Browsing by Author "Nicholson, Emerentia Cynthia"

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    Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts
    (Stellenbosch : Stellenbosch University, 2024-12) Nicholson, Emerentia Cynthia; Van der Heever, Mariana; Young, Cornelle; Van der Merwe, Anita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery.
    Background: The exponential ageing of the world population and corresponding care needs indicate a need to plan for the long-term care of older people. With residents in long-term care facilities (LTCFs) having higher acuity levels, the health workforce must comprise adequate and suitable staff appropriately allocated to meet residents' needs despite scarce resources. However, LTCFs find it difficult to maintain adequate staffing levels and provide a skill mix to ensure quality resident care while staying within the framework of the nurses' scope of practice and caregivers' scope of work. This study focused on exploring the implementation of nurse and caregiver staffing models in LTCFs. The aim of the study was to develop a framework to inform staffing models for LTCFs in resource-constrained contexts. Methods: The study was conducted in three phases from a critical realism perspective. Phase 1 included the concurrent completion of a scoping review and holistic multiple-case study. In the scoping review, four databases were searched using specific search terms, and the final sample comprised 20 studies. The holistic multiple-case study included a document review and interviews in one state-subsidised and one private for-profit LTCF in the Cape Metropole, South Africa. Purposive sampling was employed to select 45 documents for review and nineteen participants for semi-structured interviews in the two LTCFs. All the data was analysed through an inductive thematic analysis process. The scoping review and holistic multiple-case study findings were triangulated in Phase 2. In Phase 3, the triangulated data were used to develop a framework to inform staffing models for LTCFs in resource-limited contexts. Seven experts were purposefully selected, and they validated the framework. Findings: More caregivers and fewer nurses were employed in the LTCFs. This led to fewer qualified nurses in the skill mix and shifting tasks to less qualified nurse categories and caregivers beyond their scope of practice and work scope. Consequently, caregivers provided most of the resident care, overburdening ths category. Staff allocation practices did not consider residents’ acuity levels. Thus, residents received the same basic care regardless of needing more skilled care. Managers, nurses, and caregivers seemed oblivious to the legal implications of working beyond a designated scope of practice or job scope or of failing to meet legal staffing requirements. Additional barriers to implementing a staffing model that influenced the nurses’ and caregivers’ wellbeing were overly harsh disciplinary measures, a lack of management support, managers’ verbal communication which suggested bullying, and the absence of staff meetings and in-service training. Conclusion: The LTCFs implemented aspects of the prescribed staffing model by seemingly using a low-cost one. By over-employing caregivers but fewer nurses, vulnerable older persons were often deprived of care provided by more qualified staff and potentially higher-quality care than they were entitled to. This framework provides a roadmap for role players in LTCFs to ensure adherence to legal requirements, balance cost-effectiveness with quality resident care, and facilitate staff wellbeing.
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    Developing a framework to inform staffing models for long-term care facilities in resource-constrained contexts
    (Stellenbosch : Stellenbosch University, 2024-12) Nicholson, Emerentia Cynthia; van der Heever, Mariana; Young, Cornelle; van der Merwe, Anita; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery.
    Background: The exponential ageing of the world population and corresponding care needs indicate a need to plan for the long-term care of older people. With residents in long-term care facilities (LTCFs) having higher acuity levels, the health workforce must comprise adequate and suitable staff appropriately allocated to meet residents' needs despite scarce resources. However, LTCFs find it difficult to maintain adequate staffing levels and provide a skill mix to ensure quality resident care while staying within the framework of the nurses' scope of practice and caregivers' scope of work. This study focused on exploring the implementation of nurse and caregiver staffing models in LTCFs. The aim of the study was to develop a framework to inform staffing models for LTCFs in resource-constrained contexts. Methods: The study was conducted in three phases from a critical realism perspective. Phase 1 included the concurrent completion of a scoping review and holistic multiple-case study. In the scoping review, four databases were searched using specific search terms, and the final sample comprised 20 studies. The holistic multiple-case study included a document review and interviews in one state-subsidised and one private forprofit LTCF in the Cape Metropole, South Africa. Purposive sampling was employed to select 45 documents for review and nineteen participants for semi-structured interviews in the two LTCFs. All the data was analysed through an inductive thematic analysis process. The scoping review and holistic multiple-case study findings were triangulated in Phase 2. In Phase 3, the triangulated data were used to develop a framework to inform staffing models for LTCFs in resource-limited contexts. Seven experts were purposefully selected, and they validated the framework. Findings: More caregivers and fewer nurses were employed in the LTCFs. This led to fewer qualified nurses in the skill mix and shifting tasks to less qualified nurse categories and caregivers beyond their scope of practice and work scope. Consequently, caregivers provided most of the resident care, overburdening this category. Staff allocation practices did not consider residents’ acuity levels. Thus, residents received the same basic care regardless of needing more skilled care. Managers, nurses, and caregivers seemed oblivious to the legal implications of working beyond a designated scope of practice or job scope or of failing to meet legal staffing requirements. Additional barriers to implementing a staffing model that influenced the nurses’ and caregivers’ wellbeing were overly harsh disciplinary measures, a lack of management support, managers’ verbal communication which suggested bullying, and the absence of staff meetings and in-service training. Conclusion: The LTCFs implemented aspects of the prescribed staffing model by seemingly using a low-cost one. By over-employing caregivers but fewer nurses, vulnerable older persons were often deprived of care provided by more qualified staff and potentially higher-quality care than they were entitled to. This framework provides a roadmap for role players in LTCFs to ensure adherence to legal requirements, balance cost-effectiveness with quality resident care, and facilitate staff wellbeing.
