Transforming forensic care in level-one emergency departments in Gauteng through emancipatory practice development

Abstract

English: Healthcare providers in emergency departments encounter victims of violence and crime daily. Such victims of violence and crime enter emergency departments in need of medical attention, and they carry forensic evidence on their bodies. Healthcare providers offer medical attention, but, in the process, they may inadvertently destroy forensic evidence this may later deny a forensic patient the right to justice. The guidance available to healthcare providers in their training is often unclear, and the legislation and policies on forensic care are somewhat ambiguous, and are left open to the interpretation of the healthcare providers. In this context, this research provides insight into how emancipatory practice development transformed forensic care in three level-one emergency departments in Gauteng, South Africa. The research approach used was action research, in a critical realist paradigm. An emancipatory practice development conceptual framework was applied. The study was conducted with the participants, using collaborative, inclusive and participatory processes. The research commenced with an exploration and explanation of the existing forensic care practised in emergency departments. Then the actual and expected forensic roles and responsibilities were explored with healthcare providers. Next, action plans were developed and implemented. Finally, the outcomes of the research were collaboratively evaluated. The findings indicated that limited forensic care was already being provided at the time of the study. The research increased awareness of forensic care in the participating departments, as healthcare providers took the initiative to preserve evidence better, making use of the knowledge and resources acquired while participating in the research. The participants pointed out that the emancipatory practice development process followed required outsider initiation, combined with sustained support and fostering of relationships. Finally, they indicated that the research process had connected the research to the practice for them. This study demonstrated that emancipatory practice development may increase awareness of forensic care, and may encourage the healthcare providers involved to take ownership. It may simultaneously contribute to changes in existing practice. Based on the findings, healthcare providers' forensic roles and responsibilities were structured into a framework to guide their practice. Furthermore, the steps taken to follow a systematic approach, as required by the emancipatory practice development conceptual framework, have been clarified this may provide some guidance to other researchers who wish to use the same process.

Sepedi: Baabi ba tlhokomelo ya maphelo ka mafapheng a tšhoganetšo ba kopana le batšwasehlabelo ba dikgaruru le bosenyi letšatši ka letšatši. Batšwasehlabelo ba bjalo ba dikgaruru le bosenyi ba tsena mafapheng a tšhoganetšo ba hloka thušo ya kalafo, gomme ba rwele bohlatse bja forensiki mebeleng ya bona. Baabi ba tlhokomelo ya maphelo ba fana ka tlhokomelo ya kalafo, eupša, mo tshepedišong yeo, ba ka senya ka go se lemoge bohlatse bja forensiki ka go se lemoge se ka moragonyana se ka gana molwetši wa forensiki tokelo ya toka. Tlhahlo yeo e lego gona go baabi ba tlhokomelo ya maphelo ka tlhahlong ya bona gantši ga e kwagale, gomme molao le dipholisi tša tlhokomelo ya forensiki e sa kwagale gabotse, gomme e tlogetšwe e le pepeneneng tlhathollong ya baabi ba tlhokomelo ya maphelo. Ka gare ga seemo se, nyakišišo ye e fa temogo ya ka fao tlhabollo ya mokgwa wa tokologo e fetotšego tlhokomelo ya forensiki ka mafapheng a mararo a maemo a pele a tšhoganetšo ka Gauteng, Afrika Borwa. Mokgwa wa dinyakišišo wo o šomišitšwego e be e le dinyakišišo tša tiro, ka mokgwa wa go sekaseka wa kgonthe. Go dirišitšwe tlhako ya kgopolo ya tlhabollo ya mokgwa wa tokologo. Dinyakišišo še di dirilwe le bakgathatema, go šomišwa ditshepedišo tša tirišano, tša go akaretša le tša go kgatha tema. Dinyakišišo di thomile ka go nyakišiša le tlhalošo ya tlhokomelo ya forensiki ye e lego gona yeo e dirwago ka mafapheng a tšhoganetšo. Ke moka dikarolo tša nnete le tše di letetšwego tša forensiki le maikarabelo di ile tša hlohlomišwa le baabi ba tlhokomelo ya maphelo. Se se latelago, dithulaganyo tša tiro di ile tša hlangwa le go phethagatšwa. Mafelelong, dipoelo tša dinyakišišo di ile tša hlohlomišwa ka tirišano. Diphihlelelo di bontšhitše gore tlhokomelo e lekanyeditšwego ya forensiki e be e šetše e fiwa nakong ya dinyakišišo. Dinyakišišo di okeditše temošo ya tlhokomelo ya forensiki ka mafapheng ao a tšeago karolo, ka ge baabi ba tlhokomelo ya maphelo ba tšere kgato ya mathomo ya go boloka bohlatse bokaone, ba šomiša tsebo le methopo yeo e hweditšwego ge bakgatha tema dinyakišišong. Bakgathatema ba laeditše gore tshepedišo ya tlhabollo ya mokgwa wa tokologo e latetše go thoma mo go hlokagalago ga batho ba ka ntle, go kopantšwe le thekgo ye e tšwelago pele le go godiša dikamano. Mafelelong, ba laeditše gore tshepedišo ya dinyakišišo e kgokagantše dinyakišišo le mokgwa go bona. Dinyakišišo di bontšhitše gore tlhabollo ya mokgwa wa tokologo di ka oketša temošo ya tlhokomelo ya forensiki, gomme e ka hlohleletša baabi ba tlhokomelo ya maphelo bao ba amegago go tšea maikarabelo. Ka nako e tee e ka tsenya letsogo diphetogong mokgweng wo o lego gona. Go ya ka dikhwetšo, dikarolo tša forensiki le maikarabelo a baabi ba tlhokomelo ya maphelo di be di rulagantšwe ka tlhako ya go hlahla mokgwa wa bona. Godimo ga moo, magato ao a tšerwego go latela mokgwa wa thulaganyo, bjalo ka ge go nyakega ke tlhako ya kgopolo ya tlhabollo ya mokgwa wa tokologo, a hlakišitšwe gore se se ka fa tlhahlo ye nngwe go banyakišiši ba bangwe bao ba nyakago go šomiša tshepedišo ye e swanago.

