Healthcare Professionals In South Africa Research Articles

Psychological distress among South African healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has placed immense pressure on healthcare workers (HCWs). This study sought to find the prevalence and factors associated with psychological distress among HCWs in South Africa during the beginning phases of COVID-19 and make relevant recommendations. The survey was administered online through a data-free platform. Data were benchmarked to the national population of over 500 000 healthcare professionals in South Africa. Multiple logistic regressions were used to determine association between psychological distress and potential explanatory variables. A total of 7607 healthcare professionals participated in the study (1760 nurses, 2843 medical practitioners and 3004 other healthcare professionals). Half of the nurses, 41% of medical practitioners and 47% of other healthcare professionals were classified as psychologically distressed. Those who were of older age, provided with well-being support services and having a positive outlook on the healthcare system were significantly less likely to be distressed. Being female medical practitioners and female other healthcare professions, requesting routine counselling, being concerned about not having enough leave and that their life insurance policy did not cover COVID-19 were more likely to be distressed. Psychological well-being of HCWs in South Africa is at risk. We recommend that psychological distress of HCWs be routinely assessed and that routine counselling, well-being support services, appropriate hazardous leave and insurance be provided to all HCWs.Contribution: This study adds to the literature on the psychological distress faced by HCWs in South Africa during COVID-19.

Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study.

Healthcare professionals (workers) are at an increased risk for developing mental and alcohol use disorders (risky drinking) due to increased psychological distress, long working hours, medical litigation, role conflict, and verbal/physical violence from colleagues and patients. Psychological well-being in healthcare workers is crucial to provide the best quality of care to patients. Current data are limited regarding alcohol abuse (risky drinking) rates and mental health condition among healthcare professionals in South Africa. To describe the prevalence and correlates of alcohol use disorder (risky drinking), depression, anxiety, suicidality, and covid anxiety during the coronavirus pandemic in healthcare professionals in West Rand District, Johannesburg, South Africa. We carried out a cross-sectional study on a sample of healthcare professionals including doctors, nurses, clinical associates, and dentists working in the West Rand District of Gauteng, South Africa, during Covid-19 pandemic. Participants were invited to complete a paper-based questionnaire addressing sociodemographic questions, a set of measures for alcohol use disorder (AUDIT-C), depression (PHQ-2), anxiety (GAD-7), suicidality (PSS-3), covid anxiety (CAS), and awareness and utilization of support services. A total of 330 healthcare professionals (60.9% nurses, 33% doctors, 5.5% other) participated. Females comprised the majority of study participants with 78.8%, and 48.2% of the participants were in the age band 35-64 years. Overall, 20.9% of the healthcare professionals reported risky alcohol use. Females were 73% less likely to report risky alcohol use (AOR = 0.27;95% CI: 0.13-0.54). Prevalence of probable depression was 13.6% and female professionals were 5 times more likely to be classified as having probable depression (AOR = 4.86;95% CI: 1.08-21.90). The grouped prevalence of anxiety ranging from mild to severe was reported at 47.3%, female professionals were 3 times more likely to be classified as having anxiety disorder (AOR = 2.78;95% CI: 1.39-5.57). Furthermore, races other than African had higher rates of anxiety (AOR = 2.54; 95% CI: 1.00-6.42). The prevalence of suicide symptoms was 7.9% and that of covid dysfunctional anxiety 4.8%. Only 5% of participants were involved in an employee wellness program, with 60% expressing interest in joining one. Alcohol use (risky drinking) and mental disorders were common among healthcare professionals in West Rand District, Johannesburg, South Africa. There is overall poor awareness and use of support structures highlighting urgent need for interventions. Future studies could also explore in-depth the drivers of mental disorders and lack of utilization of the available service and strategies to deliver alcohol and mental disorder screening, brief intervention, and referral to treatment.

Exploring the experiences of healthcare professionals in South Africa and Uganda around communicating with children about life-threatening conditions: a workshop-based qualitative study to inform the adaptation of communication frameworks for use in these settings

ObjectivesThis study aimed to explore how published communication frameworks could be amended to ensure applicability and cultural appropriateness for professionals to support family-centred conversations by investigating’ healthcare professionals’ (1) experiences...

A Comparison of Job Satisfaction Levels Among South African Public Healthcare Professionals

The purpose of this study was to determine levels of job satisfaction among healthcare professionals in South Africa. Self-administered questionnaires were distributed through email, and by hand, to a sample of pharmacists, nurses, and doctors across the country. The study found that the majority of the doctors, nurses and pharmacists were not satisfied with their jobs. There was also a significant difference between nurses and pharmacists regarding overall job satisfaction but not between doctors and pharmacists / nurses. It is recommended that working conditions of healthcare professionals in South Africa be improved.
 
