An investigation into factors influencing the quality of nursing care in district hospitals in the West Coast Winelands region of the Western Cape

Eygelaar, Johanna Elizabeth (2009-03)

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009.

Thesis

ENGLISH ABSTRACT: Every patient comes to a hospital with the expectation of getting quality care. It is not always within the ability of nursing personnel to give quality care in the work situation. Guided by the research question “What are the factors influencing the quality of nursing care in district hospitals in the West Coast Winelands Region of the Western Cape?” a scientific investigation was undertaken. The goal of this study was to identify the factors which influence the quality of nursing care in the eight (8) district hospitals of the West Coast Winelands Region of the Western Cape. The objectives set for the study were:  to determine whether staffing is adequate for all activities;  to evaluate what the perceptions of the nursing staff is about their current working situation;  to determine what the effect of the absence of full time doctors are on the management of patient care;  to evaluate whether adequate equipment is available for the execution of nursing care and to evaluate whether adequate provisions for the execution of nursing care is done. A descriptive non-experimental design with a quantitative approach was applied. The population for this study was all the nursing staff available at the time of data collection, working in the eight district hospitals of the West Coast Winelands Region. A structured questionnaire was used to collect the data. The final sample of nursing staff was N= 280 of a total population of 340 – all the members were invited to participate. Reliability and validity were assured by means of a pilot study and the use of experts in nursing research, methodology and statistics. Data were collected personally by the researcher. Ethical approval was obtained from Stellenbosch University and various health authorities. Informed written consent was obtained from the participants. The data was analyzed with the support of the statistician; it was expressed in frequencies, tables and histograms. Comparisons between variables were made using either ANOVA (Analysis of variance) techniques or cross-tabulations with the Chi-square test. The 95% confidence interval was applied to determine whether there was an association between the various variables. The analysis shows that participants of the separate wards hospitals N=142 (90%) and the mixed wards type hospitals N=113 (95%) disagree that staff provision (numbers) is adequate. From the analysis it is clear that the patient documentation is not up to standard. A statistical significant correlation between hospital type and adequate time for the completion of written records (Chisquare Test p=0.00) was shown. Management N=13 (100%), registered nurses N=80 (86%), enrolled nurses N=63 (86%) and nursing assistants N= 81 (83%) disagree that it is not necessary to act beyond their scope of practice. The following recommendations were made: Safe staffing levels have to be determined; qualify staff with the necessary skills; where unit managers are still lacking, they have to be appointed; to make personnel development possible for staff; continuous auditing of patient documentation. It is necessary that there is always adequate equipment and consumables. More training is necessary for the effective and efficient implementation of the Batho Pele principles.

AFRIKAANSE OPSOMMING: Elke pasiënt kom na ‘n hospitaal met die verwagting om kwaliteit verpleegsorg te ontvang. Dit is nie altyd binne die vermoë van die verpleegpersoneel om sodanige diens te kan lewer nie. “Watter faktore het ‘n invloed op die lewering van gehalteverpleegsorg in die distrikhospitale van die Weskus Wynlandstreek in die Wes Kaap? het die wetenskaplike ondersoek gelei. Die doel van die studie is om die faktore te identifiseer wat ‘n invloed het op die lewering van gehalteverpleegsorg in die ag (8) distrikhospitale van die Weskus Wynlandstreek in die Wes Kaap. Die doelwitte van die studie is:  om te bepaal of personeelvoorsiening voldoende is vir al die aktiwiteite;  om te evalueer wat die persepsies is van die verpleegpersoneel betreffende hulle huidige werksituasie,  om te bepaal watter effek die afwesigheid van voltydse geneeshere het op pasiënte sorg;  om te evalueer of toerusting voldoende is vir pasiënte sorg;  om te evalueer of daar voldoende voorsiening gemaak is vir die lewering van pasiënte sorg. ‘n Beskrywende, nie-eksperimentele ontwerp as metodologie is gebruik met ‘n kwantitatiewe benadering. Die bevolking betreffende die studie was alle verpleegpersoneel, werksaam tydens die insameling van die data in die ag distrikhospitale van die Weskus Wynlandstreek. ‘n Gestruktureerde vraelys was gebruik om die data te versamel. Die finale steekproef van die verpleegpersoneel was 280 uit die totale bevolking van 340. Betroubaarheid en geldigheid is verseker deur middel van ‘n loodstudie, en deur gebruik te maak van kenners betreffende verpleegnavorsing, metodologie en statistieke. Data is persoonlik deur die navorser ingesamel. Etiese goedkeuring was verkry vanaf die Universiteit van Stellenbosch en die verskeie gesondheidsowerhede. Ingeligde, skriftelike toestemming is van elke deelnemer verkry. Data is ontleed met die ondersteuning van die statistikus en is uitgedruk in die vorm van frekwensies, tabelle en histogramme. Vergelykings tussen die veranderlikes was gedoen deur gebruik te maak van ANOVA (analise met betrekking tot variansie) en kruis-tabulerings met die Chi-kwadraat toets. 95% Betroubaarheidsinterval is toegepas om te bepaal of daar ‘n assosiasie was tussen die onderskeie veranderlikes. Die analise het getoon dat deelnemers betreffende die hospitale met aparte afdelings N=142 (90%) en die gemengde sale hospitale N=113 (95%) verskil, betreffende die stelling dat daar voldoende personeelgetalle is. Dokumentasie is volgens die analise nie op standaard nie. ‘n Statistiese betekenisvolle korrelasie is verkry met betrekking tot die hospitaal tipe en voldoende tyd betreffende volledige geskrewe dokumentasie (Chi-kwadraat Toets p=0.00). Verpleegbestuur N=13 (100%), geregistreerde verpleegkundiges N=80 (86%), stafverpleegsters N=63 (86%) en verpleegassistente N=81 (83%) het verskil met die stelling dat dit nie nodig is om buite bestek van hul praktyk te werk nie. Die volgende aanbevelings is gemaak: die bepaling van veilige personeel vlakke moet gedoen word; voldoende personeel moet gekwalifiseer word met die nodige vaardighede. Eenheidsbestuurders moet aangestel word waar dit ontbreek; personeelontwikkeling moet moontlik wees en deurlopende oudits van dokumentasie moet plaasvind. Voldoende toerusting en voorraad is nodig om kwaliteit verpleegsorg moontlik te maak. Verdere opleiding in die beginsels van Batho Pele is nodig ten einde effektiewe en doeltreffende implementering daarvan moontlik te maak.

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