ENGLISH ABSTRACT: Primary Health Care (PHC) provide a quality, comprehensive health service to
the community, based on the principles of equity, affordability, accessibility and
community participation. It is a nurse driven service with the Clinical Nurse
Practitioner (CNP), a registered nurse specialising in the clinical elements of
primary, secondary and tertiary prevention at the forefront.
It is against this background that this study was endeavored to investigate the
community’s perceptions and lived experiences of the quality of care being
rendered by CNPs in the West Coast rural district of the Western Cape. The
objectives of this study included the following:
- To explore and describe the perceptions of patients in the West Coast rural
community regarding the attitudes, knowledge and skills of CNPs.
- To provide policy makers with feedback and possible recommendations
with regards to the implementation of this nurse driven PHC service.
- To provide recommendations for improvement of the existing curricula at
nursing education institutions based on whether the current training meets
patients’ needs and thereby possibly influence curricular change.
A qualitative, descriptive, research design was used. The guideline by Colaizzi
(as cited in Streubert & Carpenter, 1999:14) was used for data collection and
analysis. Twenty-six participants took part in five different group interviews.
Semi-structured, open ended questions were used to encourage the
participants to actively partake. Each interview was audio taped and field notes
were taken. Thematic analyses was performed to highlight three main themes,
i.e. the attitudes of the CNPs, the knowledge and skills of CNPs, and the impact
of the current training programmes on the quality of care being rendered by
these CNPs.
Written approval from the Ethics Research Committee, University of
Stellenbosch, as well as from the Research unit of the Western Cape Department of Health was obtained. Prior informed consent was further
obtained from each participant, after being assured of voluntary participation,
confidentiality and anonymity.
Credibility, dependability and transferability were ensured by returning to two
participants who validated that the transcripts were a true reflection of their
experiencesand opinions.
This study concluded that patients perceived CNPs as being unfriendly,
uncompassionate and unprofessional. Dissatisfaction with the prevalence of
unjust practices due to family members and certain race groups being attended
to first by CNPs, were expressed.
Participants found the competency levels of CNPs more than adequate when
assessing, examining and providing health information and medicine. However,
they expressed the need that CNPs should be able to prescribe a greater
variety of medicines and perform more diagnostic tests than currently permitted
by the scope of practice as set out by the South African Nursing Council.
Therefore, these views of the participants indicated that the current postgraduate
training programme do fulfill their health needs, although the need for
expansion of the role and function of the CNP were expressed.
Recommendations made included: - An in-depth investigation into the alleged rude attitudes of CNPs should be
undertaken, soas to improve the professional behavior of CNPs towards
patients.
- Applicable policy makers should consider expanding the roles and
functions of the CNP.
- Enforcing continuous, professional competency through adequate and
productive in-service training programmes.
In conclusion, this study showed that CNPs need to be constantly aware that
they work with human beings, with feelings and with health needs. The need
for a therapeutic environment is thus crucial to the rendering of a quality,
comprehensive service to the community they serve.
AFRIKAANSE OPSOMMING: Primêre Gesondheidsorg (PGS) voorsien ’n kwaliteit, omvattende
gesondheidsdiens aan die gemeenskap, gebaseer op die beginsels van
gelykheid, bekostigbaarheid, toeganklikheid en gemeenskaps-betrokkenheid.Dit
is `n verpleegaangedrewe diens met die Kliniese Verpleegspraktisyn (KVP) wat
gespesialiseerd is in die kliniese elemente van primêre, sekondêre en tersiêre
voorkoming, aan die voortou.
Dit is teen hierdie agtergrond wat hierdie studie aangepak is, ten einde
ondersoek in te stel aangaande die gemeenskap se persepsies en geleefde
ervarings van die kwaliteit van sorg wat deur KVPs in die plattelandse
Weskusdistrik van die Wes-Kaap gelewer word. Die doelwitte van hierdie
studie het die volgende ingesluit:
- Om die persepsies van pasiënte, rakende die ingesteldhede (gedrag),
kennis en vaardighede van KVPs te ondersoek.
