An evaluation of the emergency care training workshops in the province of KwaZulu-Natal, South Africa

Experiences of primary health care practitioners dealing with emergencies - 'We are on our own'

BACKGROUND

Primary health care (PHC) focuses on health promotion and disease prevention; however, acute episodes and emergencies still occur at this level of care. The World Health Organization (WHO) proposes strengthening emergency care at a PHC level as a way of lessening the burden of disease on the overall health system. It is not known how health care practitioners at the PHC level experience management of emergencies.

AIM

To explore and describe the experiences of PHC practitioners dealing with emergencies at PHC facilities in Gauteng, South Africa.

SETTING

The study was conducted in the District Health Services of Gauteng province in South Africa, including clinics, community health care centres and district hospitals.

METHODS

Using a qualitative approach, semi-structured interviews were conducted with a purposively selected sample of professional nurses and doctors from various levels of the district health care system. Data were transcribed and analysed using qualitative thematic analysis.

RESULTS

Various themes were identified related to the individual confidence and competence of the PHC practitioner, the team approach, the process of role and task allocation and the need for training.

CONCLUSION

The study provided a voice for the needs of health care practitioners dealing with emergencies at the PHC level. The designing of a targeted and contextually appropriate approach to emergency care training of health care practitioners in the PHC setting that improves team dynamics and team performance, is recommended.Contribution: The insights of PHC practitioners dealing with emergencies contribute contextual relevance to any strategic improvement of care at this level.

Strategies to Enhance Knowledge and Practical Skills of Triage amongst Nurses Working in the Emergency Departments of Rural Hospitals in South Africa

Purpose: Lack of knowledge and practical skills on triage remains a global problem, especially within rural hospitals, and very little is known about enhancing the knowledge and skills of emergency nursing staff in rural hospitals of South Africa. The objective was to describe the perceived strategies for enhancing knowledge and practices of triage among nurses working in the emergency departments (EDs) of rural hospitals in South Africa. Research methods: A descriptive qualitative research design was applied to achieve the research objective. A non-probability sampling method was applied to select 17 professional nurses from rural hospitals. An unstructured face-to-face interview method was used to collect data. Data collected were analyzed using Tesch’s method of data analysis. Results: The study findings highlighted the academic needs of nurses working in the ED of rural hospitals. Two themes emerged from this study; (1) The consistent description of the importance of triage training for emergency unit staff, and (2) The description of measures to enhance triage practices amongst emergency unit staff. Findings indicated that triage knowledge and practice remains a challenge, but with formulated strategies like continuous training by workshops, refresher courses, and offering a training module on triage, evaluation of developed guidelines and benchmarks is often enhanced. Conclusions: The study describes the strategies to enhance the conversion of knowledge and practice of triage amongst nurses working in the ED of rural hospitals. The paper argues that the knowledge and practical skills of nurses working in ED are enhanced through the provision of continuous training as workshops, triage module, evaluating the developed guidelines to implement triage, and benchmarking with other hospitals.

The physical impact of long bone fractures on adults in KwaZulu-Natal

BACKGROUND

Limb fractures are increasingly common in low-income and middle-income countries due to an increase in motor vehicle and other accidents. Fractures may often lead to physical impairment that affects an individual's ability to carry out tasks.

OBJECTIVES

To assess the physical impact of long bone fractures on adults in KwaZulu-Natal.

METHOD

A standardised questionnaire pertaining to activities at home and leisure was used to establish patient-reported outcomes at nine public hospitals. English-speaking and isiZulu-speaking participants who had sustained a single long bone fracture in the preceding 4 to 12 weeks at the time of data collection were included. The following activities were evaluated: walking, running, exercising, driving, performing household chores, writing, answering telephones, texting on a cell phone, bathing, using crockery and preparing meals.

RESULTS

A total of 821 participants completed the questionnaire. Ninety-three per cent had closed long bone fractures and 69 per cent were lower limb fractures. Fifty-seven per cent of the fractures were caused by a fall. Female participants (p = 0.19) with lower limb fractures were more likely to have greater difficulty in performing tasks and participants 60 years of age and older (p = 0.001) were significantly more likely to have difficulty performing tasks.

