Literature Review Introduction Health care resources is the backbone of quality care

April 11, 2019 Critical Thinking

Literature Review
Introduction
Health care resources is the backbone of quality care. It is a broad concept that’s divided into the following subthemes:
All materials: The equipment used in the hospital.
Personnel: The nursing staff as a whole
Facilities: The wards and subsections in the hospital
Funds: The budget limited or used by the hospital
To equip themselves with the resources (Mosby, 2009). All these can be used to provide health care efficiency and effectively
In this literature review the key concepts that will be discussed will be
• Factors causing shortage of resources
• Consequences of shortage of resources on patients
• Consequences of shortage of resources on the nursing staff and lastly
• Amending current policies of the health system.

Factors contributing to lack of health care resources
Inefficiencies in the supply chain
The term supply chain describes the different links and interrelationships among many key role players, organizations, people ; steps involved in getting resources to patients. The supply chain is a major key that is directly involved in the quality of health care delivered by the healthcare system of the country (Kruger, 2016). Kruger (2016) also mentions that factors that impede the said supply chain are:
• Lack of infrastructure to store and distribute resources
• Lack of transport ensuring a constant supply
• Losses due to theft, expiration, improper storage and fraud
• And incorrect ordering of medication to suit the needs of current patients
Kachwee ; Hartmann (2013), also mention that the absence of good quality control, inefficient in-house management processes, leading to little, to no data trail and a lack of collaboration between entities lead to inefficiencies.
The supply chain includes but is not limited to the:
• National Health Department
• Provincial Health Department
• Suppliers
• Medical supply depot
• The hospitals
Distribution of resources to hospitals come from the provincial depot. The North West provinces’ provincial depot is situated in Mafikeng, commonly known as the Mmabatho medical store. Hospitals order from the provincial depot on an electronic system and receive their stock on a weekly basis. When hospital clerks don’t accurately record orders needed for the hospital to function or administrators at the North West Department of Health provincial depot process orders without urgency or stock and delivery issues at the Mmabatho medical store, impedes the quality of care rendered at hospital level (CALS, TAC ; SECTION27, 2013).

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Budgeting
Non-payment of nursing agencies
Shortages of midwives and theatre staff due to financial difficulties led to detrimental effects of services rendered. This was due to lack of payment from the Department of Health to various nursing agencies, (CALS, TAC ; SECTION27).

Corruption and lack of accountability
The health sector audit 2011/12 undertaken by the Auditor-General showed that investigations into financial misconduct was not followed up within 30 days after the discovery. Unauthorized expenditure, wasteful expenditure and irregular expenditure amounted to over one billion rand each. Poor debt collections. And Poor procurement and management of contracts led to poor health care services throughout, (CALS, TAC ; SECTION27).

