an exploration of the experiences and perceptions of health and allied health care students ...

277 Pages·2014·3.86 MB·English

AN EXPLORATION OF THE EXPERIENCES AND PERCEPTIONS OF
HEALTH AND ALLIED HEALTH CARE STUDENTS REGARDING
INTERPROFESSIONAL COLLABORATION AND EDUCATION IN A
RURAL CLINICAL SETTING IN SOUTH AFRICA

Anna Luttig Theunissen

Thesis presented in partial fulfillment of the requirements for the degree
of Master of Nursing Science in the Faculty of Health Sciences at
Stellenbosch University

Supervisor: Mrs Anneleen Damons

March 2014
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DECLARATION
By submitting this thesis electronically, I declare that the entirety of the work contained
therein is my own, original work, that I am the sole author thereof (save to the extent
explicitly unless otherwise stated), that reproduction and publication thereof by
StellenboschUniversity will not infringe any third party rights and that I have not previously in
its entiretyor in part submitted it for obtaining any qualification.

Student: Anna Luttig Theunissen
Signed date: 25 February 2014

Copyright © 2014 Stellenbosch University
All rights reserved
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ABSTRACT
An exploration of the experiences and perceptions of health and allied health care students
regarding interprofessional collaboration and education in a rural clinical setting in South
Africa was conducted.
The specific objectives included:
 The identification of the health and allied health care students placed within the IPC
and IPE context in the rural area.
 The description of the demographic placement situations and educational status of
the health and allied health care students placed in the rural area.
 The exploration of the experiences of students regarding interprofessional
collaboration within an interprofessional educational context in a rural healthcare
setting in South Africa.
 The establishment of the perceptions of students regarding interprofessional
education within the interprofessional education programme in a rural health care
context in South Africa.
An explorative, descriptive research design with a qualitative approach was applied to
explore and describe the experiences and perceptions of health and allied health care
students regarding interprofessional collaboration and education in a rural clinical setting in
South Africa.
The research aim was to explore the experiences and perceptions of health and allied health
care students regarding interprofessional collaboration and education during their clinical
placement in a rural health care context in South Africa.
Interdisciplinary rotation schedules hampered the researcher’s ability to determine an
absolute number of the accessible population at any one time. An estimated population
(N=31) over a six week period included the following disciplines: Physiotherapy (n=7),
Speech and Hearing Therapy (n=14), Nursing (n=6) and Medicine (n=4). The student
numbers varied from day to day as the various disciplines rotated at different times. The
number of students representing a specific discipline at any given time was not constant.
The inclusion and exclusion criteria were set to ensure optimal clinical experience in the
field, to ensure that valid data was obtained. The ultimate accessible research sample
consisted of all (N=8) of the purposefully selected final year undergraduate health and allied
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health care students. The respondents were purposefully selected due to the wealth of
information that they shared regarding the topic. The total number of voluntary participants
was (n=7). The focus group interviews were attended by the departments of Physiotherapy
(n=2), Speech and Hearing Therapy (n=2), Nursing (n=2) and Medicine (n=1). The totals
applied to both the pilot interview, as well as the formal study group, however the
participants differed. The pilot interview included students who had attended the clinical rural
placement during 2012 and the formal study participants were selected from the student
groups who attended the clinical placement during 2013.
Ethical approval to conduct the study was obtained from the Health Research Ethical
Committee at Stellenbosch University. Consent was obtained from participants to conduct
the interviews and permission was obtained from respondents to use a tape recorder to
record the interviews.
An interview guide was used to pose the questions, with specific prompts to facilitate the
exploration of information. The interview guide was adjusted following the pilot interview, to
ensure optimal data collection.
Data obtained was analysed and the following main themes were derived from the study:
Organisation; Perceptions and experiences related to interprofessional team structures prior
to and following interprofessional collaboration (IPC) and interprofessional education (IPE);
Team cohesion (IPC and IPE) at Avian Park; and lastly, Advantages of practices within the
Re-engineering of PHC.The data was analised according to the five steps as explained by
Terre Blanche, Durrheim and Painter (2006:322-325).Challenges such as the preconceived
barriers to collaboration and the organisational aspects related to rotation were identified;
however all the participants indicated that they had benefited greatly from the experience of
learning and working together.
