively.Conclusion: Emergency medicine needs to provide greater attention towards preparing all stakeholders for successful neonatal transfers.Contribution: The findings provide recommendations for a programme that will limit risks involved with, and support the inter-healthcare facility transfer of critically ill neonates in South Africa.

scholarly journals Towards a safer and more efficient neonatal transfer system in South Africa: A qualitative inquiry with advanced life support paramedics

2021 ◽  
Vol 18 ◽  
Author(s):  
Pradeep Ashokcoomar ◽  
Raisuyah Bhagwan
Keyword(s):  
South Africa ◽  
Critically Ill ◽  
Transfer Process ◽  
Life Support ◽  
Advanced Life Support ◽  
Qualitative Inquiry ◽  
Research Approach ◽  
Western Cape ◽  
Group Discussions ◽  
Kwazulu Natal

Introduction The inter-healthcare transfer of the critically ill neonate is a critical aspect of larger neonatal intensive care, as it influences the safe transport of neonates from the receiving to the referring hospital. It is crucial then that the transfer process be safe and efficient so as not to compromise the already fragile condition of the neonate. The aim of the study was to understand the challenges advanced life support (ALS) paramedics face during neonatal transfers and to understand how the process could be made safer and more efficient. The objectives related to understanding the transfer process, the challenges linked to the critically ill neonate and the difficulties associated with the ambulance vehicle and equipment. Methods Using a qualitative research approach we sought the views of ALS paramedics at the forefront of transfers nationally. In-depth interviews were held with eight paramedics in KwaZulu-Natal and four focus group discussions with ALS paramedics in KwaZulu-Natal, Gauteng, Free State and the Western Cape in South Africa. A total of 35 ALS paramedics were involved in these group discussions. Results The study uncovered several challenges that paramedics face related to poor organisational preparation for transfer of the critically ill neonate, and other crucial issues that compromise the transfer such as inadequate or defective equipment. Conclusion There is a need for greater scrutiny of the transfer process and a commitment from stakeholders to begin addressing the challenges confronting the safe transfer of critically ill neonates.

scholarly journals Preparedness of Western Cape advanced life support providers to provide clinical stabilisation and intensive care for neonatal interfacility transfers

2020 ◽  
Vol 17 ◽  
Author(s):  
Erefaan Ismail ◽  
Raveen Naidoo ◽  
Dorcas Rosaley Prakaschandra
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Critically Ill ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Advanced Life Support ◽  
Practical Training ◽  
Western Cape ◽  
Chi Square ◽  
Critically Ill Neonates

Introduction The Western Cape is a province in South Africa – known for the port city of Cape Town – surrounded by the Indian and Atlantic oceans. The transport of high-risk neonates between neonatal intensive care units in the Western Cape of South Africa is performed by advanced life support (ALS) providers.The implications of this practice have not been documented. This study will evaluate the preparedness of ALS providers to undertake intensive care of critically ill neonates during interfacility transfers.MethodsData collection was performed using a questionnaire with a response rate of 81% (n=145). The data analysis encompassed descriptive statistics using tables and figures. Inferential statistics was done using the chi-square test with a significance reported for p<0.05. Reliability was determined using Cronbach’s alpha.ResultsThe respondents highlighted that their initial ALS training was not adequate to prepare them for managing critically ill neonates. This view was expressed by the greater majority (n=63, 43.4%) when asked about their combined neonatal theory and practical training notional hours of their curriculum which focussed on managing critically ill neonates. ConclusionThere is an urgent need to improve the training programs of ALS providers with regards to neonatology. Numerous factors affecting the preparedness of ALS providers to manage critically ill neonates have been highlighted.

Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 681-690 ◽  
Author(s):  
James S. Seidel ◽  
Deborah Parkman Henderson ◽  
Patrick Ward ◽  
Barbara Wray Wayland ◽  
Beverly Ness
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P &lt; .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

Factors Influencing Successful Intubation in the Prehospital Setting

1995 ◽  
Vol 10 (4) ◽  
pp. 259-264 ◽  
Author(s):  
James V. Doran ◽  
Bartholomew J. Tortella ◽  
Walter J. Drivet ◽  
Robert F. Lavery
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Life Support ◽  
Advanced Life Support ◽  
High Volume ◽  
Success Rates ◽  
Structured Interviews ◽  
Technical Problems ◽  
Patients Âgés ◽  
Prehospital Airway Management

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

scholarly journals School financial management: Insights for decision making in public primary schools

2020 ◽  
Vol 40 (4) ◽  
pp. 1-9
Author(s):  
Adebunmi Yetunde Aina ◽  
Keshni Bipath
Keyword(s):  
South African ◽  
Rural Areas ◽  
Financial Management ◽  
Urban Areas ◽  
Primary Schools ◽  
Basic Education ◽  
Case Study Research ◽  
Research Approach ◽  
Structured Interviews ◽  
Continuous Training

