Rural Public Hospitals Research Articles

Carbapenemase-producing enterobacterales colonisation status does not lead to more frequent admissions: a linked patient study

BackgroundHospitals in any given region can be considered as part of a network, where facilities are connected to one another – and hospital pathogens potentially spread – through the movement of patients between them. We sought to describe the hospital admission patterns of patients known to be colonised with carbapenemase-producing Enterobacterales (CPE), and compare them with CPE-negative patient cohorts, matched on comorbidity information.MethodsWe performed a linkage study in Victoria, Australia, including datasets with notifiable diseases (CPE notifications) and hospital admissions (admission dates and diagnostic codes) for the period 2011 to 2020. Where the CPE notification date occurred during a hospital admission for the same patient, we identified this as the ‘index admission’. We determined the number of distinct health services each patient was admitted to, and time to first admission to a different health service. We compared CPE-positive patients with four cohorts of CPE-negative patients, sampled based on different matching criteria.ResultsOf 528 unique patients who had CPE detected during a hospital admission, 222 (42%) were subsequently admitted to a different health service during the study period. Among these patients, CPE diagnosis tended to occur during admission to a metropolitan public hospital (86%, 190/222), whereas there was a greater number of metropolitan private (23%, 52/222) and rural public (18%, 39/222) hospitals for the subsequent admission. Median time to next admission was 4 days (IQR, 0–75 days). Admission patterns for CPE-positive patients was similar to the cohort of CPE-negative patients matched on index admission, time period, and age-adjusted Charlson comorbidity index.ConclusionsMovement of CPE-positive patients between health services is not a rare event. While the most common movement is from one public metropolitan health service to another, there is also a trend for movement from metropolitan public hospitals into private and rural hospitals. After accounting for clinical comorbidities, CPE colonisation status does not appear to impact on hospital admission frequency or timing. These findings support the potential utility of a centralised notification and outbreak management system for CPE positive patients.

Exploring a lower carbon future: recycling opportunities in a rural public hospital in Queensland, Australia

This case study investigated waste management in a small, rural, Queensland hospital identifying areas where staff could reduce CO2e within the context of what is logistically possible. Phase I captured waste streams and disposal data for 1 May 2022–31 May 23 in a 20-bed Queensland Health hospital and included three audits of the hospital’s pharmaceutical waste bin. Phase II comprised semi-structured interviews with seven staff. Most potentially recyclable waste was being disposed of in the clinical, pharmaceutical, and general waste streams. All participants were interested in recycling more if appropriate bins were accessible in their work and lunch areas and recycling education was provided. Between 1 May 2022 and 31 May 2023, the CO2e were 44.53t, which equates to approximately 48,327 car km. This study identified opportunities for hospital-wide recycling which would reduce CO2e, waste collection fees, and landfill volume. A limitation was the small number of interviewees due to rural workforce shortages and a COVID-19 outbreak.

Patient Satisfaction With Dental Services.

Patient satisfaction is an integral aspect of healthcare quality assessment, and it plays a crucial role in evaluating the effectiveness of healthcare services. This systematic review investigates patient satisfaction with dental services provided by public dental hospitals in rural and remote areas of Saudi Arabia. The study conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards. It involved a comprehensive search across multiple databases, including Medline, Cochrane, Embase, and CINAHL, with tailored search strategies for each database using MeSH terms and keywords. To ensure inclusivity, the search covered publications in both English and Arabic and included Google Scholar for gray literature. Inclusion criteria focused on empirical studies conducted in rural and remote public hospitals in Saudi Arabia, published between 2013 and January 2023, assessing patient satisfaction in oral or dental care for adult patients. Data screening and extraction followed a rigorous two-step process, and a narrative synthesis was used to analyze and summarize the findings. The findings reveal a complex landscape of patient satisfaction in these settings, with varying levels of contentment reported. While more than 50% of patients expressed satisfaction with the quality of dental care, significant challenges related to accessibility were evident. Patients residing in remote and rural areas often had to travel long distances to access dental clinics, resulting in dissatisfaction. Demographic factors, particularly education and age, were identified as significant influencers of patient satisfaction, with more educated individuals tending to be less satisfied. This study emphasizes the importance of continuous monitoring of patient satisfaction to enhance service delivery, particularly in public dental clinics serving remote and rural areas. Addressing issues related to access, availability, clinical quality, and effective communication is vital for improving patient satisfaction in these healthcare settings. The study concludes with recommendations for policymakers, including the development of quality assurance policies, cost mitigation strategies, and targeted interventions to address demographic disparities and enhance patient satisfaction with dental care services.