CONCLUSION

These findings illustrate the daily limitations in patients' everyday activities at home, leisure and in activities such as driving.

CLINICAL IMPLICATIONS

This study highlights the difficulty that some individuals, particularly women and individuals 60 years of age and older, face in performing daily tasks after experiencing a long bone fracture.

Advanced life support courses in Africa: Certification, availability and perceptions

BACKGROUND

Advanced life support (ALS) short training courses are in demand across Africa, though overwhelmingly designed and priced for non-African contexts. The continental expansion of emergency care is driving wider penetration of these courses, but their relevance and accessibility is not known. We surveyed clinicians within emergency settings to describe ALS courses' prevalence and perceived value in Africa.

METHODS

We conducted a cross-sectional quantitative analysis of 235 clinicians' responses to the African Federation for Emergency Medicine's online needs assessment for an open-access ALS course in Africa. Participants responded to multiple-choice and open answer questions assessing demographics, ALS course certification and availability, perceptions of ALS courses, and barriers and facilitators to undertaking such courses.

RESULTS

235 clinicians working in 23 African nations responded. Most clinicians reported ALS course completion within the past three years (73%) and in-country access to ALS courses (76%). Most believed the content adequately met their region's needs (60%). Price and course availability were the most common barriers to taking an ALS course. The most common courses were cardiac and paediatric-focused, and the most common reasons to take a course included general career development, personal interest, and departmental requirements.

CONCLUSION

One-quarter of emergency care clinicians lack access to ALS courses in twenty-three African nations. Most clinicians believe that ALS courses have value in their clinical settings and meet the needs of their region. Our findings illustrate the need for an affordable, widely available ALS course tailored to lower-resource African settings that could reach rural and peri-urban clinicians.

Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal

INTRODUCTION

High-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment.

METHODS

We created a simulation lab for medical officers and students on their emergency medicine rotation at a teaching hospital in Patan, Nepal, with 48,000 ED patient visits per year. We set up a simulation lab consisting of a room with one manikin, an intubation trainer, and a projector displaying a simulation cardiac monitor. In this environment, we ran a total of eight cases over 4 simulation days. Debriefing was done at the end of each case. At the end of the curriculum, an electronic survey was delivered to the medical officers to seek improvement for future cases.

RESULTS

All eight cases were well received, and learners appreciated the safe learning space and teamwork. Of note, the first simulation case that was run (the airway lab) was more difficult for learners due to lack of experience. Survey feedback included improving the debriefing content and adding further procedural skills training.

DISCUSSION

Simulation is a valuable experience for learners in any environment. Although resources may be limited abroad, a sustainable simulation lab can be constructed and potentially play a supportive role in developing an emergency medicine curriculum.

Triage knowledge and skills among nurses in emergency units of Specialized Hospital in Hawassa, Ethiopia: cross sectional study

Objective

This study was aimed to assess knowledge and skills of triage and associated factors among nurses in emergency department of Hawassa University Comprehensive Specialized Hospital, South Ethiopia. Institutional based cross-sectional study design was conducted among 101 nurses from March 1–30, 2018. The data was coded and entered to SPSS version 22.0. Descriptive statistics was done and Chi square test was done to show the association between independent variables and dependent variable.

Results

Among the study participants, 57.4% were female and 87% were in age group of ≤ 30 years. 51.5% had low triage knowledge scores, with the mean score being 9.54 (SD = 2.317), 76.2% perceived their overall triage skill to be at good level, with mean score 95.75 (SD = 9.562). Working experience of study participants (χ² = 15.204, p < .01), Educational level of study participant (χ² = 22.148, p < .01) and triage experience (χ² = 13.638, p < .01) were factors associated with triage knowledge. Working experience (χ² = 7.944, p < .05) and triage experience (χ² = 6.264, p < .05) were factors associated with triage skill.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4062-1) contains supplementary material, which is available to authorized users.