Stemmet, Charlotte Louise (2016-03)
ENGLISH ABSTRACT: Background: Concern for patients living in remote rural communities of the Western Cape Province who do not receive quality health care due to deficiencies in the work environment of mobile clinic health workers exists. The concern is especially for the wellbeing of the nurses who work in this environment. Amidst a lack of scientific knowledge about the factors that have an influence on the quality of health provision in the mobile clinic work environment, the motivation to improve this work environment is hampered. Therefore, in striving towards excellence in mobile clinic health care by the year 2020, this study aimed to research the perceptions and experiences of nurses about the mobile clinic work environment. Method: A qualitative approach with a descriptive design was followed to research the above problem. A purposeful sampling method was used for identifying five subdistricts in the Western Cape Province to which all mobile clinic nurses were invited to take part in (n=19). Permission was granted by the Health Research Ethics Committee at Stellenbosch University, the Western Cape Department of Health and the individual study participants. Criteria for validity, namely credibility, conformability, dependability and transferability were applied to ensure trustworthiness. A pilot interview was conducted personally by the researcher in a neighboring district where she was not known, however to prevent bias a trained independent researcher conducted all other interviews. Findings: Eight semistructured interviews were carried out of which three were individual and five were group interviews. During data analyses twelve themes emerged. A perception that the mobile clinic health services are indispensable in delivering primary health care to people living in remote rural areas was identified. However, several deficiencies with regard to the vehicles that are being used, such as the adverse conditions within which medicine are kept, “I have asked many times about the medication on the bus because it reaches temperatures of 40 to 45 degrees”, emerged. An extreme workload and an extensive scope of practice that hamper the delivery of the desired health care, as well as a lack of in-service training to ensure greater competency in the mobile clinic work environment and a shortage of relief staff were also identified. Various stressors linked to deficiencies in occupational health and safety, such as the lack of telecommunication were identified, “there is no communication, no-one that will go and search for you”. Lastly, various participant suggestions on how to improve the mobile clinic work environment were identified. Conclusion: The mobile clinic health care services fulfil an essential role in delivering primary health care to the dwellers in the rural communities of the Western Cape. However, occupational health and safety, as well as quality assurance are issues that need to be addressed urgently. It is thus recommended that policy makers take cognizance of the specific needs of every individual mobile clinic team.
AFRIKAANSE OPSOMMING: Agtergrond: Kommer bestaan dat pasiënte woonagtig in afgeleё landelike gemeenskappe van die Wes-Kaap Provinsie nie gehalte gesondheidsorg ontvang nie weens leemtes in die werksomgewing van mobiele kliniek gesondheidswerkers. Daar is veral kommer dat hierdie werksomgewing nie die welsyn van die verpleegsters wat daar werk ondersteun nie. Te midde van „n gebrek aan wetenskaplike kennis betreffende die faktore wat „n invloed het op gehalte gesondheidsorgvoorsiening in die mobiele kliniek werksomgewing, is motivering tot verbetering van hierdie werksomgewing belemmer. Daarom, in die strewe na uitmuntendheid in mobiele kliniek gesondheidsorg teen die jaar 2020, het hierdie studie ten doel gehad om die persepsies en ervaringe van verpleegsters rakende die mobiele kliniek werksomgewing te ondersoek. Metode: „n Kwalitatiewe benadering met „n beskrywende ontwerp is gevolg om die bogenoemde probleem te ondersoek. „n Doelgerigte steekproefmonster is gebruik vir die identifisering van vyf sub-distrikte in die Wes-Kaap Provinsie, waarna alle mobiele kliniek verpleegkundiges genooi is vir deelname aan die studie (n=19). Toestemming is van die Etiese komitee vir Gesondheidsnavorsing van die Universiteit van Stellenbosch, die Wes-Kaap Departement van Gesondheid en die individuele studie deelnemers verkry. Kriteria vir geldigheid, naamlik geloofwaardigheid, gelykvormigheid, betroubaarheid en oordraagbaarheid is toegepas om betroubaarheid te verseker. „n Loots onderhoud is persoonlik deur die navorser in „n naby geleё distrik waarmee sy onbekend is uitgevoer, maar om vooroordeel te voorkom is alle ander onderhoude deur „n opgeleide onafhanklike navorser uitgevoer. Bevindinge: Ag semi-gestruktureerde onderhoude is uitgevoer, waarvan drie individueel en vyf groep-onderhoude was. Tydens data-analise het twaalf temas te voorskyn gekom. „n Persepsie dat die mobiele kliniek gesondheidsdienste onontbeerlik is in die lewering van Primêre Gesondheidsorg aan mense woonagtig in afgeleё landelike gebiede, is geїdentifiseer. Desnieteenstaande het verskeie leemtes ten opsigte van die voertuie wat gebruik word opgeduik: “Ek het al baie keer gevra na die medikasie in die bus, want dit raak 40 tot 50 grade”. „n Uitermate werkslading en uitgebreide werksomvang wat gehalte gesondheidsorglewering belemmer, asook „n gebrek aan indiensopleiding en aflospersoneel om groter bekwaamheid in die mobiele kliniek werksomgewing te verseker, is ook geїdentifiseer. Verskeie stressors verbandhoudend tot leemtes in beroepsgesondheid en veiligheid, soos die gebrek aan telekommunikasie is geїdentifiseer, “daar is geen kommunikasie, niemand wat sal gaan om jou te soek nie”. Laastens is verskeie deelnemervoorstelle tot die verbetering van die mobiele kliniek werksomgewing geїdentifiseer. Slotsom: Die mobiele kliniek gesondheidsdienste vervul „n onontbeerlike rol in die lewering van primêre gesondheidsorg aan inwoners in die landelike gemeenskappe van die Wes-Kaap. Beroepsgesondheid en veiligheid, asook gehalte-versekering, is egter kwessies wat dringend in elke mobiele kliniek gesondheidsdiens ondersoek moet word. Dit word dus aanbeveel dat besluitnemers kennis neem van die spesifieke behoeftes van elke individuele mobiele kliniek verpleegspa
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