 Received: 3 July 2021 / Accepted: 22 February 2022 / Published: 5 March 2022

COVID-19: 'A pandemic of the unvaccinated'? - compassion fatigue among healthcare professionals in South Africa

COVID-19: 'A pandemic of the unvaccinated'? - compassion fatigue among healthcare professionals in South Africa

Awareness of genetic counseling services among allied healthcare professionals in South Africa.

Genetic counseling has been shown to increase patient empowerment leading to positive outcomes. However, in the Johannesburg state healthcare system, the genetic counseling service is underutilized. Individuals with genetic disorders present with a variety of symptoms and are frequently referred to allied healthcare professionals for management; therefore, these professionals are in a unique position to identify appropriate patients and refer them for genetic counseling. This study aimed to determine whether allied health professionals, including physiotherapists, occupational therapists, and speech and language therapists, were aware of genetic counseling services in Johannesburg, South Africa, and whether they had previously referred patients to these services. The study also aimed to identify barriers and facilitators to referral. An adapted paper-copy questionnaire was administered to allied health professionals working at one of three state hospitals in Johannesburg. A total of 57 participants were included in this study. Results indicated that 29/57 (50.9%) of allied health professionals knew that genetic counseling services were available but only 15/29 (51.7%) of those who knew of the service had referred patients to these services in the last year. Barriers to referral included misconceptions about the role of genetic counselors, insufficient knowledge of which patients would benefit from genetic counseling, and being unable to obtain appropriate information from the Genetics Clinic for patient referral. However, allied health professionals recognized the benefit of genetic counseling and 53/57 (93%) wanted to increase their genetics knowledge. Therefore, genetics education of allied health professionals, and improved information regarding the referral procedure for genetic counseling, may improve the number of patients referred.

Critical care triaging in the shadow of COVID-19: Ethics considerations

Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.

Using Free Open Access Medical Education (FOAMed) for Emergency Medical Service education

Background: Continuous professional development (CPD) is a registration requirement for all healthcare professionals in South Africa. The shift-driven work environment of emergency and critical care providers often means it is logistically impractical to attend CPD events. FOAMed and online learning could make CPD activities more accessible. The aim of the study was to determine to what extent available FOAMed resources could be used to supplement the outcomes for successful completion of a CPD course. Methods: A retrospective content analysis was used to review FOAMed resources posted within a two-month period for their ability to cover outcomes of the Ambulance Emergency Assistant (AEA) refresher course (a CPD course). Data were subject to a three-step process of content analysis that was matched to 17 identified course outcomes (themes). Results: A total of 441 FOAMed posts were reviewed during a two-month period. Of the 441 posts, 269 (61%) were excluded, and 172 (39%) FOAMed posts were determined relevant to cover the 17 identified themes of the AEA refresher course. The two most frequently observed themes were related to (i) professionalism, with 45 (26.2%) posts, and (ii) other general medical emergencies, with 39 (22.7%) posts. The remaining 15 themes had 88 (51.1%) posts distributed between them. Conclusion: The study highlights the potential of FOAMed resources to supplement the delivery of education, such as a CPD course. Given that the outcomes were unequally represented, educational institutions should be aware that despite the value of FOAMed, due caution must be given to the critiques and limitations of this educational approach.

The socioeconomic impact of rural-origin graduates working as healthcare professionals in South Africa

Background: Studies documenting the socioeconomic impact of education leading to employment of rural youth, specifically in the healthcare professions, are lacking. The Umthombo Youth Development Foundation (UYDF) is an NGO that provides financial support for rural students to train as healthcare professionals (HCPs) as a way of addressing staff shortages at rural hospitals. The aim of this study was to understand the social and economic impact on individuals and their families of qualifying as an HCP and being employed at a rural district hospitalMethodology: A mixed methodology was used to collect data from 40 graduates at eight district hospitals in rural KwaZulu-Natal province. The research tools had qualitative and quantitative questions, with additional data being extracted from the UYDF database. The qualitative data were analysed thematically, with STATA software being used for the quantitative analysis.Results: The findings indicate that graduate household assets increased significantly, as did their socioeconomic circumstances, compared with before they qualified as HCPs. Graduates attached high value to education that led to their employment, which provided them with money to afford assets. Having a permanent job and regular income also transformed their families’ lives, as they were able to care for their siblings and extended family members.Conclusions: Training rural youth for employment in scarce skills that leads to employment, such as a career in the health sciences, boosts their socioeconomic circumstances and that of their families. This contributes to the staffing of rural hospitals, job creation and the economic development of the country.

