Doctoral Degrees (Nursing and Midwifery)

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Browsing Doctoral Degrees (Nursing and Midwifery) by Subject "Medical protocols -- South Africa"

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    The development of validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa
    (Stellenbosch : Stellenbosch University, 2020-03) Gcawu, Luleka Patricia; Stellenberg, Ethelwynn L. (Ethelwynn Linda); Whittaker, Stuart; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing & Midwifery.
    ENGLISH SUMMARY : Introduction: Substandard care resulting in billions of rand pay-outs due to malpractice litigation remains a challenge in nursing practice. Purpose: To develop validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa. Research questions: What are the contributing factors that lead to adverse events in nursing care? What are the validated guidelines that can be developed to contribute to the prevention of malpractice litigation in nursing practice in South Africa? Methodology: The study was conducted in three phases: Phase 1: A retrospective audit of adverse events using a descriptive quantitative design with Pearson Chi-Square test, CI 95%, p ≤ 0.05 was conducted on 203 malpractice litigation cases from the Eastern Cape and Gauteng public healthcare sectors. Phase 2: A comparative statistical analysis was carried out to compare and contrast adverse events - 122 malpractice litigation cases audited by two master’s students in the Western Cape and Gauteng private sector with the phase 1 litigated cases. Phase 3: Nursing practice guidelines were developed using the identified adverse events that contributed to adverse events by applying the WHO guidelines and expert validation using the Delphi method. Results: Phase 1: A key finding - Out of 143 cases admitted to labour wards 135 babies had cerebral palsy in this study. Adverse events contributing factors: • Nursing clinical management (87% of adverse events): Assessment; diagnosis; planning; implementation and evaluation including observations; tests; interpretation and documentation; as well as clinical management. • Behavioural problems (12.3% of adverse events): Not following guidelines (91.6%), non-response to clinical manifestations (79.4%), accumulation of omissions (49.8 %), an accumulation of errors (41.8 %), administering and incorrect treatment (16.0 %). • Organisational and administrative factors Lack of knowledge (28.9 %), organisational (23.7%), system failure (21.5, lack of training (19.4 %) %), lack of supervision (17.5 %) and administrative (6.5%). Phase 2: • A total of 325 trial bundles were audited - 122 by two master’s students in private and 203 in public healthcare by a PhD student. Statistical differences showed that 76.0% of patients’ quality of life were affected (p=0.01). • Statistically, it was shown that patients were more likely to die in the private sector (p=0.01) and more likely to be disabled in the public sector (p=0.01). • No statistical difference was identified in clinical management between private and public healthcare sectors (p= 0.27). • The private healthcare sector was more likely to have adverse events, due to organisational and administrative problems. • The public healthcare sector was more likely to have poor resources with a critical shortage of doctors and nurses. Phase 3: • Guidelines were developed by applying the WHO guideline development process and validated, applying the Delphi method. • One hundred and forty-four guidelines were developed, validated and grouped into Clinical Management, Human Behaviour, and Organisational factors. • National and international experts participated in the validation process. Ethical considerations: Approval was obtained from Stellenbosch University (N16/02/027A). Recommendation: The validated guidelines developed in the study should be further tested and implemented in South Africa to contribute to the prevention of the escalating malpractice litigation in nursing practice.