Strategies to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng province South Africa

Abstract

English: The neonatal mortality rate globally and in South Africa is high. South African district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes contribute to this rate. The causes are associated with patient-related factors, for example, immaturity or illness, administrative factors such as inadequate facilities or equipment for resuscitation, and healthcare provider factors such as insufficiently trained or an insufficient number of staff. Competent resuscitation is a critical intervention for the survival of infants in need of respiratory or cardiac support in the neonatal period. The lack of neonatal resuscitation skills contributes to the high mortality rates in these settings. This multifaceted problem persists in spite of various neonatal resuscitation training in district hospitals. This prompted the following main research question: How can a quality improvement initiative in neonatal resuscitation be sustained in a district hospital in Gauteng? The aim of this study was to explore and describe the existing situation regarding neonatal resuscitation to enable the researcher and stakeholders in the specific district hospital in developing strategies to sustain the neonatal resuscitation quality improvement initiative in an effort to decrease neonatal mortality. In addition, to determine what changes occurred as a result of these strategies and whether these changes were sustainable. The Problem Resolving Action Research model was the methodology of choice and the National Health Service (NHS) Sustainability Model was used as the theoretical framework for the study. The study was conducted in three cycles. Each cycle answered a sub-question: CYCLE 1: What is the existing situation regarding factors influencing neonatal resuscitation and neonatal mortality in a district hospital in Gauteng? CYCLE 2: What strategies can be implemented to sustain a quality improvement initiative in neonatal resuscitation in a district hospital in Gauteng? CYCLE 3: What were the changes that occurred as a result of the strategies for a quality improvement initiative in neonatal resuscitation that were implemented? Were the strategies implemented to sustain a quality improvement initiative sustainable? A literature review was done to determine the background and rationale and for the purpose of literature control. Both qualitative and quantitative methods of data collection and analyses were used to determine the existing situation regarding neonatal resuscitation, develop and implement the strategies, and to evaluate the changes. Ethical considerations and methods to ensure trustworthiness and validity and reliability were taken into consideration and adhered to. Based on the findings it could be concluded that the strategies to sustain a quality improvement initiative in neonatal resuscitation had the probability of sustainability. Furthermore there was also a marked decrease in the neonatal mortality in the maternity section of this district hospital. Based on the findings the researcher was able to make conclusions and recommendations for practice, education and future research.