Availability and maintenance of equipment
The purchasing and maintenance of equipment has been described by healthcare workers as one of the key system failures in rendering adequate care to patients. Equipment is a broad term used to describe the smallest scalpel to more complex equipment like CT scanners.
Four core issues related to availability and maintenance of equipment:
• Inadequate budgets for equipment
• Equipment budgets have been cut to pay suppliers for previous services rendered
• Difficulties and delays in getting equipment ordered
• Some departments wait years to receive equipment ordered and must make due with the old ones they have, using equipment well past its lifespan
Poor quality of equipment received
The quality of equipment ordered raises concern, especially in cases where only the best is paramount, due to budget constraints
Poor maintenance of equipment
Non-functional equipment due to work order delays and lack of servicing of equipment
Other factors that may be contributing to lack of health resources would be awarding of tenders to ghost companies or awarding tenders to companies who don’t deliver, (CALS, TAC & SECTION27).
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Consequences of lack of health care resources on patients
According to Pennsylvania patient safety authority (2004:32), it is proven that patients experiencing life-threatening situations in a health care facility may be at risk. This is due to a lack of relevant and effective equipment and supplies readily available to adequately treat patients. This deficiency of resources has, according to Barba (2015:773) and Riley (2013) influenced the South African mortality rate. The rate stood at 9,2% and experienced an increment to 18,2% influenced by such lack of medical resources. The life expectancy rate has also decreased rapidly. The reason for this is the scarcity of resources, limited health budget and continuous shortage of physical labour. These constrains make reaching the medical objectives challenging Batini et al. (2008:376).
Patients sometimes find themselves in situations whereby the unconscientiousness of the nursing staff has resulted in examinations, and thorough examinations not taking place. Furthermore, patient’s diagnosis is delayed, as some diagnostic equipment is unavailable. Kenyon and Sen (2014:18) mentioned that patients are usually left cold and uncomfortable as lack of funding affects resources. The lack of care and proper hygiene measures (caused by lack of physical spacing or unavailability of gloves and antiseptic soap) has led patients to be exposed to nosocomial infections as infections can be easily spread to one patient to another (Nguyen ; Jones, 2008:1297), their immune systems are then lowered. Text from Mazer-Amirashahi (2015:1732) endorses the observation that some of these patients are requested to purchase their own medication due to the drug shortages. Consequentially, the problem might be that the patient does not have enough funds to do so or the patient resides far from pharmaceutical institutions. This leads to the relapsing or defaulting of medications. Patients are left susceptible to extended long stays in the hospitals. This may also result in the loss of faith in the national health care system and invariably to reduced retention and poor health seeking behaviour in the future.
These conditions leave a patient emotionally stressed and with a disabling condition, that reduces quality of life.
Consequences of lack of health care resources on the nursing staff
The work of Jangland et al. (2012;533) asserts that the nursing profession is considered a key factor for quality care. However, the strong link between the nursing staff and adequate health care resources is hardly seen. Several nurses voice their concerns in the public media (Oulton, 2006:342) about the inability to deliver standard nursing care according to their training, professional ethical standard and quality dimensions laid out regulation and guidelines due to improvisations that is implemented. This is also emphasised by Komhaber and Wilson (2011:11), that due to insufficient health care resources, it is revealed that nurses have become demotivated to perform their duties. This form of demotivation is also illustrated through the words verbalised by most workers. These words are “We came into this profession to help, and when you cannot do that anymore you think to yourself, why am I doing this? “(Herald, 2014). This can be diagnosed as a phenomenon known as moral distress. The feeling that care providers get when they are aware of what the patient needs is unpleasant, especially when such needs cannot be remedied due to the lack of appropriate resources. The massive changes and reduction of funding in the health care sector, as observed throughout the years has bared unpleasant and consequential results. Mills et al. (2012). This has led to problems such as anxiety to the staff, to mention a few. For instance, when a specific needed resource is not accessible (needs like an intravenous infusion, a catheter, an extra pair of hands or a mere blanket). Consequently, some of the staff face problems such as drinking, smoking or even work burnout (Komhaber ; Wilson, 2011:1). It is arguably believed that people in the health field are not in the field for economic benefits, but for passion to help people. When such a dedicated nurse is incapable of providing such needed care, such failure tends to affect their mental health.
Amending current policies
According to Kruger (2016), the health care structure does not have an effective pricing in place that should help providers capture and manage information on supplies, labour and other expenses. Sampson (2016:1) added that the lack of capital and equipment management systems could add significant costs causing underutilizing of existing resources, over ordering and errors. This contributes to the current problem of resource faced by health care facilities and hinders medical personnel to effectively delivery services. However, if more policies were not tied up by contracts that go unaudited regularly, problems like overpricing and the struggle of manufacturers moving inventory through supply chains on time, revenues would not get lost and profit margins would not be negatively affected. Policies such as the national health insurance, which is funded by government and possible investors (Ataguba ; Akazili, 2010:77), would be easily managed by external, accredited, qualified and trustworthy sources to allow better spending on relevant and needed resources to each hospital.