Afrikaans: Gesondheidsorgverskaffers in noodafdelings kom daagliks slagoffers van geweld en misdaad teë. Sulke slagoffers van geweld en misdaad betree noodafdelings vir mediese hulp, en hulle dra forensiese bewyse aan hul liggame. Gesondheidsorgverskaffers bied mediese hulp, maar in die proses kan hulle onbedoeld forensiese bewyse vernietig, wat later ’n forensiese pasiënt die reg op geregtigheid kan ontsê. Die leiding wat vir gesondheidsorgverskaffers in hul opleiding beskikbaar is, is dikwels onduidelik, en die wetgewing en beleide oor forensiese sorg is taamlik dubbelsinnig - dit word oop gelaat vir interpretasie deur die gesondheidsorgverskaffers. In hierdie konteks bied hierdie navorsing insig in hoe die ontwikkeling van emansipatoriese praktyke forensiese sorg in drie vlak-een-noodafdelings in Gauteng, Suid-Afrika, getransformeer het. Die navorsingsbenadering wat gebruik is, is aksienavorsing, in 'n krities realistiese paradigma. ’n Konseptuele raamwerk vir emansiperende praktykontwikkeling is toegepas. Die studie is onder die deelnemers uitgevoer deur gebruik te maak van samewerkende, inklusiewe en deelnemende prosesse. Die navorsing het begin met ’n verkenning en verduideliking van die bestaande forensiese sorg wat in noodafdelings beoefen word. Daarna is die werklike en verwagte forensiese rolle en verantwoordelikhede saam met gesondheidsorgverskaffers ondersoek. Vervolgens is aksieplanne ontwikkel en geïmplementeer. Laastens is die uitkomste van die navorsing gesamentlik geëvalueer. Die bevindinge het aangedui dat beperkte forensiese sorg reeds ten tyde van die studie verskaf is. Die navorsing het bewustheid van forensiese sorg in die deelnemende departemente verhoog, aangesien gesondheidsorgverskaffers die inisiatief geneem het om bewyse beter te bewaar deur gebruik te maak van die kennis en hulpbronne wat hul tydens deelname aan die navorsing bekom het. Die deelnemers het daarop gewys dat die proses vir die ontwikkeling van emansipatoriese praktyk wat gevolg is deur buitestaanders geïnisieer moes word, in kombinasie met volgehoue ondersteuning en die bevordering van verhoudings. Laastens het hulle aangedui dat die navorsingsproses die navorsing vir hulle aan die praktyk verbind het. Hierdie studie het getoon dat die ontwikkeling van emansipatoriese praktyke bewustheid van forensiese sorg kan verhoog, en die betrokke gesondheidsorgverskaffers kan aanmoedig om verantwoordelikheid daarvoor te aanvaar. Dit kan terselfdertyd bydra tot veranderinge in die bestaande praktyk. Die bevindinge is as grondslag gebruik vir die opstel van ’n gestruktureerde raamwerk wat gesondheidsorgverskaffers se forensiese rolle en verantwoordelikhede aandui en as riglyn vir die praktyk kan dien. Verder is die stappe wat geneem is om ’n sistematiese benadering te volg, soos vereis deur die konseptuele raamwerk vir die ontwikkeling van emansipatoriese praktyke, verduidelik. Dit kan leiding bied aan ander navorsers wat dieselfde proses wil gebruik.

