3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Commodification of healthcare in a private healthcare facility: ethical implications for the nurse-patient relationship(2017) Ramokgopa, PrudenceMost 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.Item Assessing litigation risks in patient-doctor interactions at Helen Joseph hospital(2017) Smith, Stephen DavidIntroduction: Medical malpractice lawsuits continue to be filed at an alarming rate, with billions of dollars being paid out across the globe. Most of these claims, defendable or not, are settled out of court. These uncontrolled medical claims continue to push up the costs of medical liability insurance, which in turn pushes up the cost of health care. These pressures are felt most by the "high risk" specialties namely, Obstetrics and Gynaecology, Neurosurgery and Orthopaedics. South Africa has not escaped the wave of medico-legal lawsuits, and may be headed towards greater challenges than its first world counterparts. With the introduction of the new Consumer Protection Act, and having one of the world's most enlightened constitutions, makes the South African medical fraternity an easy target. Litigation involving South African orthopaedic surgeons suggests that the majority of claims filed are due to poor patient-doctor interaction, accounting for 13.35% of all claims. Methodology: A prospective study conducted at Helen Joseph Hospital 2014. Using a tailored patient satisfaction questionnaire, post operative orthopaedic patients were able to give insight into their satisfaction regarding their personal patient-doctor interactions. Each question was correlated to an area of patient-doctor interaction, that in the past had led to litigation. This was used to asses which areas of patient-doctor interactions were lacking in a typical resource starved state hospital. Results: Nearly 20% of patients are considering legal action at point of discharge, with no demographic data playing any significant role in this decision. All areas of patient-doctor interactions showed a significantly lower score, in those considering litigation versus those who were not. The two highest risk areas were related to doctor availability and consent taking. This study emphasizes the importance of proper communication between doctors and patients in preventing litigation, and the need for doctors to focus on improving their individual doctor-patient relationships.