The crisis of maternal and child health in Afghanistan

BackgroundThe Taliban takeover in August 2021 brought global economic sanctions, economic collapse, and draconian restrictions on women’s freedom of movement, work, political participation, and education. This study examined Afghan health workers’ experiences and perceptions of availability and quality of maternal and child health care since then.MethodsWe conducted a survey, using a convenience sample, of health workers from urban, semi-rural, and rural public and private clinics and hospitals across the 34 provinces, covering changes in working conditions, safety, health care access and quality, maternal and infant mortality as well as perceptions about the future of maternal and child health and health care. Interviews were conducted with a subsample of health workers to further explore their perceptions of changes in working conditions, quality of care, and health outcomes since the Taliban takeover.Results131 Afghan practicing health care workers completed the survey. The majority were women (80%) working in facilities located in urban areas. Most female health workers (73.3%) reported that they have not always been safe when going to and from work; 81% because of harassment by the Taliban when they did not have male accompaniment. Almost half of the respondents (42.9%) reported a decrease in availability of maternal and child care and 43.8% stated that conditions for providing care were “worse” or “much worse” than before. Almost one-third (30.2%) indicated that changed working conditions negatively impacted their ability to provide quality care, and 26.2% reported an increase in obstetric and newborn complications. Health workers also reported (38.1% )an increase in sick child needs and an increase in child malnutrition (57.1%0. 57.1% reported decreases in work attendance and 78.6% a decrease in morale and motivation. Qualitative interviews (n = 10) of a subsample of survey participants expanded on these findings.ConclusionThe combination of economic collapse, lack of sustained donor support for health care and Taliban interference with human rights has severely compromised access and quality of maternal and child health care. Strong and concerted international pressure on the Taliban to respect women and children rights to essential health service is critical for the future of the Afghan population.

Experiences of public-private contracting for caesarean delivery in rural district public hospitals: A qualitative interview study.

Governments in sub-Saharan Africa are exploring public-private-engagements for the delivery of health services. While there is existing empirical literature on public-private-engagements in high-income countries, we know much less about their operation in low and middle-income countries. Obstetric services are a priority area where the private sector can make an important contribution in terms of skilled providers. The objective of this study was to describe the experiences of managers and generalist medical officers, of private general practitioner (GP) contracting for caesarean deliveries in five rural district hospitals in the Western Cape, South Africa. A regional hospital was also included to explore perceptions of public-private contracting needs amongst obstetric specialists. Between April 2021 and March 2022, we conducted 26 semi-structured interviews with district managers (n = 4), public sector medical officers (n = 8), an obstetrician in a regional hospital (1), a regional hospital manager (1) and private GPs (n = 12) with public service contracts. Thematic content analysis using an inductive, iterative approach was applied. Interviews with medical officers and managers revealed justifications for entering into these partnerships, including retention of medical practitioners with anaesthetic and surgical skills and economic considerations in staffing small rural hospitals. The arrangements held benefits for the public sector in terms of bringing in required skills and having after hours cover; and for the contracted private GPs who could supplement their income, maintain their surgical and anaesthetic skills and keep up to date with clinical protocols from visiting specialists. The arrangements held benefits for both the public sector and the contracted private GPs and were deemed to be an example of how national health insurance could be operationalised for rural contexts. Perspectives of a specialist and manager from a regional hospital provided insight into the need for different public-private solutions for this level of care in which contracting out of elective obstetric services should be considered. The sustainability of any GP contracting arrangement, such as described in this paper, will require ensuring that medical education programmes include basic surgical and anaesthetic skills training so that GPs opening practice in rural areas have the required skills to provide these services for district hospitals where needed.