Sensory processing disorder: Perceptions on the clinical role of advanced psychiatric nurses

BackgroundNo description of the clinical role of the advanced psychiatric nurse in the management of children with sensory processing disorder could be found for the South African context. This is a loss in clinical nursing practice with regard to diagnosis, treatment and research.AimTo explore and clarify the perceptions of healthcare professionals in South Africa on the clinical role of the advanced psychiatric nurse in sensory processing disorder to provide a description of this role.SettingThe research was conducted by inviting registered healthcare professionals practicing in South Africa to complete several rounds of an on-line survey.MethodsAn explorative and descriptive design was used. Purposive sampling was used to identify an initial sample of healthcare professionals, followed by snowball sampling. The Delphi technique was implemented with three sequential rounds, gathering data on the perceptions of the healthcare professionals regarding the clinical role of the advanced psychiatric nurse in sensory processing disorder.ResultsThe following main themes crystallised from the data – (1) Specialised training of the advanced psychiatric nurse (APN) on sensory processing disorder; (2) Interventions carried out by the APN with regard to sensory processing disorder; (3) Adequate support to the family with regard to sensory processing disorder; and (4) Referral of a child with sensory processing disorder.ConclusionThe study indicates that the healthcare professionals who are experts in delivering healthcare to children with sensory processing disorder agree that the APN with additional training in this condition has a clinical role to play in rendering healthcare to these healthcare users. A preliminary clinical role description could be formulated. Recommendations for nursing practice, nursing education and further research were formulated.

The socioeconomic impact of rural-origin graduates working as healthcare professionals in South Africa

Background: Studies documenting the socioeconomic impact of education leading to employment of rural youth, specifically in the healthcare professions, are lacking. The Umthombo Youth Development Foundation (UYDF) is an NGO that provides financial support for rural students to train as healthcare professionals (HCPs) as a way of addressing staff shortages at rural hospitals. The aim of this study was to understand the social and economic impact on individuals and their families of qualifying as an HCP and being employed at a rural district hospitalMethodology: A mixed methodology was used to collect data from 40 graduates at eight district hospitals in rural KwaZulu-Natal province. The research tools had qualitative and quantitative questions, with additional data being extracted from the UYDF database. The qualitative data were analysed thematically, with STATA software being used for the quantitative analysis.Results: The findings indicate that graduate household assets increased significantly, as did their socioeconomic circumstances, compared with before they qualified as HCPs. Graduates attached high value to education that led to their employment, which provided them with money to afford assets. Having a permanent job and regular income also transformed their families’ lives, as they were able to care for their siblings and extended family members.Conclusions: Training rural youth for employment in scarce skills that leads to employment, such as a career in the health sciences, boosts their socioeconomic circumstances and that of their families. This contributes to the staffing of rural hospitals, job creation and the economic development of the country.

‘Mental capacity’, ‘sufficient maturity’, and ‘capable of understanding’ in relation to children: how should health professionals interpret these terms?

South Africa’s Children’s Act 38 of 2005 requires health professionals to determine whether a child possesses ‘sufficient maturity’ and ‘mental capacity’ to make decisions about themselves in relation to surgery, treatment, and HIV testing. Similarly, the National Health Act 61 of 2003 requires a child to be ‘capable of understanding’ to provide informed consent in research. However, neither the Children’s Act nor the National Health Act defines these terms. Moreover, there is no common definition of ‘sufficient maturity’ among healthcare professionals in South Africa. Appreciating how foreign law interprets ‘mental capacity’ and how different healthcare professionals evaluate ‘maturity’ could prove illuminative in respect to how these terms could be interpreted by health professionals in South Africa, and elsewhere.

