Browsing by Author "Gcawu, Luleka Patricia"

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    The development of validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa
    (Stellenbosch : Stellenbosch University, 2020-03) Gcawu, Luleka Patricia; Stellenberg, Ethelwynn L. (Ethelwynn Linda); Whittaker, Stuart; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY : Introduction: Substandard care resulting in billions of rand pay-outs due to malpractice litigation remains a challenge in nursing practice. Purpose: To develop validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa. Research questions: What are the contributing factors that lead to adverse events in nursing care? What are the validated guidelines that can be developed to contribute to the prevention of malpractice litigation in nursing practice in South Africa? Methodology: The study was conducted in three phases: Phase 1: A retrospective audit of adverse events using a descriptive quantitative design with Pearson Chi-Square test, CI 95%, p ≤ 0.05 was conducted on 203 malpractice litigation cases from the Eastern Cape and Gauteng public healthcare sectors. Phase 2: A comparative statistical analysis was carried out to compare and contrast adverse events - 122 malpractice litigation cases audited by two master’s students in the Western Cape and Gauteng private sector with the phase 1 litigated cases. Phase 3: Nursing practice guidelines were developed using the identified adverse events that contributed to adverse events by applying the WHO guidelines and expert validation using the Delphi method. Results: Phase 1: A key finding - Out of 143 cases admitted to labour wards 135 babies had cerebral palsy in this study. Adverse events contributing factors: • Nursing clinical management (87% of adverse events): Assessment; diagnosis; planning; implementation and evaluation including observations; tests; interpretation and documentation; as well as clinical management. • Behavioural problems (12.3% of adverse events): Not following guidelines (91.6%), non-response to clinical manifestations (79.4%), accumulation of omissions (49.8 %), an accumulation of errors (41.8 %), administering and incorrect treatment (16.0 %). • Organisational and administrative factors Lack of knowledge (28.9 %), organisational (23.7%), system failure (21.5, lack of training (19.4 %) %), lack of supervision (17.5 %) and administrative (6.5%). Phase 2: • A total of 325 trial bundles were audited - 122 by two master’s students in private and 203 in public healthcare by a PhD student. Statistical differences showed that 76.0% of patients’ quality of life were affected (p=0.01). • Statistically, it was shown that patients were more likely to die in the private sector (p=0.01) and more likely to be disabled in the public sector (p=0.01). • No statistical difference was identified in clinical management between private and public healthcare sectors (p= 0.27). • The private healthcare sector was more likely to have adverse events, due to organisational and administrative problems. • The public healthcare sector was more likely to have poor resources with a critical shortage of doctors and nurses. Phase 3: • Guidelines were developed by applying the WHO guideline development process and validated, applying the Delphi method. • One hundred and forty-four guidelines were developed, validated and grouped into Clinical Management, Human Behaviour, and Organisational factors. • National and international experts participated in the validation process. Ethical considerations: Approval was obtained from Stellenbosch University (N16/02/027A). Recommendation: The validated guidelines developed in the study should be further tested and implemented in South Africa to contribute to the prevention of the escalating malpractice litigation in nursing practice.
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    Factors affecting quality of care in a midwifery practice
    (Stellenbosch : Stellenbosch University, 2012-12) Gcawu, Luleka Patricia; Stellenberg, E. L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science.
    ENGLISH ABSTRACT: The midwives are the backbone of midwifery practice with needs and opportunities to create a tradition of caring in midwifery. However, there are problems that affect the midwifery practice. These problems include the increased maternal and perinatal mortality rate, shortage of material and human resources and poor implementation of policies and guidelines. The purpose of this study was to investigate factors that affect quality of care in a midwifery practice at a hospital complex in the Eastern Cape Province, South Africa. The objectives of the study focused on the structure and process standards. - 1 Structure Standards: To determine whether • policies and procedure manuals are available and updated • support from the supervisor is available • there is adequate staff • the required qualifications were available • the required experience of registered midwives were available • in-service training was being given - 2 Process standards : To determine whether • patients were assessed according to the national guidelines for maternity care • patients were diagnosed according to the national guidelines for maternity care • patients’ care plans were formulated according to the national guidelines for maternity care The descriptive research design with a quantitative approach was applied in this study. The target population (N=172) were the registered midwives working in the maternity department at a particular hospital in the Eastern Cape Province. A specific sampling method was not applied in this study as the total population of 155 was included and17 in the pilot study with a response rate of 81.3%. A self-administered structured questionnaire was used to collect the data. The researcher distributed the questionnaires personally to all respondents who met the criteria. Reliability and validity were assessed by means of a pilot study and the use of experts in Nursing Education, Midwifery, Research Methodology and Statistics. Ethical approval was obtained from Stellenbosch University and all other relevant parties. Computerized data analysis software namely the SPSS programmes and Stastica version 9 were used to analyze the data. The results of the study were interpreted, discussed and presented in tables and frequencies. The data was predominantly presented in a quantitative form with responses to a few close-ended questions. A confirmatory analysis to test the quality of properties across a level of variables was carried out. The Chi-square test was used to test association of variables between demographic data and the responses of midwives to factors affecting quality of care. A p-value of p< 0.05 represents statistical significance in hypothesis testing and 95% confidence intervals were used to describe the estimation of unknown parameters. Results showed that the majority of respondents had an experience of 2 to 5 years (n=34/27.0%) and (n=32/25.4%) more than 14 years working in the maternity department. The minority of respondents were those that are highly skilled. Only (n=4/3.2 %) of the midwives were registered in neonatology nursing and (n=9/7.1%) in advanced midwifery. The majority of respondents (n=118/93.7%) recorded that there was not enough staff to provide quality nursing care. Some respondents recorded that comprehensive in-service education was not offered in the hospital (n=18/14.3%). Recommendations include improvement of staffing, adherence to policies and guidelines, proper implementation of staff development and quality improvement programmes. In conclusion, in order to reduce high infant and maternal mortality rates and to reach the millennium development goals, shortcomings in midwifery should urgently be addressed.