Sepedi: Kelo ya mahu a masea a sa tšwago go belegwa lefaseng ka bophara le ka Afrika Borwa e godimo. Dipetlele tša selete tša Afrika Borwa di na le ditekanyo tša godimodimo tša mahu a masea a sa tšwago go belegwa ka pela. Dibaki tšeo di fetošwago le tšeo di ka phengwago di tlaleletša tekanyo ye. Dibaki di tswalanywa le mabaka ao a amanago le balwetši, mohlala, go se gole goba bolwetši, mabaka a taolo a go swana le dinolofatši tše di sa lekanego goba didirišwa tša go tsošološa, le mabaka a moabi wa tlhokomelo ya maphelo a go swana le bao ba sa tlwaetšwago ka mo go lekanego goba palo ye e sa lekanego ya bašomi. Tsošološo ya bokgoni ke tsenogare ye bohlokwa bakeng sa go phologa ga masea ao a nyakago thekgo ya go hema goba ya pelo nakong ya masea a sa tšwago go belegwa. Go hloka bokgoni bja go tsošološa masea a sa tšwago go belegwa go tlaleletša ditekanyong tše di phagamego tša mahu maemong a. Bothata bjo bja mahlakore a mantši bo sa dutše bo sa le gona go sa šetšwe tlwaetšo e fapa-fapanego ya go tsošološa masea a sa tšwago go belegwa dipetleleng tša selete. Se se hlohleleditše potšišo ye kgolo ya nyakišišo ye e latelago: Naa maitapišo a kaonafatšo ya boleng ka go tsošološa masea a sa tšwago go belegwa a ka tšwetšwa pele bjang ka sepetlele sa selete sa Gauteng? Maikemišetšo a nyakišišo ye e be e le go hlahloba le go hlaloša seemo seo se lego gona mabapi le go tsošološa masea a sa tšwago go belegwa go kgontšha monyakišiši le bakgathatema ka sepetleleng se se itšego sa selete go hlama maano a go tšwetša pele maitapišo a kaonafatšo ya boleng bja go tsošološa masea a sa tšwago go belegwa ka maitekelo a go fokotša mahu a masea a sa tšwago go belegwa. Go tlaleletša, go bona gore ke diphetogo dife tšeo di diregilego ka lebaka la maano a le ge e ba diphetogo tše di be di swarelela. Mohlala wa Dinyakišišo tša Kgato ya go Rarolla Mathata e be e le mokgwa wa kgetho gomme Mohlala wa go ya go ile wa Tirelo ya Maphelo ya Bosetšhaba (NHS) o šomišitšwe bjalo ka tlhako ya teori ya nyakišišo ye. Nyakišišo ye e dirilwe ka medikologo ye meraro. Modikologo wo mongwe le wo mongwe o arabile potšišo ye nnyane: MODIKO WA 1: Ke seemo sefe seo se lego gona mabapi le mabaka ao a tutuetšago go tsošološwa ga masea a sa tšwago go belegwa le mahu a masea a sa tšwago go belegwa sepetleleng sa selete sa Gauteng? MODIKO WA 2: Ke maano afe ao a ka phethagatšwago go tšwetša pele maitapišo a kaonafatšo ya boleng ka go tsošološa masea ao a sa tšwago go belegwa sepetleleng sa selete sa Gauteng? MODIKO WA 3: Ke diphetogo dife tšeo di diregilego ka lebaka la maano a maitapišo a kaonafatšo ya boleng ka go tsošološa masea a sa tšwago go belegwa ao a phethagaditšwego? Naa maano ao a phethagaditšwego go tšwetša pele maitapišo a kaonafatšo ya boleng a be a swarelela? Go dirilwe tshekatsheko ya dingwalo go laetša setlogo le mabaka le ka nepo ya taolo ya dingwalo. Bobedi mekgwa ya boleng le ya bontši ya kgoboketšo ya datha le ditshekatsheko e šomišitšwe go laetša seemo seo se lego gona mabapi le go tsošološa masea a sa tšwago go belegwa, go hlama le go phethagatša maano, le go sekaseka diphetogo. Dikakanyokgolo tša boitshwaro le mekgwa ya go netefatša go botega le go nepagala le go botega di ile tša elwa hloko le go kgomarela. Go ya ka dikhwetšo go ka phethwa ka gore maano a go tšwetša pele maitapišo a kaonafatšo ya boleng ka go tsošološa masea a sa tšwago go belegwa a be a na le kgonagalo ya go tšwetša pele. Godimo ga moo go bile le go fokotšega mo go lemogegago ga mahu a masea a sa tšwago go belegwa karolong ya pelego ya sepetlele se sa selete. Go ya ka dikhwetšo monyakišiši o kgonne go dira diphetho le ditšhišinyo tša tirišo, thuto le nyakišišo ya ka moso.

