The development of validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa

Thesis (PhD)--Stellenbosch University, 2020.ENGLISH SUMMARY : Introduction: Substandard care resulting in billions of rand pay-outs due to malpractice litigation remains a challenge in nursing practice. Purpose: To develop validated guidelines that contribute to the prevention of malpractice litigation in nursing practice in South Africa. Research questions: What are the contributing factors that lead to adverse events in nursing care? What are the validated guidelines that can be developed to contribute to the prevention of malpractice litigation in nursing practice in South Africa? Methodology: The study was conducted in three phases: Phase 1: A retrospective audit of adverse events using a descriptive quantitative design with Pearson Chi-Square test, CI 95%, p ≤ 0.05 was conducted on 203 malpractice litigation cases from the Eastern Cape and Gauteng public healthcare sectors. Phase 2: A comparative statistical analysis was carried out to compare and contrast adverse events - 122 malpractice litigation cases audited by two master’s students in the Western Cape and Gauteng private sector with the phase 1 litigated cases. Phase 3: Nursing practice guidelines were developed using the identified adverse events that contributed to adverse events by applying the WHO guidelines and expert validation using the Delphi method. Results: Phase 1: A key finding - Out of 143 cases admitted to labour wards 135 babies had cerebral palsy in this study. Adverse events contributing factors: • Nursing clinical management (87% of adverse events): Assessment; diagnosis; planning; implementation and evaluation including observations; tests; interpretation and documentation; as well as clinical management. • Behavioural problems (12.3% of adverse events): Not following guidelines (91.6%), non-response to clinical manifestations (79.4%), accumulation of omissions (49.8 %), an accumulation of errors (41.8 %), administering and incorrect treatment (16.0 %). • Organisational and administrative factors Lack of knowledge (28.9 %), organisational (23.7%), system failure (21.5, lack of training (19.4 %) %), lack of supervision (17.5 %) and administrative (6.5%). Phase 2: • A total of 325 trial bundles were audited - 122 by two master’s students in private and 203 in public healthcare by a PhD student. Statistical differences showed that 76.0% of patients’ quality of life were affected (p=0.01). • Statistically, it was shown that patients were more likely to die in the private sector (p=0.01) and more likely to be disabled in the public sector (p=0.01). • No statistical difference was identified in clinical management between private and public healthcare sectors (p= 0.27). • The private healthcare sector was more likely to have adverse events, due to organisational and administrative problems. • The public healthcare sector was more likely to have poor resources with a critical shortage of doctors and nurses. Phase 3: • Guidelines were developed by applying the WHO guideline development process and validated, applying the Delphi method. • One hundred and forty-four guidelines were developed, validated and grouped into Clinical Management, Human Behaviour, and Organisational factors. • National and international experts participated in the validation process. Ethical considerations: Approval was obtained from Stellenbosch University (N16/02/027A). Recommendation: The validated guidelines developed in the study should be further tested and implemented in South Africa to contribute to the prevention of the escalating malpractice litigation in nursing practice.AFRIKAANSE OPSOMMING : Inleiding: Substandaard sorg bly ‘n uitdaging vir die verpleegpraktyk, wat aanleiding gee tot die uitbetaling van miljarde rande weens wanpraktyk litigasie. Doelwit: Die doel is om gevalideerde riglyne te ontwikkel wat sal bydra tot die voorkoming van wanpraktyk litigasie in die verpleegpraktyk in Suid-Afrika. Navorsingsvrae: 1. Wat is die bydraende faktore wat aanleiding gee tot ongunstige gevalle in die verpleegpraktyk? 2. Wat is die gevalideerde riglyne wat ontwikkel kan word wat sal bydra tot die voorkoming van wanpraktyk litigasie in die verpleegpraktyk in Suid Afrika? Metodologie: Die navorsingstudie is in drie fases gedoen. Fase 1: ‘n Retrospektiewe oudit van ongunstige gebeure deur ‘n beskrywende kwantitatiewe ontwerp met behulp van Pearson se Chi-Kwadraat toets, CI 95%, p ≤ 0.05 is op 203 wanpraktyk litigasie gevalle van die Oos-Kaap en Gauteng openbare gesondheidsorg sektore gedoen. Fase 2: ‘n Vergelykende statistiese analise is uitgevoer om die ongunstige gevalle te vergelyk en te kontrasteer – 122 wanpraktyk litigasie gevalle is deur twee meestersgraad studente in die Wes-Kaapse en Gauteng private sektor deur fase 1 se gelitigeerde gevalle geoudit. Fase 3: Riglyne vir die verpleegpraktyk is ontwikkel, deur gebruik te maak van die geïdentifiseerde ongunstige gevalle wat gelei het tot ongunstige gevalle, deur die riglyne van die WGO, asook die deskundige validasie van die Delphi-metode toe te pas. Resultate: Fase 1: ‘n Sleutelbevinding – verloskunde is in ‘n krisis met 135 gevalle van serebrale verlamming uit die 143 gevalle opgeneem in kraamsale. Bydraende faktore wat lei tot ongunstige gevalle: • Kliniese Verplegingsbestuur (87% van ongunstige gevalle): Beraming; diagnose; beplanning; implementering en evaluering ook ingesluit observasies, toetse; interpretasie en dokumentasie; asook kliniese bestuur. • Gedragsprobleme (12.3% van ongunstige gevalle): Geen toepassing van riglyne nie (91.6%), geen respons op kliniese manifestasies nie (79.4%), opeenhoping van weglatings (49.8%), ‘n opeenhoping van foute (41.8%), en toediening van foutiewe behandeling (16.0%). • Organisatoriese en administratiewe faktore Gebrek aan kennis (28.9%), organisatories (23.7%), stelselfout (21.5%), gebrek aan opleiding (19.4%), gebrek aan toesig (17.5%) en administratief (6.5%). Fase 2: • ‘n Totaal van 325 proefbundels is geoudit - 122 deur twee meestersgraad studente in private, en 203 in openbare gesondheidsorg sektore deur ‘n PhD student. Statistiese verskille toon dat 76.0% van die lewenskwaliteit van pasiënte is geaffekteer (p=0.01). Dit is statisties bewys dat ‘n pasiënt meer waarskynlik sal sterf in die privaatsektor (p=0.01) en meer waarskynlik gestremd sal wees in die openbare sektor (p=0.01). • Geen statistiese verskil is geïdentifiseer met betrekking tot kliniese bestuur tussen private en openbare gesondheidsorg sektore nie (p = 0.27). • Die private gesondheidsorg sektor is meer waarskynlik geneig tot ongunstige gevalle, weens organisatoriese en administratiewe probleme. • Die openbare gesondheidsorg sektor is meer waarskynlik geneig tot ‘n tekort aan hulpbronne met ‘n groot tekort aan dokters en verpleegsters. Fase 3: • Riglyne is ontwerp deur die toepassing van die WGO se riglyn-ontwikkelingsproses en gevalideer deur die gebruik van die Delphi-metode. • Een honderd vier-en-veertig riglyne is ontwikkel, gevalideer en gegroepeer in Kliniese Bestuur, Menslike Gedrag en Organisatoriese faktore. • Nasionale en internasionale deskundiges het aan die geldigverklaringsproses deelgeneem. Etiese oorweging: Goedkeuring is verkry van die Universiteit van Stellenbosch (N16/02/027A). Aanbeveling: Die gevalideerde riglyne wat in hierdie studie ontwikkel is, behoort verder getoets en geïmplementeer te word in Suid-Afrika, om by te dra tot die voorkoming van die toenemende wanpraktyk litigasie in die verpleegpraktyk.Doctora