Utilisation of private general practitioners to provide caesarean deliveries in five rural district public hospitals in South Africa: a mixed-methods study

ObjectiveResearching how public–private engagements may promote universal access to safe obstetric care including caesarean delivery is essential. The aim of this research was to document the utilisation of private general...

Understanding the contribution of general medical services to acute inpatient care in Victorian public hospitals.

General medicine is an integral part of health services, yet there is little data highlighting their contribution to acute hospital care in Australia. To utilise the Victorian Department of Health's administrative dataset for hospital admissions to evaluate the relative contribution and trends over time of general medical services to acute multiday inpatient hospital separations in the Victorian public healthcare system. A retrospective time-series study of general medical activity compared to other major specialties using hospital-level data provided by the Department of Health: (i) extrapolation from diagnosis-related group (DRG) activity data (2011-2021) and, (ii) directly reported discharge unit-based activity (available from 2018). Acute multiday separations of all patients aged ≥18 years from all metropolitan and rural Victorian public hospitals were included. Using the DRG-based data, general medicine ranked as the largest care provider of all specialties studied, accounting for 12.1% of separations. Despite the largest increase at a rate of 2831 separations/year (0.336%/year of total, P< 0.001) compared to others, mean length of stay declined by 0.08 days/year (P< 0.001). These findings were significant for metropolitan and rural hospitals. The use of directly reported discharge unit-based data also ranked general medicine as the largest care provider accounting for 32.9% of total separations, with rural hospital general medical services contributing nearly 50% of all multiday separations. Both DRG-based data and discharge unit-based data indicate that general medicine is the largest provider of acute multiday inpatient care in Victorian hospitals. The estimate of contribution of general medicine differed between the two datasets as DRG data likely over-represents the role of other specialties possibly due to assumptions regarding specialty management of varying groups of diagnoses.

Job satisfaction among small rural hospital nurses: A cross-sectional study.

To explore the relationships between job satisfaction, community satisfaction, practice environment, burnout, and intention to leave of nurses working in Australian small rural hospitals. A national cross-sectional survey of 383 nurses from Australian rural public hospitals of less than 99 beds during 2018. Job satisfaction was measured on a four-point Likert scale. Factors associated with community satisfaction, practice environment, burnout and intention to leave were analyzed using multiple linear regression to explore the predictors of job satisfaction. Overall job satisfaction was positive, with most nurses moderately (n=146, 38.1%) or very satisfied (n=107, 27.9%) with their current job. Emotional exhaustion, nurse manager ability, leadership and support of nurses were the most significant predictors of job satisfaction. This study provides new insight into the factors impacting the job satisfaction of nurses working in rural hospitals. The knowledge gained is important to inform strategies to retain nurses in rural areas and, in turn, ensure rural communities have access to quality health care. The impact of nurses' job satisfaction on burnout, patient safety, and intention to leave is well recognized; however, there is limited understanding of job satisfaction in a rural hospital context. This study provides an understanding of the factors that impact job satisfaction of nurses working in small rural hospitals and highlights the importance of improving the practice environment to reduce the high attrition rates of this workforce.