Research problem: Shortage of resources in hospitals
Research topic: Health resources
Shortage of correct equipment for certain procedures could result in sub-standard patient care. Weinhold et al. (2014:201), mentions that over the last few years there has been sharp deterioration in health care services and quality due to shortages. Manyisa and Asewegan (2017:35), added that inadequate facilities and equipment impact negatively on service delivery which often leads to cancelation of surgeries or causes of secondary illness as mentioned by Hughes (2008:27) ; Lubbe et al. (2014:59). Rahmberg et al. (2015:3) highlights this by stating, “There are so many things we lack, but we keep improvising, but you reach a limit where you cannot.”
In a resource-constrained context, it is clear that value is more relevant than quality alone which is usually experienced in both public and private sectors; however, the minimum standard and need of care is different (Gray et al. 2017:). McLaughlin et al. (2013:78) states that without availability of equipment, even with high staff there is a lack of staff motivation which increases the effect on shortage; high institution costs and patient complaints. These Debilitating difficulties were more evident from the year 2012.
Multiple reasons for lack of resources are poor maintenance of equipment or delays of repair, which leads to lack of service, inadequate budget as mentioned in Rahmberg et al. (2015:3) with that of Booysens et al. (2015:129) support by mentioning Aveling et al. (financial problems and misuse of equipment’ example urinary catheters unavailability lead to use of intravenous line or suction tubes.
Majority of the people who suffer highly due to these circumstances are patients, nurses and doctors who indicated that lack of resources restricts their ability to enhance patient care Coetzee et al. (2013:163).
Research questions:
• What causes insufficient resources?
• How does this lack of resources affect patients and nurses?
• What policies can be developed to manage resources.
Research goals:
• The aim of the study is to quantitatively establish the shortage of health care resources in Potchefstroom hospital and the impact it has on patients and its staff.
• To develop policies that can be implemented in Potchefstroom hospital.
Research objectives:
• To develop an instrument that allows nursing staff to statistically voice how the shortage of resources affect their daily routine.
• To be able to use this instrument to compile statistics and present them to the local department of health.
Research design
In this quantitative research non-experimental design will be used as the information obtained needs to be descriptive
In which the research will be measured on relevant variables at a specific time, no manipulation would take place therefore the information used to reach the objective would not be biased.
Population
The population in this research study is the nursing staff of the Potchefstroom hospital in the North West province.
Sampling method
The method chosen in this study is simple random sampling, as each participant of the sample doesn’t have an equal chance of being selected which will make the findings to be unbiased
Sample method
N=40
In which N=2 nurses in each nursing category and ward
Participant should have five or more years’ experience in the field
Data collection method
The data will be collected by using a structured questionnaire, that reduces the distortion that may be caused by recall bias, “assessing the phenomena through instantaneous reports of immediate experience.” (Stone & Shiffman, 2002:236). The data collection method to be used is the “Self-report” method. Self-report is a data collection method that rely on the participant to report their own behaviors, thoughts or feelings (AlleyDog, 2018), regarding how they experience or experienced shortages of resources in hospitals. The advantages of using this technique allows the questionnaire to be distributed to several participants, giving access to a diverse view-point, allowing for uniformity which produces more comparable data as the instruments would be identical. This also gives the respondents the opportunity to complete the instruments at their own pace and at a time and place which suits them. The influence that the researcher might have is also eliminated.
Data analysis method
The analysis technique to be used within this study would be descriptive statistics. This technique uses frequencies, percentages, measures of central tendencies, and measures of variability (Taylor-Powell, 1996). To analyze the data within this study, using frequency and ratio descriptive statistics would help group data and make it easier to view. Frequency counts the number of times a specific set of data comes across in a specific category, and the ratio would be able to calculate the occurring frequency in the entire sample (Taheri et al. 2015:177). The findings here can later be generalized to a larger population, if the same sampling techniques have been used. With the use of descriptive statistics, analysis of the data will be done using Creswell steps as described by Botma et al. (2010:224), Organizing and preparing the data, Develop a general sense, Code the data, Describing and identifying themes, Representing findings and Interpreting the data This allows us to discover the larger phenomena which would likely reflect the views and opinions of those professionals affected.

