scholarly journals A self-assessment study of procedural skills of doctors in peri-urban district hospitals of Gauteng, South Africa

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Neetha J. Erumeda ◽  
Ian D. Couper ◽  
Leena S. Thomas
Keyword(s):  
South Africa ◽  
Self Assessment ◽  
Urban District ◽  
Procedural Skills ◽  
Assessment Study ◽  
District Hospitals

scholarly journals Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in Kwazulu-Natal

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Folafolu A. Adebolu ◽  
Mergan Naidoo
Keyword(s):  
South Africa ◽  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
District Hospital ◽  
Pressure Control ◽  
Urban District ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Poor Blood Pressure Control

Background: The prevalence of hypertension in South Africa has been estimated to be 20% of the adult population with over six million people being affected. Poor adherence to treatment plans lead to inadequate blood pressure control and high morbidity. Many studies have looked at factors contributing to poor blood pressure control in South Africa but few studies actually focus on district hospitals in Kwazulu-Natal in particular, despite the fact that the province has the most heterogeneous population in South Africa.Method: The study was a descriptive cross-sectional study conducted at the chronic out patient clinic of an urban district hospital involving 370 participants aged 18–90 years.Result: The study showed poorly controlled blood pressure in 58% of the participants. Only 35% knew their blood pressure results on the day of interview and 19.2% were aware of their target blood pressure. Good adherence was self-reported by 95% of the participants, whist 51.4% reported significant side-effects to medication.Conclusion: The majority of patients had poor knowledge about blood pressure and little awareness of their blood pressure reading. These may be precursors to poor blood pressure control and this needs further investigation. A high level of self-reported adherence to medication did not translate into effective blood pressure control. A significant number reported medication side-effects which may have contributed to the poor blood pressure control. The high adherence rate may therefore have been over reported. An objective way tomeasure adherence will be necessary for future research.

scholarly journals The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Liezel Rossouw ◽  
Hoosain Lalkhen ◽  
Kaashiefah Adamson ◽  
Klaus B. Von Pressentin
Keyword(s):  
South Africa ◽  
Local Community ◽  
District Hospital ◽  
Family Physicians ◽  
Clinical Governance ◽  
Short Report ◽  
Urban District ◽  
Levels Of Care ◽  
Care Access ◽  
District Hospitals

This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

2007 ◽  
Vol 30 (4) ◽  
pp. 56
Author(s):  
I. Rigby ◽  
I. Walker ◽  
T. Donnon ◽  
D. Howes ◽  
J. Lord
Keyword(s):  
Internal Medicine ◽  
Emergency Medicine ◽  
Medical Education ◽  
Family Medicine ◽  
Training Program ◽  
Correlation Coefficient ◽  
Training Programs ◽  
Self Assessment ◽  
Procedural Skills ◽  
Simulation Based

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

scholarly journals Investigating competencies needed by European-trained doctors in rural South African hospitals

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
James R. Barnacle ◽  
Oliver Johnson ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
South African ◽  
Online Survey ◽  
Rural District ◽  
Eastern Cape ◽  
Rural Medicine ◽  
Rural South ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

scholarly journals A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

2017 ◽  
Vol 42 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Liezel Ennion ◽  
Anton Johannesson
Keyword(s):  
South Africa ◽  
Lower Limb ◽  
Rural Setting ◽  
Limb Amputation ◽  
Prosthetic Rehabilitation ◽  
Rural South ◽  
Physical Strength ◽  
District Hospitals ◽  
Fitting In ◽  
Rural South Africa

Background: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. Objective: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Conclusion: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

scholarly journals Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Ozayr H. Mahomed ◽  
Shaidah Asmall ◽  
Anna Voce
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Assessment Tool ◽  
Scale Up ◽  
Self Assessment ◽  
Health Care Clinics ◽  
Clinical Support ◽  
Supportive Management

Background: An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes.Aim: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.Setting: The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa.Methods: The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability.Results: Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55.Conclusion: The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.

scholarly journals Patients’ Lived Experiences of the Care Provided Before and After Caesarean Sections in the City of Tshwane, Gauteng, South Africa

2021 ◽  
Vol 23 (2) ◽  
Author(s):  
Tendani Ramukumba ◽  
Tshidi M. E. Masala-Chokwe ◽  
Takalani Mudau
Keyword(s):  
South Africa ◽  
Caesarean Section ◽  
Lived Experiences ◽  
Caesarean Section Rate ◽  
Elective Caesarean Section ◽  
Multidisciplinary Teams ◽  
District Hospitals ◽  
Before And After ◽  
The City ◽  
Nurses And Midwives

A caesarean section is an incision of the abdomen and uterine walls to deliver the foetus. An emergency caesarean section may be performed if complications during pregnancy or labour arise. Various indications such as abnormal presentation, a previous caesarean section, and other related conditions may need an elective caesarean section. In South Africa, the national average caesarean section rate between 2015 and 2016 was 26.2 per cent, whereas the rate in district hospitals was 24.1 per cent. At a community hospital in the City of Tshwane, the caesarean section rate of 32 per cent in 2015 was recorded as high. The aim of this research was to explore and to describe patients’ lived experiences of the care provided before and after a caesarean section in the City of Tshwane, Gauteng, South Africa. To achieve the aim of the study, a qualitative, exploratory, descriptive study was conducted. The sampling method used was purposive, and the sample size was determined by data saturation. An interview schedule was used to collect the data. The study concluded that some women were satisfied with the care provided, whereas the majority were dissatisfied. The need for strategies to improve such care provided by nurses and midwives was highlighted. Multidisciplinary teams have to acknowledge gaps and develop effective strategies to motivate nurses and midwives in the workplace to provide quality care. Research should be conducted to design an effective nursing framework for caesarean section care.

scholarly journals Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Christiane Horwood ◽  
Lyn Haskins ◽  
Silondile Luthuli ◽  
Neil McKerrow
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Structured Interview ◽  
Observation Data ◽  
Good Communication ◽  
District Hospitals

Abstract Background There is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa. Methods A qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data. Results Observations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions. Conclusion Good communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.

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