Estimating technology characteristics of the U.S. hospital industry using directional distance functions with optimal directions

The use of the directional distance function (DDF) in empirical studies has steadily increased over the past decade due to its general representation of a production technology. The DDF is particularly useful in health economics as a tool for modeling the hospital technology. Choosing the direction when modeling technology with the DDF is a crucial, albeit not fully resolved, issue that has important ramifications. We first address the choice of direction by using a recently proposed approach for endogenizing the DDF’s direction vector and then extend it by imposing regularity conditions on the technology. We apply this framework to a sample of U.S. hospitals and obtain their technology characteristics after grouping them into several distinct categories. We find that publicly owned non-teaching hospitals face substantial opportunity costs of inpatient care – hundreds of outpatient visits must be forgone for each additional admission. This information can help these hospitals forecast the adjustment in outpatient capacity needed to achieve a desired level of inpatient activity. We also find that while urban-area teaching hospitals can substitute approximately two nurses per bed at the frontier of technology, the rate of substitution is less than one nurse per bed at public non-teaching hospitals as well as at all rural-area hospitals. Information on the technological trade off between beds and nurses is helpful to hospital administrators and policy makers as nursing shortages intensify and staffing requirements continue to be debated. In addition, we demonstrate that rural public hospitals, which heavily rely on licensed practical nurses (LPNs) to staff their beds, are the only hospitals that can meaningfully substitute LPNs for the other inputs, replacing each bed and each registered nurse with medians of 17 and 23 LPNs, respectively.

A comparison of malaria prevention behaviours, care-seeking practices and barriers between malaria at-risk worksite migrant workers and villagers in Northern Shan State, Myanmar—a mixed method study

BackgroundMigrant populations are at an increased risk of exposure to malaria due to their nature of work and seasonal migration. This study aimed to compare malaria prevention behaviours and care-seeking practices among worksite migrant workers and villagers in the malaria-at-risk areas of Eastern Myanmar close to the China border.MethodsA mixed method study was conducted in March 2019. The malaria-at-risk worksites in the four targeted townships, and villages located the nearest to these worksites were approached. Key stakeholders, such as worksite managers and village leaders, were interviewed.ResultsA total of 23 worksites, which employed 880 migrants and 447 locals, and 20 villages, which were homes for 621 migrants and 9731 locals, were successfully interviewed. Regarding malaria prevention behaviours, sleeping under a bed net was common among both worksites (74%) and villages (85%). In contrast, insecticide-treated nets/long-lasting insecticidal nets (ITN/LLIN) usage was much lower in the worksites than in the villages (39% vs 80%). Regarding care-seeking practices for febrile illness, self-medication was a popular choice for both worksite workers and villagers owing to the easy availability of western medicine. Moreover, local-belief-driven traditional practices were more common among villagers. For occasions in which fever was not relieved, both would seek health care from rural health centres, private clinics, or public hospitals. As for barriers, villagers mostly cited language barriers, which often lead to misunderstanding between health providers and them. In contrast, most of the worksites cited logistics issues as they were in remote areas with devastated road conditions and the routes to formal health facilities were not secure due to frequent armed conflicts.ConclusionThis study demonstrated that site-workers and villagers had different malaria prevention behaviours and care-seeking practices even though they resided in the same geographic area. Hence, it is important to recognize such differences for more effective intervention approaches.

Orientalism without Power?

Abstract Sent by the Chinese government on medical missions, Chinese female ob-gyns have served in rural and small-town public hospitals in Algeria and Morocco for more than fifty years. Yet little is known about the medical encounters or how the ob-gyns perceived patients and their health cultures. Drawing on untapped Chinese medical-mission literature, this article shows that the ob-gyns have since the 1980s constructed certain images of North African women as an inferior other, either reckless biological reproducers or incompetent health providers. In their criticisms of reproductive practices and female professionalism, they viewed local health policies and institutions through the prisms of modern obstetrics and Chinese gender rhetoric and ultimately bolstered their professional status at home in China. The article also suggests that while the ob-gyns were not attached to a hard-power colonial state apparatus, they retained considerable situational power over their patients.