Afrikaans: Die neonatale sterftesyfer is wêreldwyd en in Suid-Afrika hoog . Suid-Afrikaanse distrikshospitale het die hoogste vroeë neonatale sterftesyfers. Veranderbare en vermybare oorsake dra by tot hierdie koers. Die oorsake hou verband met pasiëntverwante faktore, byvoorbeeld onvolwassenheid of siekte, administratiewe faktore soos onvoldoende fasiliteite of toerusting vir resussitasie, en gesondheidsorgverskafferfaktore soos personeeltekorte of personeel wat nie voldoende opgelei is nie. Bekwame resussitasie is ’n kritieke intervensie vir die oorlewing van babas wat respiratoriese of kardiale ondersteuning in die neonatale periode nodig het. Die gebrek aan vaardighede in neonatale resussitasie dra by tot die hoë sterftesyfer in hierdie omgewings. Hierdie veelfasettige probleem bly voortduur ten spyte van verskeie soorte opleiding in neonatale resussitasie in distrikshospitale. Dit het tot die volgende hoofnavorsingsvraag gelei: Hoe kan ’n inisiatief vir die verbetering van die gehalte van neonatale resussitasie in ’n distrikshospitaal in Gauteng volgehou word? Die doel van hierdie studie was om die bestaande situasie rakende neonatale resussitasie te ondersoek en te beskryf om die navorser en belanghebbendes in die spesifieke distrikshospitaal in staat te stel om strategieë te ontwikkel om die inisiatief vir die gehalteverbetering van neonatale resussitasie vol te hou in ’n poging om neonatale mortaliteit te verlaag. Bykomende doelwitte was om te bepaal watter veranderinge deur hierdie strategieë teweeggebring is, en of hierdie veranderinge volhoubaar was. Die probleemoplossingsaksienavorsingsmodel was die gekose metodologie en die Nasionale Gesondheidsdiens (NGS) se volhoubaarheidsmodel is as die teoretiese raamwerk vir die studie gebruik. Die studie is in drie siklusse uitgevoer. Elke siklus het een subvraag beantwoord. Siklus 1: Wat is die bestaande situasie rakende faktore wat neonatale resussitasie en mortaliteit in ’n distrikshospitaal in Gauteng beïnvloed? Siklus 2: Watter strategieë kan geïmplementeer word om ’n gehalteverbeteringsinisiatief vir neonatale resussitasie in ’n distrikshospitaal in Gauteng te handhaaf? Siklus 3: Watter veranderinge het plaasgevind as gevolg van die geïmplementeerde strategieë vir ’n gehalteverbeteringsinisiatief vir neonatale resussitasie? Was die strategieë wat geïmplementeer is om ’n gehalteverbeteringsinisiatief vol te hou, inderdaad volhoubaar? Daar is ’n literatuurstudie gedoen om die agtergrond en rasionaal te bepaal, en met literatuurkontrolering as doel. Sowel kwalitatiewe as kwantitatiewe metodes vir datainsameling en -ontleding is aangewend vas te stel wat die bestaande situasie rakende neonatale resussitasie is; om die strategieë te ontwikkel en te implementeer; en om die veranderinge te evalueer. Etiese oorwegings en metodes om geloofwaardigheid, geldigheid en betroubaarheid te verseker, is in ag geneem en nagekom. Op grond van die bevindinge kon die gevolgtrekking gemaak word dat die strategieë vir die handhawing van ’n kwaliteitsverbeteringsinisiatief vir neonatale resussitasie waarskynlik volhoubaar is. Verder was daar ook ’n merkbare afname in die neonatale mortaliteit in die kraamafdeling van hierdie distrikshospitaal. Op grond van die bevindinge kon die navorser gevolgtrekkings en aanbevelings vir die praktyk, opleiding en toekomstige navorsing maak.

IsiZulu: Liphakeme izinga lokushona kwabantwana abasanda kuzalwa emhlabeni jikelele kanye naseNingizimu Afrika. Izibhedlela zesifunda zaseNingizimu Afrika zinezinga eliphakeme kakhulu lokushona kwabantwana abasanda kuzalwa. Izimbangela ezilungisekayo nezingagwenywa zinomthelela kuleli nani. Izimbangela zihlotshaniswa nezici ezihlobene nesiguli, isibonelo, ukungakhuli ngokwanele noma ukugula, izici zokuqondisa ezinjengezindawo ezinganele noma imishini yokuvuselela, kanye nezici zomhlinzeki wezokunakekelw kwempilo ezinjengokungaqeqeshwa ngokwanele noma inani labasebenzi elanele. Ukuvuselelwa okufanelekayo kuyisinyathelo esibalulekile sokusinda kwezinsana ezidinga usizo lokuphefumula noma lwenhliziyo esikhathini sokuba ngumntwana osanda kuzalwa. Ukuntuleka kwamakhono okuvuselela izingane kunomthelela emazingeni aphezulu okushona kulezi zimo. Le nkinga enezici eziningi iyaqhubeka naphezu kokuqeqeshwa okuhlukahlukene kokuvuselela izingane ukuze zingashoni ezibhedlela zesifunda. Lokhu kuphakamise umbuzo omkhulu wocwaningo olandelayo: Kungenzeka kanjani ukuthi amasu okulondoloza isinyathelo sokuthuthukisa ikhwalithi ekuvuseleleni izingane ezishonayo kuulondolozwe esibhedlela sesifunda esifundazweni saseGauteng Inhloso yalolu cwaningo bekuwukuhlola nokuchaza isimo esikhona mayelana nokuvuselelwa kwengane ingashoni ukuze kuvunyelwe umcwaningi kanye nababambiqhaza esibhedlela sesifunda esithile ekwakheni amasu okusekela uhlelo lokuthuthukisa ikhwalithi yokuvuselelwa kwengane ngomzamo wokunciphisa ukushona kwabantwana abasanda kuzalwa. Ngaphezu kwalokho, ukuze kutholakale ukuthi yiziphi izinguquko ezenzeke ngenxa yalezi zindlela nokuthi lezi zinguquko zazingagcinwa yini. Imodeli Yokuxazulula Izinkinga Ye-Action Research kwakuyindlela yokuzikhethela futhi Imodeli Yokusimama Ye-National Health Service (NHS) yasetshenziswa njengohlaka lwenkolelo-mbono yocwaningo. Ucwaningo lwenziwe emijikelezweni emthathu. Umjikelezo ngamunye uphendule umbuzo ongaphansi kwalowo: UMJIKELEZO 1: Siyini isimo esikhona maqondana nezici ezithonya ukuvuselelwa komntwana osanda kuzalwa ukuze angashoni kanye nokushona komntwana osanda kuzalwa esibhedlela sesifunda eGauteng? UMJIKELEZO 2: Yimaphi amasu aqalisiwe ngokuphathelene nokugcinaa isinyathelo sokuthuthukisa ikhwalithi ekuvuseleleni izingane ezishonayo kuulondolozwe esibhedlela sesifunda esifundazweni saseGauteng UMJIKELEZO 3: Ziyini izinguquko ezenzeka ngenxa yamasu esinyathelo sokuthuthukisa ikhwalithi ekuvuseleleni izingane ezisanda kuzalwa esasetshenziswa? Ingabe amasu asetshenzisiwe ukuze kulondolozwe isinyathelo sokuthuthukisa ikhwalithi esimeme? Ukubuyekezwa kwezincwadi kwenziwa ukuze kutholakale isizinda nesizathu kanye nenhloso yokulawulwa kwezincwadi. Zombili izindlela zokuqoqwa nokuhlaziywa kwedatha ezisezingeni nobungako zasetshenziselwa ukunquma isimo esikhona mayelana nokuvuselelwa kwengane, ukusungula nokusebenzisa amasu, nokuhlola izinguquko. Ukucatshangelwa kwezimilo nezindlela zokuqinisekisa ukwethembeka nokufaneleka nokwethembeka kwacatshangelwa futhi kwalandelwa. Ngokusekelwe kokutholakele kungaphetha ngokuthi amasu okulondoloza isinyathelo sokuthuthukisa ikhwalithi ekuvuseleleni izingane ezisanda kuzalwa ayenamathuba okusimama. Ngaphezu kwalokho futhi kwaba nokwehla okuphawulekayo kokufa kwabantwana engxenyeni yokubeletha yalesi sibhedlela sesifunda. Ngokusekelwe kokutholakele umcwaningi wakwazi ukwenza iziphetho nokusikisela kokusebenza, imfundo nocwaningo lwesikhathi esizayo.