Seven year overview (2007—2013) of ethical transgressions by registered healthcare professionals in South Africa

A move has taken place internationally in the delivery and “consumption” of health care where if clients and patients (health care consumers) hold the opinion that the health care professionals/providers' behaviour has had a negative effect, impact or outcome on them, they may lodge a complaint with the relevant health professional regulatory body. Ethical transgressions of health care providers can generally be clustered into the following three categories: a) Competence and conduct with clients (e.g. abandonment, sexual intimacies, dishonesty, disclosure of information); b) Business practices (e.g. billing, reports, documentation); and c) Professional practice (e.g. referral upon termination, obtaining appropriate potential employment opportunities, nonprofessional relationships).The primary objective of this study was to analyse the ethical transgressions of registered members of the twelve professional boards in the Health Professions Council of South Africa (HPCSA) in the period 2007 to 2013. A mixed methods approach was followed in this study which specifically focused on a historical research approach. The results indicate that the boards with the highest number of transgressions per the registered practitioners were firstly the Medical and Dental practitioners, closely followed by the Optometry and Dispensing Opticians Board. The predominantly complaint made against members of both these boards was for fraudulent conduct (collectively totalling to 85% of all fraudulent cases during the period) and included actions such as charging for non-rendered services, issuing false statements and submitting fraudulent medical aid claims. Cognisance needs to be taken that the South African public will increasingly demand better services and that since they are being better informed via the media of their rights and have access to a broader database of knowledge (rightly or wrongly so the internet) practitioners' opinions will not necessarily be accepted outright and that they (the public) will challenge it accordingly. This raises the concern that practitioners need to take on the responsibility to communicate with their patients/clients in order to educate them and keep them informed.

Seven year overview (2007–2013) of ethical transgressions by registered healthcare professionals in South Africa

A move has taken place internationally in the delivery and “consumption” of health care where if clients and patients (health care consumers) hold the opinion that the health care professionals/providers' behaviour has had a negative effect, impact or outcome on them, they may lodge a complaint with the relevant health professional regulatory body. Ethical transgressions of health care providers can generally be clustered into the following three categories: a) Competence and conduct with clients (e.g. abandonment, sexual intimacies, dishonesty, disclosure of information); b) Business practices (e.g. billing, reports, documentation); and c) Professional practice (e.g. referral upon termination, obtaining appropriate potential employment opportunities, nonprofessional relationships).The primary objective of this study was to analyse the ethical transgressions of registered members of the twelve professional boards in the Health Professions Council of South Africa (HPCSA) in the period 2007 to 2013. A mixed methods approach was followed in this study which specifically focused on a historical research approach.The results indicate that the boards with the highest number of transgressions per the registered practitioners were firstly the Medical and Dental practitioners, closely followed by the Optometry and Dispensing Opticians Board. The predominantly complaint made against members of both these boards was for fraudulent conduct (collectively totalling to 85% of all fraudulent cases during the period) and included actions such as charging for non-rendered services, issuing false statements and submitting fraudulent medical aid claims.Cognisance needs to be taken that the South African public will increasingly demand better services and that since they are being better informed via the media of their rights and have access to a broader database of knowledge (rightly or wrongly so the internet) practitioners' opinions will not necessarily be accepted outright and that they (the public) will challenge it accordingly. This raises the concern that practitioners need to take on the responsibility to communicate with their patients/clients in order to educate them and keep them informed.

"Because I want to be informed, to be part of the decision-making": Patients' insights on informed consent practices by healthcare professionals in South Africa.

Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language patients understand based their literacy level. This study reports an empirical study on patients' perceptions of IC as practiced by doctors and nurses in South Africa. A cross-sectional study, using a bilingual semi-structured questionnaire was conducted among patients attending randomly selected public hospitals in eThekwini Metropolitan Municipality (Durban), KwaZulu-Natal province. Competent patients or legal surrogates were eligible for inclusion. IC was obtained from all participants. Four hundred and four participants completed questionnaires of which 68% were female. The median age of participants was 35 years (range 11-91 years). Most respondents spoke IsiZulu (55%), were single (56%), unemployed (66%), and with secondary school education (69%). Patients were generally informed about the diagnosis (81%), risks (57%), and benefits of treatment (61%). Few were informed about treatment options (41%), recommended treatment (28%), and right of refusal (25%). IC was obtained verbally in 73% of cases. Patients favored disclosure of all material risks (78%) and few consulted surrogates before decision-making (76%). There was an association between participant's age and knowledge of the age of consent (P = 0.005). Most patients were satisfied with information disclosed (91%) and did not feel coerced. Some were afraid to ask questions for fear of losing free treatment (8%). This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.