A four year experience of peripartum cardiomyopathy in a rural public hospital in south india

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripartum cardiomyopathy (PPCM), as defined by the study group on PPCM of Heart Failure Association of the European Society of Cardiology (ESC), is an idiopathic Cardiomyopathy with systolic heart failure occurring towards the end of pregnancy or in the months following delivery, in previously healthy women. The current diagnostic criteria are: - heart failure in the last month of pregnancy or in the first 5 postpartum months - absence of other causes of heart failure - absence of known heart disease predating the development of heart failure. - reduced Left Ventricular Ejection Faction (LVEF) of &amp;lt; 45% or Fractional Shortening &amp;lt; 30% The global incidence of PPCM is variable, the least reported in Japan and the most in Nigeria. The estimates of the incidence in India need more scrutiny because of the difficulties in diagnosing the condition. The current incidence in literature is 1 in 1374 live births. We conducted the study to characterize PPCM among women delivered at a resource-limited setting in South India. Aim To estimate the incidence of PPCM To describe the risk factors and Feto-maternal outcomes and associated mortality To estimate the recovery of cardiac function at the end of one year. Materials and Methods This was a prospective longitudinal study conducted in a rural public hospital in South India, from 2017 to 2020. PPCM was diagnosed in pregnant and puerperal women, in concurrence with global standards. Data included were Age, Parity, Gestational age, Risk factors, Medical Management, Pregnancy outcome and Echocardiography data on diagnosis and at 1-year follow-up. Results - 32 out of 14505 women in the 4-year study period were diagnosed with PPCM. - The incidence of PPCM was 1 in 453 live births. - The mean age was 23.2 years. - 46.8% were primigravidae. - 21.8% had pre-eclampsia. - 100% had breathlessness at presentation (62.5% were in New York Heart Association – Class III). - The mean LVEF on diagnosis was 24.5%. - The Fractional Shortening was 16%. - The Left Ventricular End Diastolic Dimension was 5.8cm. - 18.75% of women were diagnosed antenatally, 75% in the early puerperium and 6.25% in the late puerperium. - 81.3% were delivered by caesarean section. - At 1-year follow up, complete recovery of cardiac function was observed in 65.6% of the women. - There was no maternal mortality or adverse perinatal outcomes. Conclusion Although rare, PPCM is an important cause for Maternal Mortality. Being a diagnosis of exclusion, a high index of suspicion and involvement of a multi-disciplinary team will aid to optimize the Feto-maternal outcomes. Setting up a National PPCM registry will help in establishing the clinical epidemiology, risk factor assessment, screening strategies, diagnostic criteria and management options for mothers suffering from the condition.

Experiences of Nurse Managers during the COVID-19 Outbreak in a Selected District Hospital in Limpopo Province, South Africa.

The South African health care system was hard hit by the second wave of Coronavirus disease (COVID-19), which affected nurse managers as healthcare facilities became overwhelmed due to an increased workload emanating from the overflow of admissions. Therefore, this study sought to explore and describe the nurse managers’ experiences during COVID-19 in order to identify gaps and lessons learnt. A descriptive phenomenological research approach was used to explore the experiences of ten nurse managers who were purposively selected from different units of a selected district hospital. Data was collected through telephonic unstructured individual interviews and analysed using Colaizzi’s seven steps method. The study revealed that nurse managers experienced human resource related challenges during COVID-19, worsened by the fact that vacant posts were frozen. It also emerged that there was a shortage of material resources that affected patient care. Nurse managers also indicated that COVID-19 brought a lot of administrative duties plus an additional duty of patient care. Also, nurse managers who had previously contracted COVID-19 experienced stigma and discrimination. The government needs to address resource related challenges in rural public hospitals and provide continuous support to nurse managers, particularly during a pandemic like COVID-19.

