Factors influencing adverse events resulting in malpractice litigation in nursing practice in private hospitals in the Western Cape

Thesis (MCur)--Stellenbosch University, 2018.ENGLISH SUMMARY: Patient safety is the focus of the healthcare environment. However, the incidences of medical negligence leading to malpractice litigation cases are increasing globally. The aim of this study was to investigate factors that influence adverse events resulting in malpractice litigation in nursing practice in private hospitals in the Western Cape, which is a sub-study to the principle study “A retrospective analysis of malpractice litigation in nursing practice in South Africa”. The ethics approval for the main study is confirmed by reference number N16/02/027. The research question was “What are the factors that influence adverse events resulting in malpractice litigation in nursing practice in private hospitals in the Western Cape?” The objectives included: Complete an audit analysis of the nursing process Categorise the adverse events into principle types Determine factors associated with the adverse events involving the nurse practitioners that have resulted in malpractice litigation Identify other healthcare team members who may be associated with the adverse events that have resulted in malpractice litigation Assess the severity of the adverse events associated with malpractice litigation. A quantitative, retrospective audit research design was used for the purpose of this study. The study focused on malpractice litigation cases that occurred in private hospitals in the Western Cape. A convenience sample was applied. Seven attorneys, who had a variety of cases from various private hospitals within the Western Cape, granted the researcher permission to audit a total of 81 trial bundles. The test-retest method was applied to ensure the instrument included all required information to audit the trial bundles. The main study conducted a pilot study which confirmed reliability of the instrument. Expert opinions were obtained to ensure validity of the instrument. A rigorous process ensured face and content validity. The pilot study which is a sub study was conducted for the main study and not repeated in this study. The individual trial bundles were audited with the use of an audit instrument at the offices of the attorneys who specialised in malpractice litigation cases. With the support of the biostatistician, a descriptive analysis was completed and presented in tables and graphs. Ethical approval (S16/10/204) was granted by the Faculty of Medicine and Health Science at Stellenbosch University. The researcher found that n=49 (60.5%) of the cases were settled out of court. Clinical manifestations were not recorded in n=62 (76.5%) of the trial bundles. Clinical management was the most common principle type found, n=72 (88.9%). The majority of the adverse events were extreme, n=29 (35.8%) resulting in death or disability. The recommendations include encouraging continuous professional development, improving supervision in the clinical environment, promoting the ‘Just Culture’ within the healthcare environment to encourage reporting of adverse events: thereby allowing measures to be put into place to prevent a recurrence of the adverse event.AFRIKAANSE OPSOMMING: Die veiligheid van die pasiënt is die fokus binne die omgewing van die gesondheidsorg. Nietemin, die voorkoms van mediese nalatigheid wat tot wanpraktyk litigasie-sake lei, is wêreldwyd aan die toeneem. Die doel van hierdie studie was om faktore te ondersoek wat nadelige gebeurtenisse beïnvloed wat lei tot wangpraktyk-litigasie in die verpleegpraktyk in privaat hospitale in die Wes-Kaap. Dit is 'n substudie vir die hoofstudie. 'n Terugwerkende analise van wanpraktyk-litigasie in die verpleegpraktyk in Suid-Afrika. Die etiese goedkeuring vir die hoofstudie word bevestig deur verwysingsnommer N16/02/027. Die navorsingsvraag was: "Wat is die faktore wat nadelige gebeurtenisse beïnvloed, wat lei tot wanpraktyk-litigasie in die verpleegpraktyk in privaat hospitale in die Wes-Kaap?" Die doelwitte was om: ‘n Ouditanalise van die verpleegproses te voltooi. Die negatiewe gebeure in beginsel tipes te kategoriseer. Die faktore wat verband hou met die nadelige gebeuretenisse waarby die verpleegkundige praktisyns betrokke is, wat tot wangedrag litigasie gelei het te bepaal. Ander gesondheidsorgspanlede wat geassosieer kan word met die nadelige gebeurtenisse wat tot wanpraktyk-litigasie gelei het te identifiseer. Die erns van die nadelige gebeurtenisse wat verband hou met wanpraktyk- litigasie te bepaal. ‘n Kwantitatiewe, retrospektiewe oudit-navorsingsontwerp was gebruik vir die doel van hierdie studie. Die studie het op wanpraktyk litigasie-sake wat in private hospitale in die Wes-Kaap gebeur het, gefokus. ‘n Gerieflike steekproef is uitgevoer. Sewe prokureurs wat ’n verskeidenheid sake van verskillende private hospitale in die Wes-Kaap ondersoek het, het die navorser toestemming gegee om ‘n totaal van 81 hofstukke te oudit. Die toets- en hertoetsmetode was toegepas om te verseker dat die instrument alle vereiste inligting om die hofstukke te oudit, insluit. ‘n Steekproef is vir die hoofstudie gedoen wat die betroubaarheid van die instrument bevestig het. Vakkundige opinies is ingewin om die geldigheid van die instrument te verseker. ‘n Nougesette proses het sig- en inhoudgeldigheid verseker. Die loodsstudie wat ’n substudie is, was vir die hoofstudie uitgevoer en is nie in hierdie hoofstudie herhaal nie. Met die ondersteuning van die biostatistikus is ‘n beskrywende analise voltooi en is in tabelle en grafieke aangebied. Die individuele hofstukke was by die kantore van die prokureurs wat in wanpraktyk litigasie-sake spesialiseer geoudit deur gebruik te maak van ‘n oudit-instrument. Etiese goedkeuring (S16/10/204) is goedgekeur deur die Fakulteit van Medisyne en Wetenskap aan die Universiteit van Stellenbosch. Die navorser het gevind dat n=49 (60.5%) van die sake buite die hof besleg is. Kliniese manifestasies was nie opgeneem in n=62(76.5%) van die hofstukke nie. Kliniese bestuur was die mees algemene beginseltipe wat bevind was, n-72(88.9%). Die meeste van die nadelige gebeurtenisse was uiterste gevalle n-29 (35.8%) wat tot die dood en gestremdheid gelei het. Aanbevelings sluit in gedurige professionele ontwikkeling moet aangemoedig word, toesig in die kliniese omgewing behoort verbeter te word, die ‘just culture’ binne die gesondheidsorg omgewing moet bevorder word om die rapportering van nadelige gebeurtenisse aan te moedig; daardeur word maatstawwe in plek geplaas om die herhaling van die nadelige gebeurtenise te voorkom