- Om toepaslike beleidsmakers metterugvoer en moontlike aanbevelings te
voorsien aangaande die implimentering van verpleegaangedrewe, PGS.
- Om aanbevelings te maak vir die verbetering van bestaande kurrikula aan
verpleegopleidingsinstellings op grond van óf die huidige opleiding in
pasiëntbehoeftes voorsien, en sodoende kurrikulumverandering moontlik
te beïnvloed.
’n Kwalitatiewe, beskrywende navorsingsontwerp is gebruik. Die raamwerk van
Colaizzi (soos beskryf in Streubert & Carpenter, 1999:14) is tydens datainsameling
en analiese gebruik. Ses-en-twintig deelnemers het aan die vyf
verskillende groepsonderhoude deelgeneem. Semi-gestruktureerde, oop-einde
vrae was gebruik om die deelnemers aan te moedig om aktief aan die
besprekings deel te neem. Elke onderhoud is op oudio band opgeneem en
veldnotas is gemaak. Tydens analiese is drie hooftemas geïdentifiseer, nl die
houdings van KVPs, die kennis en vaardighede van die KVPs sowel as die
impak van die opleidingsprogram op die kwaliteit van sorg wat deur KVPs
gelewer word. Skriftelike toestemming vir die studie is by die Etiese Navorsingkommittee,
Universiteit van Stellenbosch, asook die Navorsingseenheid van die Wes-
Kaapse Departement van Gesondheid verkry. Voorafgaande toestemming is
voorts vanaf elke deelnemer verkry, nadat hulle verseker is van vrywillige
deelname, konfidensialiteit en anonimiteit.
Geloofwaardigheid, afhanklikheid en oordraagbaarheid is verseker, deur na
twee van die deelnemers terug te gaan wat die transkripsies geverifieër het as
juis en korrek.
In hierdie studie is tot die slotsom gekom dat pasiënte KVPs as onvriendelik
enongevoeligervaar het. Onbillike praktyke kom steeds voor, deurdat
familielede en sekere rassegroepe voorkeur behandeling kry.
Deelnemers se ervarings aangaande die bevoegdheid van KVPs was as
toereikend beskryf aangaande die assessering, ondersoek en voorsiening van
gesondheidsinligting en medisyne. Hulle het egter ook die behoefte uitgespreek
dat die KVP’s `n groter verskeidenheid medisyne behoort voor te skryf
en meer diagnostiese toetse behoort te kan uitvoer as wat tans binne die bestek
van praktyk, soos neergelê deur die Suid-Afrikaanse Raad op Verpleging,
moontlik is. Hierdie persepsie van die deelnemers impliseer dat die huidige nagraadse
opleidingsprogram voldoende is en hul gesondheidsbehoeftes
aanspreek. Die behoefte vir die uitbreiding van die rol en funksie van die KVP
is egter uitgespreek. Die aanbevelings wat gemaak is sluit in:
- ’n In-diepte ondersoek oor die onbeskofte ingesteldhede van KVPs
behoort uitgevoer te word, ten einde die professionele gedrag van KVPs
teenoor pasiënte te verbeter.
- Beleidmakers behoort die uitbreiding van die rolle en funksies van die KVP
te oorweeg.
- Benadruk voortgesette, professionele bevoegdheid deur toepaslike en
produktiewe indiensopleidingsprogramme.
Ter aflsuiting: hierdie studie het aangetoon dat KVPs voortdurend bewus
moetbly dat hulle met mense werk wat gevoelens het en wat gesondheidshulp benodig. Dit is uiters belangrik om aan die behoeftesvan ’n terapeutiese
omgewing te voorsien, ten einde ’n kwaliteit, omvattende diens aan die
gemeenskap te lewer.