Recommendations or suggestions were made by the researcher to further improve IPC
within IPE in a multi-cultural student group and society.
In conclusion, the experiences and perceptions were very positive and valuable information
was obtained which may serve as the foundation for much needed future research within the
South African context.
Key words: interprofessional collaboration; interprofessional education; health and allied
health care students
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OPSOMMING
‘n Verkennende ondersoek van die ondervindinge en persepsies van studente in
gesondheidsorg en verwanteberoepe ten opsigte van interprofessionele samewerking en
onderrig in ’n landelike kliniese area in Suid Afrika is onderneem.
Die spesifieke doelstellings het die volgende ingesluit:
 Die identifisering van die studente in gesondheidsorg en verwante beroepe, soos
geplaas binne die interprofessionele samewerking en interprofessionele onderrig
konteks in ’n landelike gebied
 Die beskrywing van die demografiese plasingsituasie en die onderrigstatus van die
studente in gesondheidsorg en verwante beroepe, soos geplaas in die landelike area
 Die ondersoekvan die ondervindinge ten opsigte van interprofessionele
samewerkingskonteks binne landelike gesondheidsorg in Suid-Afrika
 Die bepaling van die persepsies van studente ten opsigte van die interprofessionele
onderrig binne die interprofessionele onderrigprogram in ’n landelike kliniese area in
Suid-Afrika.
’n Uitgebreide, beskrywende ondersoekontwerp is toegepas met ’n kwalitatiewe benadering
om ondersoek in te stel, asook om die ondervindinge en persepsies van studente in
gesondheidsorg en verwante gesondheidsberoepe ten opsigte van interprofessionele
samewerking en interprofessionele onderrig te beskryf.
Interdissiplinêre rotasieskedules het die navorser se vermoë om die absolute aantal
studente op een slag te bepaal, beïnvloed. Die beraamde populasie (n-31) binne ‘n periode
van ses weke het die volgende dissiplines ingesluit: Fisioterapie (n-7), Spraak- en
gehoorterapie (n-7), Verpleegkunde (n-7) en Geneeskunde (n-4). Die studentegetalle was op
’n daaglikse basis verskillend, want die onderskeie dissiplines het op verskillende tye roteer
Die aantal studente wat een spesifieke dissipline op ’n gegewe tyd verteenwoordig het, was
nie konstant nie.
Om optimale kliniese ondervinding te verseker, is die insluitings- en uitsluitingskriteria van so
’n aarddat toepaslike en geloofwaardige data versamel kon word. Die uiteindelike
navorsingstudiegroep (steekproefgrootte) het uit 8 deelnemers bestaan. Hierdie groep was
doelbewus vanuit die finale jaar voorgraadse studentegroep van die gesondheidsorg- en
verwante gesondheidsberoepegeïdentifiseer. Die studente is doelbewus gekies vanweë hul
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kundigheid aangaande die onderwerp. Die totale aantal vrywillige deelnemers was sewe.
Onderhoude van die fokusgroep is bygewoon deur studente van die volgende departmente:
Fisioterapie (n-2), Spraak- en gehoorterapie (n-2), Verpleegkunde (n-2) en Geneeskunde (n-
1). Hierdie totale is van toepassing op die loodstoetsing-onderhoud, asook die formele
onderhoude maar die deelnemers het egter verskil. Die loodsonderhoud het die studente
wat die landelike kliniek in 2012 bygewoon het, ingesluit. Die formele studiegroep het die
studenteingesluitwatdie landelike kliniek in 2013 bygewoonhet.
Etiese goedkeuring vir die uitvoer van die studie, is deur die Gesondheidsnavorsing
Etiesekomitee Stellenbosch Universiteit verleen. Toestemming van die deelnemers vir hul
deelname aan die studie, asook toestemming vir die opname van die onderhoud op ’n
klanktoestel is verleen.
‘n Onderhoudsgids is gebruik die stel van vrae aan die deelnemers en spesieke frases wat
aansporing van antwoorde kon fasiliteer,is gebruik sodat inligting ingesamel kon word. Die
onderhoudsgids is aangepas metdie voltooiing van die loodstoetsing-onderhoud om
optimale versameling van data te verseker.
Die versamelde data is geanaliseer en die volgende hooftemas is uitgelig, naamlik
organisasie, persepsies en ondervindinge verwant aan interprofessionele spanstrukture voor
en na aanleiding van interprofessionele onderrig (IPE); spankohesie in Avain Park en dan
laastens, die voordele van die praktyke binne die herontwerp van primêre gesondheidsorg.
Die data is geanaliseer na aanleiding van die vyf stappe soos uiteengesit deur Terre
Blanche, Durrheim and Painter (2006:322-325). Uitdagings soos vooropgestelde idees
teenoor interprofessionele samewerking, asook aspekte wat verband hou met
rotasieskedules is geïdentifiseer, alhoewel al die deelnemers aangedui het dat hulle almal
grootliks gebaat het deur die ondervinding om saam te leer en te werk.
Aanbevelings of voorstelle is gemaak deur die navorser vir die verdere verbetering van
interpersoonlike samewerking en onderrig ten opsigte van die bevordering daarvan binne die
multi-kulturele studentegroep en die gemeenskap.
Ter afsluiting, die ondervindinge en aannames was baie positief en waardevolle inligting was
bekom wat behoort tekan dien as die grondslag van baie noodsaaklike toekomstige
navorsing binne die Suid-Afrikaanse konteks.
Sleutelwoorde: interprofessionele samewerking; interprofessioneleonderrig;
gesondheidsorg en verwante gesondheidsberoepe.
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DEDICATION
I dedicate this work to:

God, without Him none of this would have been possible.
All who protect God’s creatures.
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ACKNOWLEDGEMENTS
I would like to acknowledge the following people:
 My Supervisor, Mrs Anneleen Damons, Division of Nursing, Faculty of Health
Sciences, Stellenbosch University
 Stellenbosch University Rural Education Partnership Initiative (SURMEPI) for the
financial assistance
 Professor Marina Clark, who motivated and inspired me
 Dr Stefanus Snyman, Manager: Interprofessional Education and Practice (IPOP)
Service learning, for his wonderful support and kindness
 Liesl Strauss for her support
 Lize Vorster for technical editing
 Niny West, typing and transcribing of recorded data
 Ms Ilona Meyer , the 2nd language editor
 Dr Ethelwynn, L. Stellenberg, Head of Research, Division of Nursing, Faculty of
Health Sciences, Stellenbosch University
 Joan Petersen and Sybil Abrahams
 Drienie Kimberg and Coleen Emmenis
 Jeanne Santovito the 1stlanguage editor
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TABLE OF CONTENT

Declaration .......................................................................................................................... ii
Abstract .............................................................................................................................. iii
Opsomming ......................................................................................................................... v
Dedication ......................................................................................................................... vii
Acknowledgements ......................................................................................................... viii
List of Tables ..................................................................................................................... xv
List of Flow diagrammes ................................................................................................. xvi
List of Appendices .......................................................................................................... xvii
List of abbreviations ...................................................................................................... xviii
CHAPTER 1: FOUNDATION OF THE STUDY ............................................................... 1
1.1 Introduction ............................................................................................................. 1
1.2 Significance of the problem ..................................................................................... 1
1.3 Background and rationale ....................................................................................... 1
1.4 Problem statement .................................................................................................. 6
1.4.1 Relevance of the study .................................................................................... 6
1.5 Research questions ................................................................................................ 7
1.6 Aim ......................................................................................................................... 7
1.7 Objectives ............................................................................................................... 8
1.8 Conceptual framework ............................................................................................ 8
1.8.1 The Neuman Systems Model ........................................................................... 8
1.8.2 Graphical presentation of theories and concepts.............................................. 8
1.8.2.1 The interprofessional student implementation conceptual map ................. 9
1.9 Research methodology ......................................................................................... 10
1.9.1 Research design ............................................................................................ 11
1.9.2 Research setting ............................................................................................ 12
1.9.3 Population and sampling ................................................................................ 12
1.9.4 Inclusion and exclusion criteria ...................................................................... 13
1.9.4.1 Inclusion criteria ...................................................................................... 13
1.9.4.2 Exclusion criteria ..................................................................................... 13
1.9.5 Data collection ............................................................................................... 13
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1.9.5.1 Data collection tool / instrumentation....................................................... 14
1.9.5.2 Data collection technique ........................................................................ 14
1.9.5.3 Interview information ............................................................................... 15
1.9.6 Pilot testing .................................................................................................... 16
1.9.7 Trustworthiness / validity testing of the study ................................................. 16
1.9.7.1 Credibility ................................................................................................ 16
1.9.7.2 Transferability ......................................................................................... 16
1.9.7.3 Dependability .......................................................................................... 16
1.9.7.4 Conformability ......................................................................................... 17
1.9.7.5 Instrument validity ................................................................................... 17
1.9.7.6 Veracity ................................................................................................... 17
1.9.7.7 Bias ........................................................................................................ 17
1.9.8 Literature control ............................................................................................ 17
1.9.9 Data analysis ................................................................................................. 18
1.10 Ethical considerations ........................................................................................... 18
1.10.1 Confidentiality and anonymity ........................................................................ 18
1.10.2 Consent and Informed consent ...................................................................... 19
1.10.3 Benefits and risks of participation ................................................................... 19
1.10.4 Recording of interview ................................................................................... 19
1.11 Operational definition ............................................................................................ 20
1.11.1 Interprofessional collaboration ....................................................................... 20
1.11.2 Interprofessional education ............................................................................ 20
1.11.3 Community Health Workers (CHW) ............................................................... 20
1.12 Duration of the study ............................................................................................. 20
1.13 Chapter outline ..................................................................................................... 20
1.14 Significance of the study ....................................................................................... 21
1.15 Summary .............................................................................................................. 21
1.16 Conclusion ............................................................................................................ 22
CHAPTER 2: PRELIMINARY LITERATURE REVIEW ................................................. 23
2.1 Introduction ........................................................................................................... 23
2.2 Health care problem .............................................................................................. 25
2.2.1 Historical overview of primary health care ...................................................... 25
2.2.2 Exploration of health care strategy: Brazil ...................................................... 26