“Becoming a Shapeshifter”: Towards Developing Best Practice Guidelines for Arts Therapies Outside of Private Practice in South Africa

The development and evaluation of a nurse anaesthesia model for practice in South Africa

This paper examines what harm reveals about psychoactive power in the arts therapies. A 20-year sample of fitness-to-practise cases brought to the UK statutory regulator (the Health and Care and Professions Council) was examined to establish the prevalence of practitioners who cause harm which was low (0.165%). Transcripts of sanctioned cases were used to construct a grounded theory of how harm is mediated in arts therapies practice. This revealed service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. In arts therapies practice, the arts create powerfully emotionally salient elements to aid therapy which can affect both service user and arts therapists’ attachment systems to fulfil this task. Harm was enacted when the arts therapist used the power of that trust to isolate the relationship and introduce their own needs through arts therapies practices. This increased service user dependency on the arts therapist and further decreased their self-trust resulting in harm. Harm was only possible where the arts therapist’s self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary. Plain language summary This paper examines harm in the arts therapies (art, drama and music therapies as regulated by the Health and Care Professions Council (HCPC)). Harm is understudied but important because it tells us how things can go wrong and also indicates where areas of strong psychoactive power may operate in therapy which can also help people. Arts therapies have been regulated by the HCPC for 20 years and we found there were 77 cases brought against arts therapies practitioners with a total of 16 cases that led to HCPC sanction. We used a grounded theory method of analysis to try to understand how harm was mediated in those harmful arts therapy practices because it is an established form of qualitative research used to construct a theory of social action using examples drawn from real-world examples. We found that service users enter arts therapies with damaged self-trust in the expectation that they can trust the professional. In non-harmful therapy, trust in the professional is then used to boost self-trust in the service user. Within arts therapies, the arts support access to powerful emotions which underpins the building of trust, an element essential to good therapy. However, harm happened when the arts therapist used the power of that trust to isolate the relationship, introduced personal issues and used the service user for their own needs. This increased service user dependency on the arts therapist, detrimentally affecting their sense of self-trust and resulting in harm. Harm was only possible where the arts therapists’ self-reflection failed and they distorted theory to self-justify their actions and refute all feedback to the contrary.

Implementing Best Practice Guidelines in Pain Assessment and Management on a Women's Psychiatric Inpatient Unit: Exploring Patients' Perceptions

The objectives of this study were to: (1) explore pharmacy support staff (PSS) opinions of and attitudes towards the supply of non-prescription medicines (NPMs); (2) assess whether NPM supply is compliant with professional and good practice guidelines. This exploratory study was conducted in community pharmacies in Grampian, Scotland, and comprised non-participant observation of NPM consultations, semi-structured interviews with, and a questionnaire of, PSS. Guideline compliance was assessed by a consensus group of practising community pharmacists. The percentage of consultations which achieved compliance with professional guidelines was calculated. A total score was also calculated for each consultation to assess compliance with good practice guidelines. Fifty-seven support staff from 21 pharmacies participated in at least one component of the study. In total, 195 observed consultations were evaluable. Fifty-four participants completed a questionnaire and 95 post-consultation interviews were completed. Most consultations involved product requests and were for self-treatment. Overall, interviewees were satisfied or very satisfied with 78 (83.0%) and 14 (14.9%) of all consultations, respectively. Participants' self-reported scores for the quality of consultation were high indicating that they perceived their consultations to be appropriate. Most PSS were aware of good practice guidelines and thought their use was important/very important, yet few consultations were fully guideline compliant. Non-product consultations were more guideline compliant than product consultations. Just over one third (35.6%) of consultations established whether other medication was being used by the intended recipient of the NPM. Few PSS (21.2%) had read the professional guidelines and as such, compliance with these guidelines was extremely low. The percentage of guideline compliant consultations were 6.6% (n = 5) (sufficient information gathered), 13.2% (n = 10) (adequate advice/information provision), 46.1% (n = 35) (personal involvement of pharmacist), 21.1% (n = 16) (particular care of specific patient groups) and 28.9% (n = 22) (pharmacist involvement with specific NPMs). Few consultations for NPMs in this study were fully guideline compliant. The reasons for non-compliance with good practice and professional guidelines need to be explored. Although failure to comply with professional guidelines could be due to PSS's lack of awareness, this does not explain non-compliance with good practice guidelines.

Background: Biobanking practice continues to proliferate in South Africa, yet little is known about how stakeholders engage with social, cultural, and religious considerations in this area of research. This study was undertaken to establish the perspectives of South African stakeholders (researchers, biobankers, clinicians, and research committee members) on sociocultural considerations in biobanking research. Methods: This in-depth exploratory study used semistructured face-to-face or Skype interviews with 25 purposively selected stakeholders involved in the biobanking-related practice. The study sample comprised biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee members in South Africa. The interview focused on social and cultural challenges facing the biobanking practice in the country. Further probes included stakeholder perspectives on ownership and custodianship of stored biosamples. Thematic analysis was used to analyze the collected data. Results and Discussion: Several themes arose from the data analysis. These included respondents' perceptions of poor understanding of biobanking among research participants and communities; inconsistency in defining ownership and custodianship of biosamples; variability in respondents' understanding of cultural, religious, and social implications of biobanking; the notion of distrust; and building trust in biobanking. There were also inconsistencies in respondents' recognition of social, cultural, and/or religious influences on participant decision-making in biobanking research. Respondents highlighted that a general climate of distrust existed in the biobanking practice in South Africa. Conclusion: There is a need for greater stakeholder awareness of sociocultural considerations in biobanking practice in South Africa. One possible way to achieve this could be through the availability of training programs aimed at improving stakeholder understanding of the sociocultural context for biobanking practice in addition to greater efforts at community engagement with respect to all biobanking activities and research.

There has been limited scholarly research undertaken to understand child and youth care practice in South Africa. While there have been research studies undertaken on the Isibindi model, the focus on the actual practice of child and youth care workers has been minimal. The Isibindi model was developed to provide child and youth care services to vulnerable children in the context of their families and communities in South Africa. The core components of the Isibindi model focussed on the recruitment, training, and deployment of unemployed women and men in rural communities as paraprofessional or auxiliary level child and youth care workers. The roles of these child and youth care workers were to visit vulnerable families in local communities and provide children and families with a broad range of child and youth care services. The aim of this study was to identify the unique needs of children and their families within different community contexts across South Africa, and to develop a theoretical framework for understanding how child and youth care practice within the Isibindi model responded to these needs. A qualitative research inquiry was used to implement this study, with a grounded theory approach to guide the inquiry and to understand how Isibindi child and youth care workers practised with children and families in South African communities. The samples of child and youth care workers, children and youth, and community members who were selected as research participants came from three provinces in three specific Isibindi projects that demonstrated good practices according to identified criteria (Alice – Eastern Cape, Naas – Mpumalanga, and Hlabisa – KwaZulu-Natal). Three participants from each of the three research samples were interviewed through a semi-structured interviewing process. In addition, focus group discussions were held with the child and youth care workers in the Isibindi projects that were selected. The study presents the process of data analysis that underlies the emergence of the theoretical framework with the grounded theory concepts of theoretical sampling, memoing, coding, and constant comparison being discussed herein. The search for patterns and connections in the data through the constant comparison approach resulted in the identification of the core category and basic social processes in the child and youth care practice. The findings are discussed with the core category of practising intentionally and its unique properties are presented. This is followed by a discussion of the basic social processes, viz. embedding spirit in practice and embedding love in care, encompassing their respective categories. The integrated elements of practice, namely, practising relationally, creating a child rights culture, and championing social justice and equity are also deliberated, along with their particular properties. The thesis concludes with a discussion on the research findings in relation to the weave of the core category practising intentionally through the theoretical framework discovered. The theoretical framework Inhlanganisela: Integrated Patterns of Practice that emerged from the study was one that in Barney Glaser’s (1998: 68) words: “fits, works and is relevant” for practice, education, policy, and further research. Inhlanganisela is an IsiZulu word referring to a “multi-pronged system of activities which results in a web of movements all with differing directions but all aimed at a singular outcome”.

The International Network of Quality Assurance Agencies in Higher Education’s Guidelines of Good Practice by higher education quality assurance agencies need substantial revision before they can be considered adequate by stakeholders in any national higher education system. Various revisions are proposed in this article. But the International Network of Quality Assurance Agencies in Higher Education also argues that adoption of its Guidelines of Good Practice has international significance in that the decisions about higher education quality made by agencies which comply with them can be accepted at face value universally. This conclusion, however, cannot be accepted until the Guidelines of Good Practice are amended to address the processes whereby each agency can become comfortable with the criteria and standards which the others impose in their respective jurisdictions. This article also maintains that, even if the Guidelines of Good Practice were technically perfect, agencies and/or governments ought to subject any proposals for their implementation to the discipline of rigorous risk management processes.

For most complementary and alternative medicine interventions, the absence of a high-quality evidence base to define good practice presents a serious problem for clinicians, educators, and researchers. The Delphi process may offer a pragmatic way to establish good practice guidelines until more rigorous forms of assessment can be undertaken. To use a modified Delphi to develop good practice guidelines for a feasibility study exploring the role of Chinese herbal medicine (CHM) in the treatment of endometriosis. To compare the outcomes from Delphi with data derived from a systematic review of the Chinese language database. An expert group was convened for a three-round Delphi that initially produced key statements relating to the CHM diagnosis and treatment of endometriosis (round 1) and then anonymously rated these on a 1-7 Likert scale (rounds 2 and 3). Statements with a median score of 5 and above were regarded as demonstrating positive group consensus. The differential diagnoses within Chinese Medicine and rating of the clinical value of individual herbs were then contrasted with comparable data from a review of Chinese language reports in the Chinese Biomedical Retrieval System (1978-2002), and China Academy of Traditional Chinese Medicine (1985-2002) databases and the Chinese TCM and magazine literature (1984-2004) databases. Consensus (good practice) guidelines for the CHM treatment of endometriosis relating to common diagnostic patterns, herb selection, dosage, and patient management were produced. The Delphi guidelines demonstrated a high degree of congruence with the information from the Chinese language databases. In the absence of rigorous evidence, Delphi offers a way to synthesize expert knowledge relating to diagnosis, patient management, and herbal selection in the treatment of endometriosis. The limitations of the expert group and the inability of Delphi to capture the subtle nuances of individualized clinical decision-making limit the usefulness of this approach.

BackgroundObjective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation.MethodsA mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.ResultsFew changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice.DiscussionSimilarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations.ConclusionsFindings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role.Electronic supplementary materialThe online version of this article (doi:10.1186/s41077-016-0014-1) contains supplementary material, which is available to authorized users.

ABSTRACTThis article proposes steps to decolonizing art therapy, based on the author's experiences using an Indigenous framework of art therapy developed during her Master's degree at Concordia University. The author also explores ideas of how art therapy can contribute toward reconciliation, inspired by her work with Indigenous communities in Canada. A call to action is proposed to art therapists on an individual level, as well as the profession as a whole, to support the decolonization of art therapy. This includes the development of guidelines for best practice when working with Indigenous populations, through the creation of an Indigenous art therapy circle composed of art therapists who support an ethos of Indigenization.

This paper discusses the theory of financial regulation and practices in countries and South Africa in particular. One of the causes of the global financial crisis (2007-2009) often cited is inadequate or improper regulation and supervision of the financial sector. The global financial crisis revealed inadequacies of extant regulatory systems which arguably had not kept pace with financial innovation. Consequently, all major economies are reforming their regulatory systems in the aftermath. In the UK the Financial Services Authority (FSA) has devised a set of banking regulation while the USA enacted the Dodd-Frank Act to revamp the regulation of financial services. Historically, financial regulation and supervision has been premised on the silo (institutional) approach whereby institutions are regulated according to functional lines. However, in the past two decades many countries in advanced economies adopted a consolidated approach in response to the emergence of financial conglomerates whose regulation could not be adequately handled by the traditional silo approach. South Africa, a middle-income developing country, has had a regulatory and supervisory system that has been driven by the market and international trends. Having started as a institutional approach, it metamorphosed into a functional approach in the late 1980s. Since the 1990s the South African regulatory and supervisory system has had at its heart the central bank regulating the banking sector and a multi-sector regulatory approach for other non-banking financial services. Though the financial sector was largely unscathed by the global financial crisis, South Africa has also moved to reform its regulatory system to embrace the twin peak model in line with trends in related countries.

Microfranchising is one of the new innovative business concepts that has gained traction in the past few years, and which could provide a solution to the challenges faced by micro- entrepreneurs and stimulate the growth of entrepreneurship. Microfranchising has therefore, emerged as a potential strategy meant to rapidly scale-up entrepreneurship behaviour within the Bottom of the Pyramid (BoP). However, despite microfranchising being singled out as a panacea for economic growth globally, very little is known about the microfranchising business concept in South Africa. Resultantly, the latter is ignored from entrepreneurship discussion and discourse at both academic and policy levels. To address this gap, the study assessed microfranchising practices in South Africa, to profile the characteristics of microfranchise businesses in South Africa. The study used the interpretivism research paradigm to achieve the study objectives. Primary and secondary data were employed to collect data on the microfranchising practices in South Africa. Five in-depth interviews were successfully conducted with microfranchisees, while secondary data (microfranchisees’ and microfranchisors’ success stories) was employed to collect data on the former and current practices of microfranchising in South Africa. The collected data was analysed using the ATLAS.ti. The study results show that the microfranchise business exhibits traits of BoP markets, centralised inventory buying, comprehensive training of microfranchisees, decentralised inventory buying, job creation, master microfranchisee, sales orientation, self-reliance of the business, standardisation and adaptation.

Nurses in remote areas of Australia are the primary healthcare professionals, who need to be able to deliver comprehensive and culturally sensitive care to clients, many of whom are Indigenous Australians. Adequate and specific preparation for practice is crucial to the quality of care delivered by remote area nurses (RANs). Objective structured clinical examinations (OSCE) provide an excellent opportunity for student practice in a simulated environment that is safe, authentic, fair and valid when well constructed. Seven integrated best practice guidelines (BPGs), previously developed by project team members to inform OSCEs within educational programs, provided guidance in restructuring the OSCE. This paper provides a detailed analysis of the value of BPGs used in the development, teaching and learning, and evaluation of OSCEs in a rural and remote postgraduate course for RANs. A pre-site visit to the Centre for Remote Health, Alice Springs, Northern Territory, was conducted with modification of the course and previous OSCE according to BPGs. Following delivery of the course and OSCE, evaluations occurred via a mixed method approach. Student surveys (n=15) and focus groups (n=13) and staff interviews (n=5) provided an in-depth analysis of their perceptions of the revised OSCE. Descriptive statistics were used to describe the student sample. The narrative data were transcribed verbatim and analysed using content analysis. Triangulation was achieved with the convergence of the separate data sources focusing on themes and patterns within and between students and tutors. All 15 students and five tutors provided feedback. The majority of student participants had limited experience in working in remote area nursing prior to participation and therefore the opportunities that availed themselves were critical in adequately equipping them with the requisite knowledge, skills and abilities. Three themes emerged from the data: (1) value of common and significant events in OSCE; (2) power of deliberate actions; and (3) learning cultural sensitivity. OSCEs in this setting proved to be a good way for students to learn the skills required by RANs. Overwhelmingly, the modifications using the BPGs were highly valued by students and staff. Three themes emerged and were clearly linked to specific BPGs, indicating the positive impact the BPGs had on the OSCEs and student learning. The authentic content for the scenarios was seen as relevant and motivational for student learning. The practice element of the OSCEs enhanced the learning experience and feedback supported learning. OSCEs developed, taught and assessed using BPGs were highly valued. The BPGs provided an integrated approach with real-life scenarios with a strong cultural perspective - all important features to the RANs' future success in providing individualised care to clients in remote areas of Australia. Further use of BPGs is recommended.

