Views of frontline service providers on the accreditation of occupational health services in South Africa

Background: In South Africa, occupational health services are delivered in a fragmented and complex environment. There is, however, a global emphasis on high-quality, universal occupational health coverage. Objective: To describe occupational health practitioners' perceptions of the accreditation of occupational health services. Methods: We used a mixed methods approach, which combined a self-administered web-based survey of 475 occupational health nurses and 11 semi-structured focus group discussions, which included a broad selection of occupational health stakeholders. Results: The majority of respondents supported the statutory accreditation of healthcare services for workers, provided that a phased approach is used. Challenges that need to be addressed for a successful and sustainable accreditation system include the current lack of national standards for occupational health, human resource shortages, potentially high costs of accreditation, and the suboptimal and fragmented governance of occupational health services. Conclusion: The majority of respondents were of the opinion that statutory accreditation of occupational health services will improve the quality-of-service delivery. However, prerequisites for successful and sustainable implementation of accreditation include improved collaboration between Government departments, coalition building with all stakeholders, the development of specific standards against which a service can be assessed, and education and training of occupational health practitioners to meet the established standards

The use of the socratic inquiry to facilitate critical thinking in nursing education

Background: Critical thinking is a skill that nurse practitioners are required to have. Socratic inquiry can be used to facilitate critical thinking in nursing. Nurse educators seek methods to infuse into teaching content to facilitate students' critical thinking skills, and one of such methods is the use of Socratic inquiry as a teaching method.Aim: This article aims to explore and describe how Socratic inquiry can be used to facilitate critical thinking in nursing education.Setting: This study took place in a nursing department at a university in Johannesburg.Methods: A qualitative, exploratory, descriptive and contextual design was used. Purposive sampling was used to draw a sample of 15 nurse educators determined by data saturation. Miles, Huberman and Saldaña's methodology of qualitative data analysis was used. Lincoln and Guba's strategies for trustworthiness and Dhai and McQuoid-Mason's principles of ethical consideration were used.Results: Three main themes emerged: the context necessary for Socratic inquiry, dispositions in Socratic inquiry and strategies to use in Socratic inquiry to facilitate critical thinking skills of students.Conclusions: Socratic inquiry can be used both in education and practice settings to facilitate the use of critical thinking skills to solve problems

Perceptions of Central Gauteng Occupational Health Nursing Practitioners of their Traditional and Expanded Roles

This paper provides an overview of the fi ndings of a cross-sectional survey conducted in 2011 that investigated the perceptions of Central Gauteng occupational health nursing practitioners of their traditional and expanded roles and role activities; using a self-administered questionnaire. In the traditional role area; high importance was given to the functions of health assessment and providing direct care of job-related emergency and minor illness episodes. The assistance of rehabilitation and relocation of disabled workers was rated low in overall importance. In the expanded role area; the highest importance was given to managing an occupational health service; while the lowest importance was given to research-related activities. The results demonstrate that occupational health nursing practitioners need to engage in research activities and conduct situational analyses of workplaces

Breastfeeding: Mothers and Health Practitioners in the Context of Private Medical Care in Gauteng

Despite the well-documented health benefits of breastfeeding and recommendations by the Department of Health for women to exclusively breastfeed for approximately the first six months of life and continuation beyond one year; a large percentage of South African women do not breastfeed their infants; or only do so for a short period of time. No national South African statistics are available but figures emerging from the attendance of mothers at a baby clinic on the West Rand in Gauteng indicated the following: 64of the mothers breastfeed up to six weeks; after which the figure rapidly declines to less than 20at three months (Truter 2007). Several studies have assessed the attitudes of health care personnel towards breastfeeding; but little is known of the type of information given to breastfeeding mothers by private medical practitioners who are the frontline of contact with clients and who may convey information that either promotes or discourages breastfeeding. The following question was thus formulated: With regard to breastfeeding; what are the constraints to breastfeeding in private practice? Therefore; in order to understand the constraints to breastfeeding; the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy; to describe the management of breastfeeding in the consulting rooms of private medical practitioners; and to describe women's experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the first six weeks. Purposive convenient sampling; as described by Babbie and Mouton (2002:166); was used in both phases of the study. All participants chose a gynaecologist as the primary care giver and delivered in various private hospitals in Johannesburg. Data were collected by means of an anonymous questionnaire; compiled from national and international literature; as well as personal interviews. Data from the questionnaires were analysed by hand. Descriptive statistics were applied. The interviews were analysed according to the descriptive analysis suggested by Tesch (in Creswell; 1994:155). Themes that emerged were clustered and coded. A co-coder; experienced in the field of qualitative research; assisted with the analysis of the transcripts of the interviews. A literature control was conducted to validate the findings. Ethical considerations were based on the DENOSA Ethical Standards for Nurse Researchers (1998:2.3.2-2.3.4). Themes and sub-themes were identified

