Commodification of healthcare in a private healthcare facility: ethical implications for the nurse-patient relationship

A research report submitted in partial fulfillment of the degree of MSc. Med (Bioethics & Health Law) Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand (Wits), Johannesburg November 2017.Most literature on commercialisation of healthcare reports on the effects of the continuing commodification of healthcare on the doctor-patient relationship. It suggests that the commodification of healthcare as a management practice has the potential to alter the power balance between doctor and patient, and affect the care relationship. This has resulted with the global rebranding of patients as healthcare consumers, in the process impacting on the caring value that characterises the healthcare doctor-patient relationship. In contrast, however, these concerns have not been widely investigated in relation to the nurse-patient relationship. This relationship, grounded as it is in care ethics, has the potential to be severely altered by the pressures of healthcare commodification – particularly as nurses continue to be the primary caregivers in hospital settings. Thus, the study aimed to address this by empirically identifying and exploring areas of ethical tension relating to nurse-patient relationships in a commodified healthcare environment. The objectives of the study were to offer an empirically-based care ethics discussion on nursing care in private healthcare facilities. This study plays a part in addressing the current absence of both theoretical and empirical studies that examine the impact of commodification of healthcare on the actions of nurses. The study used a qualitative, explorative and descriptive approach to thematically analyse data collected from interviews with 16 nurses working in a private healthcare facility in Johannesburg. The findings support the argument that the commodification of healthcare transforms the nature of healthcare provision resulting with the replacement of professional ethics with marketplace ethics. This is harmful to the mutual trust and respect between the nurses and their patients. Hence, it is critical to rethink the value of compassionate and humane care as an integral part of ethical nursing practice.LG201

A milestone for mental health in South Africa

No Abstract

The impact of National Curriculum Statement principle in teaching of physical sciences in Grade 10 to 12 around Sekhukhune District

The integration of knowledge and skills across subjects and terrains of practice is crucial for achieving applied competence as defined in the National Qualifications Framework (NQF) (Department of Education 2003:3).). Physical science underperformance has plagued out Further Education Training (FET) schools sector for some time and therefore this study which is directed at the possible causes of poor performance and to device strategies that could assist physical science teachers to teach more effectively addresses a crucial gap in the performance of the country’s education provision. Emanating from the above, this study focused on the impact of National Curriculum Statement principle in the teaching of physical science in Grades 10 to 12 around Sekhukhune district. The study looked at integration as a principle endorsed in the National Curriculum Statement and how this is implemented by teachers in the teaching of physical science in grades 10-12.A literature study on the impact of National Curriculum Statement principle in the teaching of physical science was undertaken. A qualitative approach was used to obtain data from Grades 10-12 teacher in FET around Sekhukhune district. Data were collected in the form of participant observation, semi-structured and focus group interviews. The results indicate that teaches had no clear idea of integrating the relevant concepts in the subjects they were teaching (physical science). It was also found that teachers did not receive adequate in-service training specifically targeting the principle of integration. The study recommends the professional development of physical science teachers. The study indicated that the continuum model of integration is suitable for the implementation of concepts integration. It is believed that if the continuum model of integration could be used and followed by teacher as a guiding principle in the integration process, the challenges experienced by teachers in this regard will be minimized.Science and Technology EducationM. Ed. (Natural Science Education

Leadership in establishing the Gauteng City-Region : the case of the City of Tshwane Metropolitan Municipality

City-regions have increased in many developed countries as the primary political and administrative units to drive development and growth at a sub-national level. The Gauteng Province has all the hallmarks of an ideal city-region given its dominant role in the South African economy. The study examined the efforts of the City of Tshwane in facilitating the realisation of a Gauteng City-Region (GCR) by responding to the primary research question: “Leadership in establishing the Gauteng City-Region: the Case of the City of Tshwane Metropolitan Municipality”. In the quest to respond to the primary research question, a qualitative research study was adopted and the case study method was utilised. Four case studies were selected on the following basis: replicability, innovation, and potential impact in realising the GCR. The lessons which emanated from the case studies were utilised to propose interventions necessary to realise the GCR. The study revealed that misaligned planning cycles; lack of enabling legislation, and a poor record of implementation track record were selected impediments to the GCR. The study formulates policy and provides recommendations on public leadership aimed to facilitate the realisation of the GCR. It is comprehensively concluded that the City of Tshwane has contributed meaningfully towards advancing the prospect of the GCR.Thesis (PhD)--University of Pretoria, 2018.School of Public Management and Administration (SPMA)PhDUnrestricte

Establishment of a service centre by the rural aged

This paper describes a participatory action research project involving a group of the aged from the Makgoba community. The focus of this study was the establishment ofa service centre by the rural aged. In the course of this project, the researcher discovered how the rural aged were empowered through the participatory action research process. This process enabled the aged to accomplish their goals, and so to grow and develop. In particular, they improved their lives, and enhanced their self esteem and dignity.Social WorkM.A. (Social Science : Mental Health

Repairing broken bones and broken promises: informed consent and orthopaedic practice in South Africa

The discipline of orthopaedic surgery is a fast growing surgical specialty directed at the diagnosis and management of disorders of the musculoskeletal system e.g. acute trauma, fractured or dislocated joints, elective reconstructive surgery as well as related research. The standard of care in orthopaedic surgery treatment reflects the status of its evolution and what is currently available in terms of the knowledge, surgical expertise, orthopaedic implant materials, and equipment. It is the duty of the orthopaedic surgeon to live up to the promise as best he or she can to heal when it is possible to heal and to provide the level of care expected that transcends simple surgical expertise and bio-technological intervention. The informed consent process is an often neglected but vital component of the standard of care which has to satisfy prescribed ethical and legal requirements. This research is focused on how to heighten the awareness of, and to encourage engagement within the orthopaedic surgery fraternity with the informed consent process. If the informed consent is given more recognition within this group, it will benefit the potentially vulnerable orthopaedic patient, protect the orthopaedic surgeon against litigation, and importantly, contribute to the ethical imperatives bound in a doctor-patient relationship. For this research, a vast search of the available local and international literature has been perused and my finding is that the application of Ethics and recognition of the informed consent concept within the medical community in general is gathering momentum and it must be both supported and internalized by those in orthopaedic surgical practice

Exploring possibilities of social entrepreneurial activities as a tool to reduce unemployment amongst churches in Tshwane central and Mamelodi East: Pretoria case study

Unemployment is one of the major problems in South Africa. It is the concern of the government and the people at large to engage in means in order to reduce poverty. In this research, I would like to explore the possibilities of social entrepreneurial activities as a way of social and economic transformation in Tshwane. If this could be a possibility it means the church can go all out to see that the communities and members are encouraged to engage in. People will be able to improve their lives without depending on the grants from the government. Our methodology will be a literature review and intra-disciplinary approach. The method would be community mapping, World Café and focused group

Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture : A substudy protocol of the hip fracture Accelerated surgical TreaTment and Care tracK (HIP ATTACK) international randomised controlled trial

Introduction Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number NCT02027896; Pre-results

Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p\u3c0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (−1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (−2 to 4; p=0·71). Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Funding: Canadian Institutes of Health Research

Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture : a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial

Introduction Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number NCT02027896; Pre-results