Development of a diabetes mellitus nutritional management manual for South African healthcare professionals

Background: The objective was to develop a standardised education manual for healthcare professionals in South Africa on the nutritional management of diabetes mellitus.Method: The manual was developed using seven steps: needs assessment and problem definition, a literature search, the first draft of the manual, peer review, the second draft of the manual, expert panel evaluation and the final manual.Results: Following the literature search, the first draft of the manual was developed and sent for peer review and language editing. Recommended changes were made and the second draft was developed and sent to 77 dietitians, of whom the majority were satisfied with the content, which led to the final manual.Conclusion: A diabetes mellitus nutritional management manual for healthcare professionals in South Africa was developed using a systematic approach using peer review and expert panels. The next step will be to evaluate its impact on the knowledge of healthcare professionals.

Providing truly patient-centred care: Harnessing the pragmatic power of interpreters

In order to achieve the aims set out in South Africa’s National Policy on Quality in Health Care (2007:4), the gap between standards and actual practice must be measured, reduced, and ultimately, eradicated. One of the most obvious gaps in our health service is the failure to ensure that patients and healthcare professionals understand each other. Without successful communication, the provision of quality patient-centred care will always hang in the balance. Healthcare professionals in South Africa have to improvise when treating patients who do not speak their language – generally by using ad-hoc interpreters, who may be nurses, refugees, family members, or even children. A number of studies (Cambridge 1999, Meyer et al. 2003, Penn 2007) have found that using ad-hoc interpreters to overcome language barriers is often problematic. In this article, a specific intervention is described which takes the form of a professional development workshop for counsellors and community workers working with refugees, aimed at reaching a better understanding of how to work with interpreters. An ad-hoc interpreter participated in a role play with a therapist and refugee client, and was then substituted by a professional liaison interpreter. The workshop participants (who could not understand French or Lingala, the languages spoken by the refugee client and the refugee interpreter) commented on the differences between the two interpreters’ performances and their impressions of the power dynamics between participants, caused in part by factors such as positioning and eye gaze. The researcher then conducted a conversation analysis to supplement these findings. Aspects considered include the effect of procedural factors (control of turn length, attribution of roles and briefing of participants, use of the first person, memory management and overload) as well as linguistic aspects of the communication flow. The analysis indicated that it was the ad-hoc refugee interpreter’s lack of knowledge regarding the procedural aspects of the interpreting process that impacted most on the communication flow, rather than any possible transference or re-telling of her own story, as has previously been indicated in the literature. The trained interpreter’s linguistic knowledge and awareness of procedural aspects led to smoother communication between participants. It is recommended that interpreters in therapeutic contexts be trained to participate as active co-participants so that they may control turn duration, be aware of role attribution and positioning, and extend their memories to enable them to interpret accurately in the long consecutive mode.

Recommendations for the establishment of a clinical simulation unit to train South African medical students

Background. The burden of HIV and tuberculosis epidemics in South Africa (SA), Africa and developing countries in other parts of the world has an influence on the change in case mix. Shortages of beds in training hospitals and the need to train more healthcare professionals contribute to the saturation of the teaching platform. Clinical simulation as a tool to enhance the education and training of medical students in SA and recommendations in this regard were investigated. Objective. To obtain recommendations regarding the development of simulation training, assessment facilities and programmes, and determine whether simulation training could enhance medical education and training in the developing world. Methods. Qualitative research methods, including semi-structured interviews with international simulation experts and focus group interviews with heads of department and lecturers of the local medical school, were used to generate data. Results. A set of recommendations regarding the introduction of simulation training at an SA medical school was developed to improve patient safety, create a better training environment, and address the healthcare education challenges in SA hospitals. Conclusion. The incorporation of simulation into medical curricula and the development of clinical simulation training facilities for healthcare professionals in SA could bridge the gap currently experienced in health sciences education in the country. The recommendations outlined in our study may assist other medical training institutions in the developing world in setting up simulation training facilities.

Mandatory reporting of child abuse in South Africa: Legislation explored.

Legislation concerning mandatory reporting of child abuse in South Africa has been in effect since 2010, with the promulgation of amendment 41 of 2007 to the Children's Act of 2005. This article explores mandatory reporting legislation in an attempt to improve the reporting practices of healthcare professionals in South Africa.

Urban food insecurity: A neglected public health challenge

Our current way of eating makes us ill, divides us, and harms our planet. The health burden of our current diet is considerable, and there is increasing evidence that it is not environmentally or socially sustainable. Yet food and nutrition continue to receive little attention in health policy and professional training, locally and internationally. This is particularly true when the urban scale is considered. National food security and nutrition policy focuses disproportionately on rural populations. We argue that a revitalised public health agenda focusing on the conditions that shape what we eat would have significant benefits for current and future generations of South Africans. This has implications for how we educate the future generation of medical and healthcare professionals in South Africa (SA).