Health Seekers’ Acceptance and Adoption Determinants of Telemedicine in Emerging Economies

This study investigates health seekers’ acceptance and adoption determinants of telemedicine services in a rural public hospital setting in an emerging economy using an adapted, extended Technology Acceptance Model. The present study pursued synthesising a plethora of existing literature and contextualised the significance of seven broad categories of potential determinants that significantly affect patients’ acceptance and adoption intentions: perceived usefulness, perceived ease of use, self-efficacy, service quality, privacy and data security, social influence, and facilitating conditions. The partial least square structural equation modeling technique was employed to test the conceptual model and research hypotheses. A cross-sectional survey was administered among 500 telemedicine users in randomly selected rural and remote areas of Bangladesh. Excluding self-efficacy and ease of use, five determinants expressively contributed to patients’ acceptance of telemedicine adoption, explaining 65% of the variance (R2) in behavioural Intention. The empirical findings have the quality of rigour obtained from rich data sets in health informatics and can contribute to build telemedicine into an institutionalised health infrastructure in Bangladesh and similar settings. Pertinent implications, limitations and future research directions were recommended to secure the long-term sustainability of telemedicine healthcare projects.

\u201cThis is streets ahead of what we used to do\u201d: staff perceptions of virtual clinical pharmacy services in rural and remote Australian hospitals

BackgroundThe use of medications is the most common intervention in healthcare. However, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. A Virtual Clinical Pharmacy Service (VCPS) was introduced in rural and remote New South Wales public hospitals to support safe and effective use of medications. In this model clinical pharmacy services are delivered via a telehealth cart at the patient’s bedside and through electronic medical and pharmaceutical record systems. The aim of this research was to understand healthcare staff perspectives of the VCPS and identify areas for improvement.MethodsA qualitative approach informed by Appreciative Inquiry was used to investigate healthcare staff perceptions of the VCPS. Focus group discussions (n = 15) with hospital staff and medical officers were conducted via videoconference at each study site. Focus groups explored issues, benefits and barriers 3 months after service implementation. Transcribed data were analysed using thematic analysis and team discussion to synthesise themes.ResultsFocus group participants identified the value of the VCPS to patients, to the health service and to themselves. They also identified enhancements to increase value for each of these groups. Perceived benefits to patients included access to specialist medication advice and improved medication knowledge. Staff valued access to an additional, trusted workforce who provided back-up and guidance. Staff also reported confidence in improved patient safety and identification of medication errors. Enhanced compliance with antimicrobial stewardship and hospital accreditation standards were beneficial to the health service. Suggested improvements included extending virtual service hours and widening patient eligibility to include aged care patients.ConclusionsThe VCPS brought a positive, collegiate culture regarding medications. Healthcare staff perceived the VCPS was effective and an efficient way for the health service to supply pharmacy services to smaller hospitals. The ease of use, model of delivery, availability, local knowledge and responsiveness of highly skilled pharmacists was the key to user satisfaction.Trial registrationANZCTR ACTRN12619001757101, 11/12/2019.

Forecasting care seekers satisfaction with telemedicine using machine learning and structural equation modeling.

Many individuals visit rural telemedicine centres to obtain safe and effective health remedies for their physical and emotional illnesses. This study investigates the antecedents of patients’ satisfaction relating to telemedicine adoption in rural public hospitals settings in Bangladesh through the adaptation of Expectation Disconfirmation Theory extended by Social Cognitive Theory. This research advances a theoretically sustained prediction model forecasting patients’ satisfaction with telemedicine to enable informed decision making. A research model explores four potential antecedents: expectations, performance, disconfirmation, and enjoyment; that significantly contribute to predicting patients’ satisfaction concerning telemedicine adoption in Bangladesh. This model is validated using two-staged structural equation modeling and artificial neural network approaches. The findings demonstrate the determinants of patients’ satisfaction with telemedicine. The presented model will assist medical practitioners, academics, and information systems practitioners to develop high-quality decisions in the future application of telemedicine. Pertinent implications, limitations and future research directions are endorsed securing long-term telemedicine sustainability.

