Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

Background: The fall rate of patients in hospitals is a worldwide concern due to the impact falls have on patients, the family or relatives, as well as the healthcare setting. Factors influencing patient falls are categorised as intrinsic and extrinsic. Intrinsic factors refers to physical conditions and the extrinsic factors include the environment of the patient, nursing staffing levels and skill mix.Aim: The study aimed to determine the factors that influence patient falls.Setting: A private hospital group in the Cape Metropole of the Western Cape.Methods: A quantitative retrospective descriptive research approach was used by analysing 134 records of patients that have fallen from October 2016 to February 2018. Data was collected using a data extraction sheet and analysed using the Statistical Package for the Social Sciences (SPSS).Results: Intrinsic factors contributing to patient falls includedthe patient's age, hypertension, co-morbidities and the use of benzodiazepines as a sedative. Extrinsic factors were the incorrect use of bed rails and the skill mix of the staff. In over half of the cases (n = 68; 50.7%), risk assessments were not performed according to the protocol. Only 5 (3.7%) patients sustained major injuries due to the falls. However, the risk of more severe falls increased 2.4 times with the lack of risk assessment.Conclusion: The lack of accurate and consistent patient fall risk assessments, use of benzodiazepines as a sedative and the staff skill mix were contributors to the fall rate in these hospitals

Factors influencing the confidence and knowledge of nurses prescribing antiretroviral treatment in a rural and urban district in the Western Cape province

Background: Since the introduction of nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa in 2010, initiation of antiretroviral therapy (ART) in primary care has become the responsibility of nurses. The continued success of this approach is dependent on factors such as adequate training and effective support systems.Objectives: This study aimed to investigate factors influencing the knowledge and confidence of professional nurses in managing patients living with human immunodeficiency virus (HIV) in primary healthcare settings in a rural and urban district in the Western Cape.Methods: A cross-sectional survey was conducted amongst 77 NIMART-trained nurses from 29 healthcare facilities to measure demographic details, influencing factors, HIV management confidence and HIV management knowledge.Results: The majority of participants had adequate HIV management knowledge and reported being very confident or expert in the HIV management skills or competencies. Participants trained recently on local guidelines (Practical Approach to Care Kit) (3 years ago or less) had significantly higher knowledge scores. Regular feedback about clinic and personal performance was associated with higher HIV management knowledge. Participants who received NIMART mentoring over a period of 2 weeks had a higher mean confidence score compared to other periods of mentoring. A higher caseload of patients living with HIV was also associated with higher knowledge and confidence.Conclusion: Training, mentorship and clinical practice experience are associated with knowledge and confidence. Recommendations include the strengthening of current training and mentoring and ensuring that NIMART-trained nurses are provided with regular updates and sufficient opportunities for clinical practice

Trends in task shifting in HIV treatment in Africa: effectiveness, challenges and acceptability to the health professions

Background: Task shifting has been suggested to meet the demand for initiating and managing more patients on antiretroviral therapy. Although the idea of task shifting is not new; it acquires new relevance in the context of current healthcare delivery.Aim: To appraise current trends in task shifting related to HIV treatment programmes in order to evaluate evidence related to the effectiveness of this strategy in addressing human resource constraints and improving patient outcomes; challenges identified in practice and the acceptability of this strategy to the health professions. Method: Electronic databases were searched for studies published in eng between January 2009 and December 2014. Keywords such as 'task shifting'; 'HIV treatment'; 'human resources' and 'health professions' were used.Results: Evidence suggests that task shifting is an effective strategy for addressing human resource constraints in healthcare systems in many countries and provides a cost-effective approach without compromising patient outcomes. Challenges include inadequate supervision support and mentoring; absent regulatory frameworks; a lack of general health system strengthening and the need for monitoring and evaluation. The strategy generally seems to be accepted by the health professions although several arguments against task shifting as a long-term approach have been raised.Conclusion: Task shifting occurs in many settings other than HIV treatment programmes and is viewed as a key strategy for governing human resources for healthcare. It may be an opportune time to review current task shifting recommendations to include a wider range of programmes and incorporate initiatives to address current challenges