The perception of patients regarding comprehensive care rendered by Clinical Nurse Practitioners in the West Coast rural district in the Western Cape

[摘要] ENGLISH ABSTRACT: Primary Health Care (PHC) provide a quality, comprehensive health service tothe community, based on the principles of equity, affordability, accessibility andcommunity participation. It is a nurse driven service with the Clinical NursePractitioner (CNP), a registered nurse specialising in the clinical elements ofprimary, secondary and tertiary prevention at the forefront.It is against this background that this study was endeavored to investigate thecommunity's perceptions and lived experiences of the quality of care beingrendered by CNPs in the West Coast rural district of the Western Cape. Theobjectives of this study included the following:- To explore and describe the perceptions of patients in the West Coast ruralcommunity regarding the attitudes, knowledge and skills of CNPs.- To provide policy makers with feedback and possible recommendationswith regards to the implementation of this nurse driven PHC service.- To provide recommendations for improvement of the existing curricula atnursing education institutions based on whether the current training meetspatients' needs and thereby possibly influence curricular change.A qualitative, descriptive, research design was used. The guideline by Colaizzi(as cited in Streubert & Carpenter, 1999:14) was used for data collection andanalysis. Twenty-six participants took part in five different group interviews.Semi-structured, open ended questions were used to encourage theparticipants to actively partake. Each interview was audio taped and field noteswere taken. Thematic analyses was performed to highlight three main themes,i.e. the attitudes of the CNPs, the knowledge and skills of CNPs, and the impactof the current training programmes on the quality of care being rendered bythese CNPs.Written approval from the Ethics Research Committee, University ofStellenbosch, as well as from the Research unit of the Western Cape Department of Health was obtained. Prior informed consent was furtherobtained from each participant, after being assured of voluntary participation,confidentiality and anonymity.Credibility, dependability and transferability were ensured by returning to twoparticipants who validated that the transcripts were a true reflection of theirexperiencesand opinions.This study concluded that patients perceived CNPs as being unfriendly,uncompassionate and unprofessional. Dissatisfaction with the prevalence ofunjust practices due to family members and certain race groups being attendedto first by CNPs, were expressed.Participants found the competency levels of CNPs more than adequate whenassessing, examining and providing health information and medicine. However,they expressed the need that CNPs should be able to prescribe a greatervariety of medicines and perform more diagnostic tests than currently permittedby the scope of practice as set out by the South African Nursing Council.Therefore, these views of the participants indicated that the current postgraduatetraining programme do fulfill their health needs, although the need forexpansion of the role and function of the CNP were expressed.Recommendations made included: - An in-depth investigation into the alleged rude attitudes of CNPs should beundertaken, soas to improve the professional behavior of CNPs towardspatients.- Applicable policy makers should consider expanding the roles andfunctions of the CNP.- Enforcing continuous, professional competency through adequate andproductive in-service training programmes.In conclusion, this study showed that CNPs need to be constantly aware thatthey work with human beings, with feelings and with health needs. The needfor a therapeutic environment is thus crucial to the rendering of a quality,comprehensive service to the community they serve.

[发布机构] Stellenbosch University