Background: Despite an increasing focus of integrating new knowledge and evidence into practice, implementation of research into practice is still under researched. Less attention has been paid to how nurses perceive the impact and outcomes of participating in Evidence Based Practice (EBP) implementation on themselves, their colleagues, and their patients. EBP is the use of scientific evidence to direct patient care whereas best practice guidelines are tools which guide clinical care to integrate best evidence into practice. Given the importance of EBP implementation linked to better patient outcomes, research is required to understand how nurses perceive being involved in implementation of EBP. This paper provides an overview of a study that was undertaken to explore nurses’ perceptions of being involved in implementing multiple best practice guidelines at one organization. Methods: A two phased qualitative design was employed in this study. The first phase involved interviews and focus groups with 116 nurses. The second phase included a return of findings of the key themes stratified by unit level data with 63 nurses. Data was analyzed using a directed content analysis approach. Results: Four key themes emerged related to nurses’ perceptions associated with implementation of multiple best practice guidelines dataset: having more credibility, being more mindful, increasing collaboration, and enhancing accountability. Conclusions: The evidence derived from this qualitative study contributes to the body of knowledge around EBP and best practice guideline (BPG) implementation. Study findings may be used by nurse leaders in their efforts to ensure learning opportunities focus on equipping new nursing staff and reminding existing nursing staff of the principles of EBP and BPG implementation.

PurposeLandfilling can result in a loss in revenue that would otherwise have been accrued from recycling plastic waste, loss in potential jobs, and groundwater contamination. Plastics in landfills may also eventually find their way into marine environments, where they can be damaging to animals. This work aims to establish the environmental sustainability of current plastic waste management practices in South Africa using the City of Johannesburg (CoJ) as a case study.MethodologyFive scenarios encompassing combinations of landfilling, mechanical recycling, incineration with energy recovery, gasification, and use of plastic waste in a cement kiln were assessed through an environmental Life Cycle Assessment (e-LCA). Scenarios were developed based on an extensive literature review, current practices in South Africa and Europe, and the country’s National Waste Management strategy, which aims to achieve “zero waste to landfill”. SimaPro 9.1.1 software and the Ecoinvent Database were used to assess the life cycle impacts of each scenario over seven impact categories. The ReCiPe endpoint method, Egalitarian version, was employed in determining the impact potentials. A sensitivity analysis was also carried out to evaluate the model’s robustness.Results and discussionOverall, the impact assessment results, including damage assessments and single score results, revealed that moving away from landfilling and combining mechanical recycling, incineration, gasification, and use of plastic waste (PW) as solid refuse fuel in a cement kiln is the least environmentally impactful scenario when managing plastic waste. Landfilling alone was the worst-performing scenario, resulting in adverse effects on human health, ecosystems, and resource depletion. This agrees with the waste hierarchy. On sensitivity analysis, the increase in transportation distances and reduction in market substitution factor in mechanical recycling did not change the ranking of scenarios despite reducing the net benefits to the environment. Including open dumping as an end-of-life scenario significantly increased the negative impact of the current plastic waste management scenario being practised in South Africa, while assuming a 100% mechanical recycling rate had the least environmental impact when compared to the other modelled scenarios.ConclusionsThe current plastic waste management practices in South Africa were found to be environmentally unsustainable based on the modelled scenarios, and a move away from landfilling is encouraged. The outcomes of this study will assist policymakers and other stakeholders in making informed decisions based on scientific evidence when formulating sustainability-related waste management policies.