Human resource challenges experienced by nurse managers at a South African rural district hospital during COVID-19 pandemic

Background: The Coronavirus disease of 2019 [COVID-19] has drastically transformed the health care system. People are infected almost every day with COVID-19. Some of the people infected end up in the hospitals leading to overcrowding of the wards. Thus, the nurse managers are expected to ensure that the hospital and wards are well managed. The situation may be worse in rural hospitals where the resources are limited. Aim: This study explored the human resource challenges experienced by nurse managers during the COVID19 pandemic, in the district hospital of Vhembe, Limpopo Province. Method: The researchers followed a descriptive phenomenological approach. Data were collected through telephonic in-depth individual interviews from seven purposively selected nurse managers. Data analysis followed the seven procedural steps by Colaizzi. Results: Results indicate that nurse managers had to deal with staff shortages on a daily basis. The staff shortage resulted from absenteeism due to COVID-19 infection or COVID-19 infected family members at home. Shortage of staff was also worsened by early retirement, resignation or death of nurses. The nurse managers ensured that the hospital remains functional by devicing means of curbing the shortage through provision of COVID-19 centred management and flexible allocation. Conclusion: The study findings highlighted that managers has to deal with staff shortage on daily basis. The shortage seems to be worsening. The situation highlights the urgent need of improving staffing at the hospital and supporting available nurses in rural public hospitals to ensure that they continue to provide services. There is need for providing incentives for the nurses who are continuously risking their lives in ensuring that patients with COVID-19 receive care. This revealed a need for the government to provide continuous support to nurse managers, more specifically during a pandemic like COVID-19.

Identifying practical approaches to the normalisation of interprofessional collaboration in rural hospitals: A qualitative study among health professionals

ABSTRACT This qualitative study explores the ideas and experiences of interprofessional collaboration (IPC) among health professionals in rural public hospitals and to propagate its normalization into practice by identifying existing or suggested solutions. The literature focuses largely on the barriers and facilitators to IPC in metropolitan areas and there is room to identify more practical responses for implementing solutions. Semi-structured interviews were conducted with 13 healthcare professionals (October 2018-March 2019). Interviews were audio-recorded, transcribed and underwent thematic analysis to identify themes derived from the dataset. Using the lens of the Normalization Process Theory (NPT) allowed for amalgamation of participant ideas and identification of solutions to implement IPC in practice. Participants’ definitions of IPC and Interprofessional Teamwork were incongruous with the current literature, however when provided with formal definitions, participants agreed that they both participated and observed IPC with varying degrees of success. Factors influencing this success included good working relationships and positive workplace cultures, having an understanding of each professions’ roles and needs and the hierarchy of professions in conjunction with attitudes of senior healthcare professionals. Solutions to improved IPC and its normalization included induction processes and informal introductions, formalized interprofessional interactions, interprofessional education and positive leadership, such as the ‘assertive followership model’. Analyzed in the framework of the normalization process theory, this research shows that IPC is increasingly becoming a coherent, integrated aspect of the healthcare system but there is room for improvement, and cognitive participation in IPC varies across healthcare professionsals. In order to facilitate the normalization process, program and policy makers, hospital administrations and professional associations could consider formalized interprofessional team interactions, formalizing IPC through simple introductions, interprofessional education and positive leadership. Future research could explore through the NPT specific areas of care that benefit from IPC implementation such as community aged-care.

Here and now: Lived experiences of professional nurses practising caring presence in a rural public hospital in the North West Province, South Africa.

BackgroundPractising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing.AimThis study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.SettingThe study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.MethodsA descriptive phenomenological method, specifically Husserl’s approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi’s seven-step method.ResultsFive themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.ConclusionProfessional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.

Ethical conflicts experienced by intensive care unit health professionals in a regional hospital, Limpopo province, South Africa.

BackgroundConflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained.AimThis study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa.SettingThe study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured.MethodsThis study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch’s method of data analysis was used. Ethical considerations were adhered to.ResultsPatients’ care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and ‘use once’ pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist.ConclusionLack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.