To realise the ideal of quality inclusive education, proper financial management is vital. Existing literature indicates that the mismanagement of school funds is largely due to principals and the school governing bodies (SGB) in many schools not having good working relationships with stakeholders and lacking the necessary financial skills, more specifically in schools in townships and rural areas. The study we report on in this article investigated the financial management of public primary schools situated in urban areas by adopting a qualitative research approach and employing a multiple case study research design. Five schools participated and data were collected through individual semi-structured interviews with the principal, school accountant and chairperson of the SGB of the selected schools. Findings revealed that, despite the fact that all South African schools are governed and controlled by the South African Schools Act, the financial management of fee-paying schools differs from no-fee schools situated in townships and rural areas. In many schools, the unavailability of the parent members of SGBs and their limited financial skills were barriers to effective financial decisions. Based on these findings, we recommend that the relevant stakeholders involved in school financial management obtain continuous training from the Department of Basic Education, in order to empower and support school governors to effectively carry out their financial functions.

scholarly journals Protocol for Investigating the Technical Efficiency of District Hospitals in the Public Health Sector of KwaZulu-Natal, South Africa (Preprint)

2018 ◽  
Author(s):  
Tesleem K Babalola ◽  
Indres Moodley
Keyword(s):  
South Africa ◽  
Health Care ◽  
Resource Allocation ◽  
Technical Efficiency ◽  
Policy Formulation ◽  
Data Availability ◽  
Research Approach ◽  
Policy Makers ◽  
District Hospitals ◽  
Kwazulu Natal

BACKGROUND The central objective of policy makers and health managers is efficiency in the delivery of health care. With frequent reports of global economic crises, there is a need to continuously measure the performance of various sectors of the health care system. This can inform the decision-making process toward allocating scarce resources with the aim of maximizing output. OBJECTIVE The aim of this study is to determine the technical efficiency (TE) of public sector district hospitals in the province of KwaZulu-Natal, South Africa to provide information that will assist in policy formulation that may further assist in more efficient resource allocation decisions. METHODS This is a health system research based on a quantitative research approach. All 38 public district hospitals in the 11 municipalities of the province will be included in this study. The data for the study will include inputs from hospitals’ operations that contribute toward subsequent outputs. The input data will include information such as the number of health professionals (doctors, nurses, and other personnel) and number of hospital beds, whereas the output data will include information such as outpatient visits and number of admissions or discharge. Other data categories to be included will be determined by data availability and will be uniform for all facilities. Data for each facility for a 3-year period from 2014 to 2017 will be obtained from databases of the district health information, basic accounting, and personnel salary systems. On the basis of the data obtained, a model will be developed that can be used to assess how TE of public districts hospitals may be improved. TE will be determined using Data Envelopment Analysis, and factors influencing efficiency will be computed using StataCorp statistical package. RESULTS As of February 2019, the study is at the data collection, data input, and analysis stages. The results are expected to be available from the second quarter of 2019. CONCLUSIONS Findings from this study can add to tools available to policy makers, health planners, and managers in making decisions about resource allocation in health care systems. Moreover, these findings will be disseminated electronically and in print. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12037

scholarly journals Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi

2020 ◽  
Author(s):  
Jakub Gajewski ◽  
Marisa Wallace ◽  
Chiara Pittalis ◽  
Gerald Mwapasa ◽  
Eric Borgstein ◽  
...  
Keyword(s):  
Rural Areas ◽  
Research Approach ◽  
Middle Income ◽  
Bachelor Of Science ◽  
Middle Income Countries ◽  
Barriers And Enablers ◽  
Surgical Workforce ◽  
District Hospitals ◽  
The Government ◽  
Clinical Officers

Background: Low- and middle-income countries (LMICs) are the worst affected by a lack of safe and affordable access to safe surgery. The significant unmet surgical need can be in part attributed to surgical workforce shortages that disproportionately affect rural areas of these countries. To combat this, Malawi has introduced a cadre of non-physician clinicians (NPCs) called clinical officers (COs), trained to the level of a Bachelor of Science (BSc) in Surgery. This study explored the barriers and enablers to their retention in rural district hospitals (DHs), as perceived by the first cohort of COs trained to BSc in Surgery level in Malawi. Methods: A longitudinal qualitative research approach was used based on interviews with 16 COs, practicing at DHs, during their BSc training (2015); and again with 15 of them after their graduation (2019). Data from both time points were analysed and compared using a top-down thematic analysis approach. Results: Of the 16 COs interviewed in 2015, 11 intended to take up a post at a DH following graduation; however, only 6 subsequently did so. The major barriers to remaining in a DH post as perceived by these COs were lack of promotion, a more attractive salary elsewhere; and unclear, stagnant career progression within surgery. For those who remained working in DH posts, the main enablers are a willingness to accept a low salary, to generate greater opportunities to engage in additional earning opportunities; the hope of promotional opportunities within the government system; and greater responsibility and recognition of their surgical knowledge and skills as a BSc-holder at the district level. Conclusion: The sustainability of surgically trained NPCs in Malawi is not assured and further work is required to develop and implement successful retention strategies, which will require a multi-sector approach. This paper provides insights into barriers and enablers to retention of this newly-introduced cadre and has important lessons for policy-makers in Malawi and other countries employing NPCs to deliver essential surgery.

