Key issues in clinic functioning - a case study of two clinics.

OBJECTIVE: The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management. DESIGN: An in-depth case study was conducted. A range of qualitative information was collected at both clinics. Data collected in the two clinics were compared, to gain an understanding of the important issues. SETTING: Data were collected in a government and an NGO clinic in North West province. SUBJECTS: This report presents the findings from patient and staff satisfaction surveys and in-depth individual interviews with senior staff. RESULTS: Key findings included the following: (i) there are attitudinal differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture. CONCLUSIONS: This research provides lessons regarding key issues in clinic functioning which can make a major difference to the way services are experienced. A respectful and caring approach to patients, and an organisational culture which supports and enables staff, can achieve much of this without any additional resources.

A Qualitative Study on the Relationship between Doctors and Nurses Offering Primary Health at KwaNobuhle (Uitenhage)

"Background: Primary health care; which was the domain of the nursing profession; was popularised by the introduction of free health services by the South African legislature. In addition; the district health system was developed with the aim of keeping people healthy by creating small management systems adapted to cater for local needs. These measures increased public access to healthcare centres; leading to an increased workload at primary health level. The government; being a large organisation; relies on groups that include doctors and nurses to accomplish its goals; and the governess of these groups plays a major role in determining the effectiveness of the overall organization. ""The nurse has an ethical responsibility in the interest of the welfare of her patient to be a loyal and petent colleague to the doctor. The nurse and the doctor must be able to rely on each other. Mutual respect is vital."" Nurses have dependent; independent and interdependent roles in their interaction with doctors; and both professions should embrace the Patient's Rights Charter; which requires a good standard of practice and care of patients. International journals have published numerous letters citing doctor-nurse disagreements in their interactions. Historically; the doctor-nurse relationship is an unequal one characterised by the dominance of the doctor; with nurses assuming a position of lower status and dependence on physicians. One qualitative study showed that nurses perceive the quality of communication with doctors as being poor. Lack of teamwork in the relationship resulted from different expectations and a confusion of roles. Both professions have however demonstrated a willingness to promote teamwork in hospitals. A journal review on interventions to promote collaboration between nurses and doctors showed positive gains once collaboration was embraced.Method: This was a descriptive qualitative study in which the experiences of Kwa-Nobuhle general practitioners and professional nurses were explored. An equal number of nurses and doctors (five each) were purposefully selected; for the free-attitude interviews used for data collection. All interviews were analysed using the thematic analysis method. Themes were integrated into a single Model.Results: Majority of respondents experienced a relatively good relationship. The positive factors were balanced by negative experiences by almost all respondents. The positives were personal growth; efficiency at work; opportunity for education and learning at the primary healthcare level. The negatives were doctors' inconsistent clinic visits; role confusion (with doctors being confused with policymakers); dominance of the doctor in the relationship; and lack of doctor-nurse forums for communication; with subsequent suspicion and tension. The impact of the conflicts was neutralised by the track record of the relationship and the behaviour of the participants towards each other.Conclusion: This study showed congruence with other studies; where the doctor-nurse relationship was influenced by a power differential; collaboration; role confusion; impact of the respondents' competence; the significance of recognising the nurses' hierarchy and continuity of the care they provide at the primary health level. Maximum variation; strict admission criteria and data validation through a member check addressed issues of bias in this study. The exploration of relationships is a sensitive issue and a different methodology may produce different results. The environment where this research was conducted may differ from others; leading to discrepancies in findings. Future research could further focus on team building and the essential elements to sustain the doctor-nurse-patient team."

How the families of the victims suicide through self-incineration function before and after the event a qualitative assessment

Background Durkheim defines suicide as all death resulting directly or indirectly from a positive or negative act of the victim himself or herself; which he or she knows will produce this result. Suicide is as old as human history itself. It is most frequently seen as a fatal sequel of psychiatric illnesses and it is thought that suicide only occurs in a state of insanity; and that it is by itself a special form of insanity. Health workers; especially family practitioners; are constantly confronted by family tragedies; which they have to deal with competently. It is therefore imperative that a health worker contextually understand a family tragedy; such as when a family member commits suicide through self-incineration. Between 1987 and 1998; Matsulu Township; Mpumalanga experienced a high incidence of suicide through self-incineration. Each victim either ingested or doused him or herself with inflammable liquid (usually kerosene) and set his or her body alight. This gruesome form of suicide; and the increased frequency of occurrence; horrified the families and reverberated through the township. This phenomenon drew the principal researcher's attention and resulted in this study. The principal researcher was the only family practitioner in the township during this period. It was hoped that the knowledge gained from this study would form the basis for interventions in similarly affected families in the future. The focus was on the surviving family members; in order to learn about the family dynamics before and after the events; and how the family dealt with the event. Although studies that focused on the role of doctors in suicide prevention found that there is little predictive power for the suicide candidates; which means that there were no identifiable factors directly associated with suicide outcome; information gleaned from the affected families could be used profitably in community campaigns and by support groups. Methods The aim of the study was to understand how the families of those who committed suicide through self-incineration functioned before and after the event. In-depth interviews were conducted with six focus groups selected urposively from 36 affected families. Interviews were conducted in Siswati; audiotaped; transcribed and translated into eng. Themes and sub-themes were identified. To enhance the trustworthiness of the information gathered; the data were triangulated. Results Themes identified were a shocking experience; no chance of survival; triggering factors; mystery; emotional and physical scars; and coping strategies. The perception of witchcraft being responsible for suicide featured prominently in the data analysed. Conclusions The functioning of the families affected by the suicide of a member through self-incineration was markedly reduced after the events. It is recommended that attention be given especially to the perception of witchcraft being responsible for suicide; and that grief support groups be established in the community to assist affected families cope better with the loss