Hester van der Walt

Bio: Hester van der Walt is an academic researcher from Medical Research Council. The author has contributed to research in topics: Qualitative research & Public health nursing. The author has an hindex of 5, co-authored 5 publications receiving 136 citations.

Changing professional practice in tuberculosis care: an educational intervention

Abstract: Aim. This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa. Background. Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level. Despite efforts to improve quality of care for these patients, many fail to complete their treatment as prescribed. Poor rapport between health care providers and patients with tuberculosis is a major reason for non-adherence to treatment. Methods of improving the quality of care delivery and communication between health care providers and patients with tuberculosis is therefore a priority. Discussion. The paper outlines the stages of developing and implementing the education programme and reflects on this process. Data is drawn from an in-depth qualitative evaluation of the delivery and impacts of the intervention. The approach was acceptable to health care providers and adaptable to the needs of specific clinics. Participants evaluated the educational intervention positively, noting that it facilitated critical reflection on their work; encouraged problem-solving; and heightened their awareness of communication with patients and with colleagues. However, important structural barriers to practice change were identified, including conditions of service, relations with colleagues and support from management. Conclusions. Experiential, participatory in-service education can be implemented on a large scale in primary care settings. However, the process is resource intensive and the impacts of such education may be limited by barriers at other levels of the health system.

Isabel Menzies Lyth revisited institutional defences in public health nursing in South Africa during the 1990s

Abstract: In this paper we revisit Isabel Menzies Lyth's work which sheds light on institutional defences in British hospital nurses during the 1960s. Today this work continues to inform dynamic organizational consultation in diverse areas, but to our knowledge it is not well known or applied by the nursing profession. We describe clinical examples of the work patterns of nurses in a tuberculosis-control programme in the Western Cape, South Africa, to illustrate examples of splitting, detachment and depersonalization. We discuss the tension between caring for the sick individual and containing an epidemic which threatens public health. We argue that Menzies Lyth's framework still serves as a useful tool for understanding the dynamics of relationships between health providers and patients, and that it is robust enough to provide useful insights in the South African public-health context.

Health systems research training enhances workplace research skills: a qualitative evaluation.

Abstract: INTRODUCTION: In-service education is a widely used means of enhancing the skills of health service providers, for example, in undertaking research. However, the transfer of skills acquired during an education course to the workplace is seldom evaluated. The objectives of this study were to assess learner, teacher, and health service manager perceptions of the usefulness, in the work setting, of skills taught on a health systems research education course in South Africa and to assess the extent to which the course stimulated awareness and development of health systems research in the work setting. METHODS: The education course was evaluated using a qualitative approach. Respondents were selected for interview using purposive sampling. Interviews were conducted with 39 respondents, including all of the major stakeholders. The interviews lasted between 20 and 60 minutes and were conducted either face to face or over the telephone. Thematic analysis was applied to the data, and key themes were identified. RESULTS: The course demystified health systems research and stimulated interest in reading and applying research findings. The course also changed participants' attitudes to routine data collection and was reported to have facilitated the application of informal research or problem-solving methods to everyday work situations. However, inadequate support within the workplace was a significant obstacle to applying the skills learned. DISCUSSION: A 2-week intensive, experiential course in health systems research methods can provide a mechanism for introducing basic research skills to a wide range of learners. Qualitative evaluation is a useful approach for assessing the impacts of education courses.

Qualitative research methods in health technology assessment: a review of the literature.

Abstract: ed summaries and general concepts can be formulated, which may, upon further investigation, be found to be germane to a wider variety of settings. Case studies, therefore are not necessarily restricted

Why do nurses abuse patients? Reflections from South African obstetric services - Social Science & Medicine - Vol. 47, 11 - ISBN: 02779536 - p.1781-1795

Abstract: Afrique du Sud. La violence des personnels infirmiers a travers des entretiens individuels et de groupe, pour les soins en maternite. La violence est liee a au besoin d'identite professionnelles et de classe moyenne des soignants, et banalisee du fait de la non responsabilite du systeme et des cadres. Sous-tendue par l'idee d'une inferiorite des patients

Interprofessional Teamwork for Health and Social Care

Abstract: List of Boxes, Figures and Tables. The Authors. Series Foreword. Acknowledgements. Glossary. Introduction. 1. Interprofessional teamwork the basics. 2. Current developments affecting interprofessional teamwork. 3. Interprofessional teamwork: key concepts and issues. 4. A conceptual framework for interprofessional teamwork. 5. Using theory to better understand interprofessional teamwork. 6. Interprofessional teamwork interventions. 7. Evaluating interprofessional teamwork. 8. Synthesising studies of interprofessional teamwork. 9. Ways forward. References. Appendices. Index.

Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis.

Abstract: Title. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-synthesis Aim. This paper reports the findings from a qualitative meta-synthesis concerning people with, or at risk of, tuberculosis, service providers and policymakers and their experiences and perceptions of tuberculosis and treatment. Background. Directly observed therapy is part of a package of interventions to improve tuberculosis treatment and adherence. A Cochrane systematic review of trials showed an absence of evidence for or against directly observed therapy compared with people treating themselves. Method. Qualitative systematic review methods were used to search, screen, appraise and extract data thematic analysis was used to synthesize data from 1990 to 2002, and an update of literature to December 2005. Two questions were addressed: ‘What does qualitative research tell us about the facilitators and barriers to accessing and complying with tuberculosis treatment?’ and ‘What does qualitative research tell us about the diverse results and effect sizes of the randomized controlled trials included in the Cochrane review?’ Findings help explain the diverse trial results in a Cochrane systematic review of directly observed therapy and tuberculosis and consider implications for research, policy and practice. Findings. Five themes emerged from the 1990 to 2002 synthesis: socio-economic circumstances, material resources and individual agency; explanatory models and knowledge systems in relation to tuberculosis and its treatment; the experience of stigma and public discourses around tuberculosis; sanctions, incentives and support, and the social organization and social relationships of care. Two additional themes emerged from the 2005 update. Conclusion. The qualitative meta-synthesis improved the relevance and scope of the Cochrane review of trials. The findings make a major contribution to the development of theory concerning global WHO-branded disease control and the practicality of local delivery to people.

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low‐ and middle‐income countries: a qualitative evidence synthesis

Abstract: Background In many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care. Objectives To explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies. Search methods Our search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016). Selection criteria We included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries. Data collection and analysis One review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review. Main results We included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America. Our synthesis pointed to a number of factors affecting SBAs’ provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always given sufficient training during their education or after they had begun clinical work. Also, inadequate staffing of facilities could increase the workloads of skilled birth attendants, make it difficult to provide supervision and result in mothers being offered poorer care. In addition, SBAs did not always believe that their salaries and benefits reflected their tasks and responsibilities and the personal risks they undertook. Together with poor living and working conditions, these issues were seen to increase stress and to negatively affect family life. Some SBAs also felt that managers lacked capacity and skills, and felt unsupported when their workplace concerns were not addressed. Possible causes of staff shortages in facilities included problems with hiring and assigning health workers to facilities where they were needed; lack of funding; poor management and bureaucratic systems; and low salaries. Skilled birth attendants and their managers suggested factors that could help recruit, keep, and motivate health workers, and improve the quality of care; these included good-quality housing, allowances for extra work, paid vacations, continuing education, appropriate assessments of their work, and rewards. Skilled birth attendants’ ability to provide quality care was also limited by a lack of equipment, supplies, and drugs; blood and the infrastructure to manage blood transfusions; electricity and water supplies; and adequate space and amenities on maternity wards. These factors were seen to reduce SBAs’ morale, increase their workload and infection risk, and make them less efficient in their work. A lack of transport sometimes made it difficult for SBAs to refer women on to higher levels of care. In addition, women’s negative perceptions of the health system could make them reluctant to accept referral. We identified some other factors that also may have affected the quality of care, which were based on findings assessed as of low or very low confidence. Poor teamwork and lack of trust and collaboration between health workers appeared to negatively influence care. In contrast, good collaboration and teamwork appeared to increase skilled birth attendants’ motivation, their decision-making abilities, and the quality of care. Skilled birth attendants’ workloads and staff shortages influenced their interactions with mothers. In addition, poor communication undermined trust between skilled birth attendants and mothers. Authors' conclusions Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors.