Browsing by Author "Lourens, Andrit"

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    Acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa: a knowledge, attitudes and practices survey
    (2020-04-28) Lourens, Andrit; Hodkinson, Peter; Parker, Romy
    Background Acute pain is frequently encountered in the prehospital setting, and therefore, a fundamental aspect of quality emergency care. Research has shown a positive association between healthcare providers’ knowledge of, and attitudes towards pain and pain management practices. This study aimed to describe the knowledge, attitudes, and practices of emergency care providers regarding acute pain assessment and management in the prehospital setting, in the Western Cape, South Africa. The specific objectives were to, identify gaps in pain knowledge; assess attitudes regarding pain assessment and management; describe pain assessment and management behaviours and practices; and identify barriers to and enablers of pain care. Methods A web-based descriptive cross-sectional survey was conducted among emergency care providers of all qualifications, using a face-validated Knowledge, Attitudes and Practices of Pain survey. Results Responses of 100 participants were included in the analysis. The survey response rate could not be calculated. The mean age of respondents was 34.74 (SD 8.13) years and the mean years’ experience 10.02 (SD 6.47). Most respondents were male (69%), employed in the public/government sector (93%) as operational practitioners (85%) with 54% of respondents having attended medical education on pain care in the last 2 years. The mean percentage for knowledge and attitudes regarding pain among emergency care providers was 58.01% (SD 15.66) with gaps identified in various aspects of pain and pain care. Practitioners with higher qualifications, more years’ experience and those who did not attend medical education on pain, achieved higher scores. Alcohol and drug use by patients were the most selected barrier to pain care while the availability of higher qualified practitioners was the most selected enabler. When asked to record pain scores, practitioners were less inclined to assign scores which were self-reported by the patients in the case scenarios. The participant dropout rate was 35%. Conclusion Our results suggest that there is suboptimal knowledge and attitudes regarding pain among emergency care providers in the Western Cape, South Africa. Gaps in pain knowledge, attitudes and practices were identified. Some barriers and enablers of pain care in the South African prehospital setting were identified but further research is indicated.
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    Developing an in-depth understanding of acute pain assessment and management in the prehospital setting in the Western Cape, South Africa, the factors influencing practice and what improvement measures could advance prehospital acute pain management
    (2020) Lourens, Andrit; Hodkinson, Peter; Parker, Romy
    Introduction: Acute pain is a common reason for seeking emergency care in the prehospital and emergency centre settings where pain prevalence ranges widely. Pain is a significant global health problem which often goes unnoticed and is undermanaged. To this end, a project consisting of a series of research studies aimed to develop an understanding of acute prehospital pain assessment and management in South Africa was conducted to identify how best to improve this field. Methods: The project consisted of four distinct objectives to be investigated as separate but interconnected studies. The first objective was answered through a secondary research methodology (scoping review) to identify and map the body of evidence on acute prehospital pain assessment and management in Africa. The remaining three objectives were answered using primary research methods in studies conducted in the Western Cape, South Africa. Two observational studies, (i) a cross-sectional online survey and (ii) a retrospective review, respectively, aimed to describe (i) the knowledge, attitudes and practices regarding prehospital acute pain assessment and management among emergency care providers and (ii) current prehospital acute pain assessment and management practices in high acuity trauma patients. The final study employed qualitative research methods using focus groups and content analysis to explore and describe emergency care providers' perspectives of acute pain assessment and management as well as perceived barriers and facilitators to pain management. Main results: In the scoping review, six publications on acute pain research in the African prehospital setting were identified, indicative of the paucity and immaturity of this research area. In the cross-sectional online survey, suboptimal levels of knowledge and attitudes regarding pain (58.01%) were found among emergency care providers, with gaps in all aspects of pain knowledge and attitudes of distrust in self-reported pain identified. The retrospective review recorded pain scores were documented in only 18.1% of the high acuity trauma patients reviewed, while moderate-to-severe pain (78.6%) was prevalent among those who had a pain score documented. Less than 3% of all trauma patients, and less than 8% of those with moderate-to-severe pain received analgesic medication, thus, suggesting less than ideal prehospital pain assessment and management practices. In the final qualitative study, six focus groups and one interview were conducted among 25 emergency care providers. Through content analysis five themes, namely: assessing pain is difficult in this setting; many factors affect clinical reasoning some unique to this (hostile) setting; basic and intermediate life support practitioners' reality of prehospital pain care; the emergency centre does not understand what we do, how we work, what it is like; and how can we do better; emerged from the data. Conclusion: Africa has a scarcity of prehospital pain research with current evidence mainly from South Africa while knowledge of prehospital pain assessment and management in the Western Cape, South Africa proved to be a significant gap. This gap appears to be underpinned by limited educational focus, lack of pain prioritisation in emergency medical services (EMS) organisations, lack of clear evidence-based prehospital pain clinical practice guidelines, and emergency care providers' indifference towards prehospital pain care. A joint approach from EMS organisations and educational institutions, coupled with clinical practice guideline development, as well as interdisciplinary collaboration between prehospital emergency care and emergency medicine, are required. Further research must focus on developing the body of African prehospital pain knowledge to inform clinical practice and advance quality prehospital pain care.
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    Rapid sequence intubation: a survey of current practice in the South African pre-hospital setting
    (2020) Botha, Johanna Catharina; Stassen, Willem; Lourens, Andrit
    Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.