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    Factors associated with safe medication administration in specified residential facilities for older persons within the Metro-North, Western Cape Province
    (Stellenbosch : Stellenbosch University, 2021-03) Nicholson, Emerentia Cynthia; Damons, Anneleen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY : Background: With the current population growth, the population is also ageing which leads to more chronic diseases and the elderly receiving multiple medications. In South Africa, the Western Cape Province has the third-largest proportion of elderly persons (Statistics South Africa, 2019). However, limited published research exists on factors associated with safe medication administration in residential facilities for older persons, which attest to the fact that the safety of vulnerable older persons receives little attention. To address this gap in knowledge, the research aimed to determine the factors associated with safe medication administration in specified residential facilities for older persons within the Metro-North, Western Cape Province. Methods: After obtaining ethics approval from The Health Research Ethics Committee of Stellenbosch University (S19/10/252) as well as permission from the residential facilities for older persons, a non-experimental cross-sectional descriptive design was applied, with a quantitative approach. Pre-testing of a self-administered validated questionnaire during a pilot test allowed for modifications to enhance reliability, validity, and appropriateness for the South African context. With the application of a stratified sampling method, 10 funded and 18 private residential facilities for older persons within the Metro-North, Western Cape Provence, were included. Study participants comprised of all three nurse categories, namely Professional nurses (registered nurses) (RNs) n=60 (48.8%), Enrolled nurses (ENs) n=35 (28.5%), and Nursing auxiliary (assistants) (ENAs) n=28 (22.8%). The response rate was n=123 (60.6%) of the total study population of N=203. Descriptive and inferential analyses were performed using the Statistical Package for the Social Sciences Version 27 (SPSS27), with the support of a biostatistician. Results are presented in bar graphs, tables, and figures. Results: The description of the results is according to the components in Donabedian’s Structure-Process-Outcome standards of the Quality of Care Model (2005:691-729). Study results showed that the workforce was mature, with n=34 (27.6%) having more than nine years of work experience. A total of n=43 (35.0%) did not receive medication training in the last five years. Increased workloads n=93 (75.6%) was perceived by participants as the highest source of job pressure. Organisational resources and infrastructures showed constraints in terms of medication storage difficulties, n=56 (45.5%), and blisters in an incorrect order, n=68 (55.3%). Procedures followed by the nurses during medication administration indicated various weaknesses, such as the negation of the performing of thorough checks in favour of administering medications based on assumptions that it would be correct, as n=95 (77.2%) will not check the content of blisters or containers, assuming it was correct. This was despite n=102 (82.9%) of the study participants who did come across incorrect content when administering medications. Furthermore, a witness signature was not required when making amendments to the MARs, n=47 (38.2%). A total of n=5 (4.1%) conceded that they signed the MAR charts before administering the medications. The use of technology was limited, as almost half of the participants did not use computers in the workplace, n=58 (47.2%). Missing of medication altogether was the most predominant medication error encountered in the facilities, n=79 (64.8%). Statistical tests showed a significant correlation between medications administered at the wrong times and interruptions during medication rounds p = <.001. Also, the most common error of medication accountability was not signing for medication administered, n=70 (56.9%). Conclusion: From these study results, it was clear that determining the factors associated with safe medication administration in the residential facilities for older persons could assist with avoiding medication errors among older persons to prevent harm and death. Recommendations regarding the implementation of the prescribed staffing model and increased medication training should be emphasised. A multifaceted approach is advised to address constraints such as bulky medication storage systems and inadequate workflow processes. Facilities should develop and implement risk management strategies to encourage medication error reporting. Also, further research is needed to identify the prevalence of medication errors in residential facilities for older persons. Therefore, the constant review of evidence-based practices can ensure effective ways to provide for the needs of the vulnerable elderly.