Reforming the workers' compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment.

PURPOSE: The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators. METHODS: During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity. RESULTS: The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity. CONCLUSION: Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.

A rare case of genital labial phylloides tumour.

SUMMARY: Phylloides tumour is an extremely rare fibroepithelial neoplasm, accounting for less than 1% of breast pathologies. We report a rare case of primary phylloides tumour arising within the vulva.

Implementing community-based education in basic nursing education programs in South Africa.

Education of health professionals using principles of community-based education is the recommended national policy in South Africa. A paradigm shift to community-based education is reported in a number of nursing education institutions in South Africa. Reviewed literature however revealed that in some educational institutions planning, implementation and evaluation of Community-based Educational (CBE) programmes tended to be haphazard, uncoordinated and ineffective, resulting in poor student motivation. Therefore the purpose of this study was to analyse the implementation of community-based education in basic nursing education programmes in South Africa. Strauss and Corbin's (1990) grounded theory approach guided the research process. Data were collected by means of observation, interviews and document analysis. The findings revealed that collaborative decision-making involving all stakeholders was crucial especially during the curriculum planning phase. Furthermore, special criteria should be used when selecting community learning sites to ensure that the selected sites are able to facilitate the development of required graduate competencies. Collaborative effort, true partnership between academic institutions and communities, as well as government support and involvement emerged as necessary conditions for the successful implementation of community-based education programmes.

Clinical supervision and support for bridging programme students in the greater Durban area.

Reviewed literature revealed that clinical supervision is a conceptually sound learning model, which, unfortunately, is flawed by problems of implementation. Some of the more glaring problems include limited emphasis upon problem-solving, lack of clear expectations for student performance, inadequate feedback to students, inappropriate role models in clinical settings and inadequately prepared clinical teachers. The purpose of the study was to explore and describe the nature of clinical supervision and support provided to bridging programme students in the clinical settings. Participants were drawn from three nursing colleges and 122 participants returned questionnaires. College 1:26, 2% (n = 32), College 2:15, 6% (n = 19) and the majority, 58, 2% (n = 71) were from College 3. The participants were second year students in the Bridging Programme. Purposive sampling was used for the selection of the hospitals. The researcher purposively selected those hospitals offering the Bridging Programme. The students were randomly sampled. According to Burns and Grove (2001), simple random sampling is the most basic and most effective of the probably sampling methods. Data was collected by means of a questionnaire and a critical incident report. The questionnaire used in this study was adapted from the Manchester Clinical Supervision Instrument. The findings revealed that clinical supervision contributes positively to the academic, professional and personal development of students. Although there was support for clinical supervision by the nursing staff, time for clinical supervision was the main problem. Clinical supervision was viewed as time consuming. Clinical learning emerged as secondary to ward routine. The students functioned as part of the workforce and missed out on some important learning opportunities. Results also showed that some clinical supervisors were not adequately prepared for their roles and responsibilities; as a result there was no significant relationship between clinical supervision sessions and the acquisition of knowledge. The critical incidence revealed positive and negative experiences regarding clinical supervision and the support provided by clinical supervisors and clinical staff. There is a need for clear policies regarding clinical supervision, a structured and well monitored process of clinical supervision, building the capacity of clinical supervisors, and addressing the issues of use of bridging programme students as part of the workforce.

Conceptualisation of community-based basic nursing education in South Africa: a grounded theory analysis.

Community-based education is about a decade old in basic nursing education in South Africa. An extensive review of literature revealed that although CBE was a familiar concept in South Africa, there was however, limited understanding of what this phenomenon means. The purpose of the study was to analyse the concept 'community-based education' with the aim of discovering shared understanding of this phenomenon in basic nursing education within the South African context. Strauss and Corbin's (1990) grounded theory approach was used to guide the research process. The South African Nursing Council's (SANC) education committee, the National Department of Health, human resources division representatives as well as seven nursing education institutions with well-established CBE programmes participated in the study. The data was collected by means of observations, interviews and document analysis. Purposive sampling and later theoretical sampling was used for selecting interviewees. This resulted in a total of 45 interviewees. The data collection and initial data analysis took place concurrently. Descriptive analysis followed by conceptual analysis was performed using Strauss and Corbin's model. The findings in this study revealed that community-based education is education that uses the community extensively, especially the under-developed and under-resourced settings, for learning purposes in order to enhance relevance of nursing education to the needs of the South African population. The core discriminatory characteristics of CBE were found to include; primacy of the community as a learning environment; the early exposure of students to community-based learning experiences; community-based learning experiences dominating the curriculum, exposure to community-based learning experiences throughout the curriculum, vertical sequencing of community-based learning experiences in a curriculum, starting from primary settings to secondary and later tertiary health care settings to facilitate the development of competencies required when serving in all these settings, and lastly, learning through providing service to the under-resourced communities. Community involvement and partnership, problem-centred learning, valid assessment of learning emanated as important characteristics of CBE but which were identified as gaps in the existing programmes. Recommendations focused on these gaps as well as to the problem of community-based learning experiences which were mainly concentrated in first and/or second year levels in most of the programmes.

A comparative analysis of ethical development of student nurses registered for a basic degree and basic diploma programme in KwaZulu Natal.

A comparative descriptive study was conducted to establish whether the Comprehensive Basic Nursing Course (CBNC) is able to develop students ethically, and how educational preparation from two different programmes (basic degree and basic diploma) influence their ethical development. This study was conducted because of the concerns on the escalating number of litigations instituted against nurses. Several studies have indicated that some of these litigations are as a result of the growing complexity of the health care system and the society's increasing awareness of their human rights. Some studies have shown that nurses are failing to make principled and ethically sound decisions because they are inadequately prepared to handle ethical issues in an ethically responsible manner. A purposively selected sample of third and fourth year students from both programmes was used. Data was collected from both groups through the use of questionnaires. The findings revealed that the students are developing ethically in a CBNC but the level of ethical development is influenced by their educational preparation, teaching approaches and strategies used, clinical environment, hospital bureaucracy, rules and policies.