The Professional Nurse's Experience of Dying Process of Terminal AIDS Patient

The increase in HIV/AIDS raises international concern. Statistics indicate that South Africa has the fastest increasing HIV-infection rate in the world. Secondary infections complicate the issues and could result in hospitalisation and death of terminal AIDS patients. Nurses are increasingly exposed to this process. This directed the researchers to explore and describe the nurse's experience of the dying process of the terminal AIDS patient through a qualitative research design. Purposive; voluntary sampling was conducted followed by individual interviews. Data saturation was reached after 10 interviews. The data were then analysed involving a co-coder to ensure trustworthiness. The results indicated specific themes. Firstly; nurses experience that various factors influence the pace of the dying process. Secondly; contrasting experiences regarding medical treatment of these patients surfaced. The study indicated that the nurse experienced emotions such as powerlessness; relief and fear. Finally; the needs and behaviours of the terminal AIDS patient; and the specific behaviours of the nurses were revealed. Value judgements regarding the patient; his family; medical treatment and the nurse's conduct during the dying process were also noted. Recommendations focus on the following: nurses' personal coping with the dying process; extended coping skills in the guidance of terminal AIDS patients and their handling of specific themes during the dying process.regarding the patient; his family; medical treatment and the nurse's conduct during the dying process were also noted. Recommendations focus on the following: nurses' personal coping with the dying process; extended coping skills in the guidance of terminal AIDS patients and their handling of specific themes during the dying process

The community involvement of nursing and medical practitioners in KwaZulu-Natal

Background: The basis of the health system in South Africa is purported to be primary health care (PHC); as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities; but it would appear that a very limited or selective PHC approach is actually being pursued in South Africa; without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach; which demands a broader scope of practice than primary medical care. Methods: The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care; to document their practices and perceptions with regard to their community involvement; to analyse the common themes arising from the findings; and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal; half of whom were professional nurses and the rest medical practitioners; were purposively selected through their district managers. A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. The interviews were recorded; translated where necessary; and transcribed. Content analysis was carried out as a team; with the identification of major and minor themes.Results: The findings of this study were consistent with studies from other countries; with some interesting differences. The major themes that emerged from the data included the wide range of activities that subjects were involved in; the importance of relationships; the context of poverty; the frustrations of this kind of work; and the respondents' motivations. These are illustrated by numerous verbatim quotes from the respondents. Minor themes were the roles that the respondents play in the community; the difficulty of obtaining funding; and experiences in starting up. Significantly; the fact that the role of clinicians in the community emerged as only a minor theme rather than a major theme in this study indicates the absence of expectation and policy in this area of practice in South Africa. In the light of the supposed centrality of the primary healthcare approach in the national health system; this is a serious gap.Conclusion: The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care is discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement; and this study serves as a basis for further research into the subject

Ethical Standards for the Occupational Health-Nursing Practitioner Regarding the HIV Positive Person in the Workplace

The occcupational health-nursing practitioner often becomes involved in ethical dilemmas with regard to the handling of HIV-positive people in the workplace in that the interests of the HIV-positive people conflict with the interests of the employer. Therefore; the occupational health-nursing practitioner could find himself ? Herself acting as mediator between the two parties. Despite the existence of legal norms ancl ethicirl standards to regulate the interests of the HN-positive person in the workplace; no guidelines exist as to how these norms and standards should be operrationalised during interaction between the HN-positive person; the occcupational health-nursing practitioner and the employer: The occupational health-nursing practitioner is therefore rrncertain us to the manner in which to act professionally within the laid-ilown ethical standards for HN positive people in the workplace.The purpose of this study is to provide guidelines and criteria for the operationalisation of ethical standards for the occupational health-nursing practitioner regarcling the HN-positive person in the workplace. This is done through a literatrrre study with specific reference to current ethical frameworks within the occupational health-nursing context; after which the research is focused on two target groups; namely the occupational haalth-nursing practitioners and HIV-positive persons in the workplace. The design of the research is qualitative; explorative and descriptive. In order to assist the occupational health-nursing practitioner to handle the HIVpositive person in the workplace in an ethical manner guidelines and criteria were compiled for the operationalisation of the standards