Exploring registered nurses' compliance to standards for medical male circumcision
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Date
2020-11
Authors
Ntsupa, Mamokete
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Medical Male Circumcision (MMC) is recommended as a Human Immune Virus (HIV) prevention strategy in countries with high HIV prevalence and low MMC prevalence. Lesotho, as the country with the second-highest HIV infection globally, is implementing this strategy. Although MMC services have been accessible to the intended recipients, there is a challenge of poor compliance with WHO standards by Registered Nurses that are providing MMC services in Lesotho. These have been noted during regular quality assessments conducted at MMC sites in Lesotho by supervisors and researcher. The focus group participants had to answer the following research question: What factors can influence the RNs' compliance with quality standards at the MMC sites in Lesotho? The purpose of the study is to explore and describe the factors that influence Registered Nurses' compliance with MMC standards. A qualitative, exploratory, descriptive, and phenomenology research design was used. A purposive sample was utilized. The target population for this study was all the RNs offering MMC services in the five lowlands districts of Lesotho. Explorative interviews were conducted before the main study to determine the questions and pre-empt the problems that might arise in the main study. For the main study, focus group interviews were conducted with 19 registered nurses. The data were analyzed using ATLAS. ti Windows 8 User Manual. The ethical standards regarding the principles of respect for persons, beneficence and justice were adhered throughout the study. The research revealed three key themes: (1) knowledge of quality standards, (2) barriers to compliance, and (3) perceived enabling working environment. This research highlights that system barriers such as poor infrastructure, insufficient staffing, and inadequate supplies make it difficult for RNs to comply with standards. Furthermore, fatigue and burnout were prevalent among MMC providers due to workload. MMC providers have also stated that carelessness in their work brought on by overconfidence in one's skills often led to poor compliance with quality standards. This research's main conclusions show that high workloads and limited resources contribute to poor compliance with quality standards. The studies revealed that a well-established quality improvement framework increases accountability and prevents the risk of intentional errors. It also enhances systems that reduce the recurrence of similar mistakes. Furthermore, the study and literature findings demonstrate that it is possible to address the quality of MMC using a Continuous Quality Improvement (CQI) approach, supportive supervision, and feedback. Key recommendations are as follows: managers should establish programs for continuous professional development and evaluate their clinical practice impact. Performance-based incentives should be linked to appraisals for better quality services, and the strengthening of accountability is recommended. Healthcare institutions should establish and sustain human resources that will meet the population's needs to provide quality services. Managers must be held accountable for the provision of quality health care. Registered nurses should take an active role in quality improvement activities in a healthcare setting and align nursing practice with professional values.
Description
Keywords
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2020, Compliance, Quality, Standards, Registered nurse, HIV, Circumcision, Penis - Surgery, Medical male circumcision