IsiZulu: Abahlinzeki bezokunakekelwa kwezempilo eminyangweni yezimo eziphuthumayo bahlangana nezisulu zobudlova kanye nobugebengu nsuku zonke. Izisulu ezinjalo zobudlova nobugebengu zingena eminyangweni yezimo eziphuthumayo ezidinga usizo lwezokwelapha, futhi ziphethe ubufakazi bokuhlolwa kwezomthetho emizimbeni yazo. Abahlinzeki bezokunakekelwa kwempilo banikeza ukunakekelwa kwezokwelapha, kodwa, enqubweni, bangase babhubhise ubufakazi bokuhlolwa kwamacala ezomthetho ngokuhamba kwesikhathi lokhu kungasenqabela isiguli sokuhlolwa kwamacala ezomthetho ilungelo lobulungiswa. Isiqondiso esitholakalayo kubahlinzeki bezokunakekela kwempilo ekuqeqesheni kwabo ngokuvamile asicaci, futhi umthetho nezinqubomgomo ekunakekelweni kwamacala ezinsolo zingaqondakali ngandlela-thile, futhi zishiywa zivulekele incazelo yabahlinzeki bezokunakekelwa kwempilo. Kulo mongo, lolu cwaningo lunikeza ukuqonda kokuthi ukwakhiwa komkhuba wokukhululwa kwaguqula kanjani ukunakekelwa kwamacala ezimo eziphuthumayo eminyangweni emithathu yezimo eziphuthumayo esezingeni elilodwa eGauteng, eNingizimu Afrika. Indlela yocwaningo esetshenzisiwe kwakuwucwaningo lwezenzo, emfanekisweni obucayi weqiniso. Kusetshenziswe uhlaka lwemibono yokuthuthukiswa komkhuba wokukhululwa. Ucwaningo lwenziwe nabahlanganyeli, kusetshenziswa izinqubo zokubambisana, ezingabandlululi nezokubamba iqhaza. Lolu cwaningo luqale ngokuhlola kanye nencazelo yokunakekelwa kwezokwelashwa kwezimo eziphuthumayo okukhona eminyangweni yezimo eziphuthumayo. Khona-ke izindima nezibopho zangempela nezilindelekile zokuhlola zahlolwa nabahlinzeki bezokunakekelwa kwempilo. Ngokulandelayo, izinhlelo zesenzo zasungulwa futhi zaqaliswa. Ekugcineni, imiphumela yocwaningo ihlolwe ngokubambisana. Okutholakele kubonise ukuthi ukunakekelwa okulinganiselwe kwe-forensic kwase kunikezwa vele ngesikhathi socwaningo. Ucwaningo lwakhulisa ukuqwashisa ngokunakekelwa kwezokwelapha eminyangweni ebambe iqhaza, njengoba abahlinzeki bezokunakekelwa kwempilo bathatha isinyathelo sokulondoloza ubufakazi kangcono, besebenzisa ulwazi nezinsiza ezitholakele ngesikhathi behlanganyela ocwaningweni. Ababambiqhaza baveza ukuthi inqubo yokuthuthukisa umkhuba wokukhululwa ilandele ukuqaliswa kwangaphandle okudingekayo, kuhlangene nokusekelwa okuqhubekayo nokwakhiwa kobudlelwano. Ekugcineni, babonisa ukuthi inqubo yocwaningo yayihlobanise ucwaningo nokusebenza kwabo. Lolu cwaningo lubonise ukuthi ukwakhiwa kokwenza umsebenzi wokuzikhulula kungakhulisa ukuqwashisa ngokunakekelwa kwezokwelapha, futhi kungakhuthaza abahlinzeki bezokunakekela kwempilo abathintekayo ukuba bangabanikazi. Kungase kube nomthelela ngesikhathi esisodwa ekushintsheni kokusebenza okukhona. Ngokusekelwe kokutholakele, izindima nezibopho zabahlinzeki bezempilo zahlelwa zaba uhlaka lokuqondisa umkhuba wabo. Ngaphezu kwalokho, izinyathelo ezithathiwe zokulandela indlela ehlelekile, njengoba kudingeka ngohlaka lomqondo wokuthuthukiswa komkhuba wokukhulula, zicacisiwe lokhu kungase kunikeze isiqondiso esithile kwabanye abacwaningi abafisa ukusebenzisa inqubo efanayo.