scholarly journals Organization and management of nursing services in NICU, levels of transport

2022 ◽  
Vol 4 (4) ◽  
pp. 151-153
Author(s):  
Onaisa Aalia Mushtaq ◽  
Javaid Ahmad Mir ◽  
Bushra Mushtaq
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Nursing Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Respiratory Support ◽  
Organization And Management ◽  
Nursing Services ◽  
Intensive Care Nursery ◽  
Critically Ill Neonates

Neonatal Intensive Care is defined as, “care for medically unstable and critically ill newborns requiring constant nursing, complicated surgical procedures, continual respiratory support, or other intensive interventions.” A NICU is a unit that provides high quality skilled care to critically ill neonates by offering facilities for continuous clinical, biochemical and radio logical monitoring and use of life support systems with the aim of improving survival of these babies. Intermediate care includes care of ill infants requiring less constant nursing care, but does not exclude respiratory support. Care of ill infants requiring less constant nursing care, but does not exclude respiratory support. When an intensive care nursery is available, the intermediate nursery serves as a “step down unit” from the intensive care area.

scholarly journals Inter-healthcare facility transfer of critically ill neonates : the development of a programme for emergency medical care in the South African context

2018 ◽  
Author(s):  
◽  
Pradeep Ashokcoomar
Keyword(s):  
South African ◽  
Critically Ill ◽  
Healthcare Facility ◽  
Emergency Medical Care ◽  
The South ◽  
Transfer Processes ◽  
Emergency Medical ◽  
African Context ◽  
Critically Ill Neonates ◽  
Organisational Structures

Neonates are considered a vulnerable age group due to a variety of clinical problems that can occur. Critically ill neonates are a high risk population with single or multiple organ system failure that places their lives at risk. They require urgent medical lifesaving intervention and where appropriate care is unavailable, are transferred to a higher level of care to improve their chance of survival. Inter-healthcare facility transfers are the responsibility of Emergency Medical Service, and an integral part of the South African medical system. The Emergency Medical Service serves as an extension of the intensive care unit, but is associated with a very high level of risk due to the stressors of the pre-hospital environment which impacts on the clinical outcomes of the neonate. The aim of this study was to develop a programme for inter-healthcare facility transfer of critically ill neonates in the South African context. Developmental Research and Utilization (DRU) model was the overarching framework, guided by critical realism paradigm that enabled a deeper level of understanding of the context. Developmental research methodology provided a guide to collect data and through predetermined steps, each designed to achieve a specific purpose towards achieving the study aim, using a qualitative approach. The study found that the Advanced Life Support paramedics were inadequately prepared to deal with the neonates and the accompanying family members during the transfer process. Organisational structures and transfer processes were found to be inadequate. Emergency Medical Care lecturers were ill prepared to provide appropriate experimental instruction and the accompanying mothers were neglected during the transfer. A holistic and multi-dimensional inter-healthcare facility transfer programme that was relevant for the local context, with appropriate organisational structures and transfer processes was developed and thereafter appriaised by a group of experts. It included the knowledge and skills required by paramedics and support for accompanying family members during the transfer process.

scholarly journals Advanced Life Support in Obstetrics

2019 ◽  
Vol 2 (2) ◽  
pp. 49
Author(s):  
Lisa Soldat
Keyword(s):  
Rural Areas ◽  
Maternity Care ◽  
Life Support ◽  
Quality Care ◽  
Advanced Life Support ◽  
Care Providers ◽  
Patient Centered ◽  
High Quality ◽  
Middle Income ◽  
Service Training

Multiple barriers to high quality maternity care have been identified in Indonesia. One barrier is the shortage of well-trained maternity care providers, particularly in remote and rural areas. Maternity care training programs do not consistently prepare their graduates to provide high quality care. Poor pre-service training may then be compounded by a lack of post-service supervision and inadequate multispecialty teamwork. Maternity care continuing education is an important means to reinforce and improve the skills needed to provide high quality maternity care. Programs that have been developed for low- to middle-income countries focus on providing culturally appropriate information to improve competency, communication and teamwork. Improvement in quality of care has been documented, showing a decrease in maternal morbidity and mortality. This trend is reflected in improvements in patient satisfaction and trust, and ultimately supports the tenets of patient-centered care.

Sign in / Sign up

Export Citation Format

Share Document