Ethical considerations
According to Polit and Beck (2012), it’s clear to say this research will deal with ethical issues as this research involves human beings. Ethical approval will be requested from Potchefstroom hospital ethics committee and the North West University.
The main ethical principles that will be considered in this research study is in the respect for persons, their confidentiality and beneficence
Respect for person
Respect for people is demonstrated by maintaining anonymity where the researcher will not know to whom the responds belong to. Confidentiality will be ensuring protection of personal information by reducing access to it (Bothma et al, 2010:17). As individuals are autonomous beings they have a right to decide whether or not they want to participate in this research proposal, without any risk of penalty. If they decide to withdraw, it is important to make them aware that their spontaneous withdrawal may affect the validity of the results. Informed consent will be sought from research participants however before consent is sought, details of the nature and purpose of the research will be given, which will explain the procedure, potential subjects and potential hazards in this case.
Who will have access to data and proposed outcome of the research? All of this will be done to protect and promote personal liberty. A universal language, which is English will be used so that all participants will understand the concept clearly. This will also reduce the risk of being biased towards any other languages, it will also make communication very simple.
At the completion of the questionnaire which will be done by the participants, the questionnaire will be taken as more evidence of their choice and consent to participate in the study. Most importantly participants will be given adequate time to consider their participation.
Privacy/ Confidentiality
In this study privacy is very vital, as the healthcare practitioners involved needs to be aware that all possible measures were taken to prevent invasion which will prevent loss of employment, guilt or dignity.
A self-administered questionnaire will be used to enhance anonymity and privacy of the respondents.
To make sure confidentiality is protected, the questionnaire used in this study will not be numbered instead only a code number will be allocated, a master list of the people that participated will be kept in a locked storage and only accessible to the research team. The research team members will sign a confidentiality pledge.
Principle of justice
In practice of fair treatment and protection from discomfort and harm as supported by Botma et al. (2010:17) means participants should be treated fairly.
Participants used in this study will be based on fair selection and treatment of the chosen sample. There is no abuse or exploitation based on gender, race, age, class or sexual orientation as stated (Botma et al, 2010:15). Privacy will be continuously respected, and anonymity maintained. Participants will be informed of time allocated to be involved in the research. The venue of where the study will be conducted. There will be no new interventions introduced that was not on the informed consent.
Research protocol will be followed throughout the study and a contact number will be given for any complains or misunderstandings.
Beneficence
This is known to be manifested in the risk/benefit ratio (Botma,2010:20)
Although questionnaires are considered to be less inescapable than interviews they can still potentially cause harm. At the pilot study state the questionnaire will be thoroughly checked for potentially damaging questions or non-threatening to the employer of the health professionals taking part in the study. A written guarantee will be given to each participant that the data collected will remain accessible only to the researcher and statistician who is involved.
Benefits of society
Knowledge that their concerns and complains about the hospital treatment they received when their families where admitted as patients or themselves are patients are heard.
Gaining insight will be benefited for them, as they will get to see what the causes of their problem is, and that nurses themselves are somewhat affected.
A universal language will be used to allow participants to answer and understand in such a way that validity of results will make a difference in their lives.
Psychosocial benefits
A sense of relief of health professionals that their cries or voices are being noticed.
Types of harm that may occur
Physical – mental exhaustion having to sit down and express your feelings or emotions and having extra hope that things will get better
Psychological – anxiety, introspection
Social harm – employment discrimination which could be caused by people who misuse the resources or role players that are not directly affected forcing them to not participate
Economic harm – time spent during working hours
Self determination
In this study the researcher will give participants adequate information to allow them to ask questions so that they can decide if they want to participate in the study or not. The participant has every right to refuse or withdraw from the study.
The participants will receive another consent for their responds to be published.

Rigor
Validity
Content validity
Content validity ensures that all the content used in the instrument covers the entire phenomena that is researched and measures it correctly. To assure whether the instrument used, experts in research were asked their opinion on whether the instrument measures the intended concept accurately (Heale ; Twycross, 2015:66).
Construct validity
By applying construct validity, the researcher can draw conclusions regarding the amount of times the participant had to improvise when resources weren’t adequate enough. This means that operational variables should adequately represent the theoretical constructs of the research (Steckler & McLeroy, 2008).
External validity
External validity is important, as the researcher would want to make the conclusion that the findings can be generalized to the wider population (Lund Research, 2012).
Reliability
Homogeneity
Cronbach’s coefficient was used, as it is the most commonly used test to determine the internal consistency of the instrument used (Heale ; Twycross, 2015:67).
Stability
The stability of the instrument was tested using the test re-test and alternate form reliability testing. Using the same instruments and giving them to the same participants on more than one occasion, under the same circumstances, allowed for a statistical comparison to be made of the participants. It provided an indication of the reliability of the instrument used. “For an instrument to demonstrate stability, there should be a high correlation between the source each time the participant completes the test.” (Heale ; Twycross, 2015:67), this was achieved when the alternate form reliability testing occurred, as the concepts being tested was the same as the instrument used, just with different wording each time.
Equivalence
Equivalence is measured when two observers must measure the same event, and their observations are compared to one another (Botma et al. 2010:177). This is not applicable to this study as the researcher will be gathering data, by means of using a set instrument.
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