Browsing by Author "Naidoo, Navindhra"

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    Gender-based violence: strengthening the role and scope of prehospital emergency care by promoting theory, policy and clinical praxis
    (2017) Naidoo, Navindhra; Artz, Lillian; Martin, Lorna J
    Gender-based Violence has a considerable prevalence globally, but it is South Africa that has recorded the highest femicide rate in the world. Prehospital Emergency Care providers appear to be well positioned (as first responders) to respond to abuse early. The aim was to understand and strengthen current/potential practice of domestic violence intervention by prehospital emergency medical systems in the context of global health-sector responses. The paradigm was critical theory and the methodology was exploratory sequential mixed methods. Interviews with managers/policy-makers, focus group discussions of clinician-educators and non-participant observation of simulated practice resulted in hypothesis generation. The quantitative phase involved a survey and cohort study with a screening intervention in a public emergency service. The qualitative phase found challenges and threats to responses require organisational/ideological change as paradoxical practice exists relative to the domestic violence behavioural pathology. Further, role-definition, identity and violence re-contextualisation is needed amidst ambivalent and contradictory positions. Emergent theoretical propositions include: typologies of victims, perpetrators and stakeholder responses; an eco-systemic relationship of state/societal expectations; and a 'conceptual compass' for preventing systemic research bias. The cohort study found bio-psycho-social responses and prehospital screening for domestic violence effective and that the evaluation of prehospital met/unmet need was prudent. The historical domestic violence detection rate was found to be 5,1/1000. A nine-fold increase in detection following the screening training and implementation translated to 47,9/1000 emergency care patients, with no adverse events. These rates are unprecedented for South African emergency care and support screening-policy implementation. The difference in domestic violence detection, quantifies the extent of the practice gap, with an alarming missed case detection of 42,8 per 1000 patients (females, 14 years plus). Conceptualisation of the emergency care burden of domestic violence and an awakening to the unacceptability of current practice is warranted. There is a risk of regulatory and organisational 'capture' mediated by masculine hegemony and resuscitation bias. Professionalization should enable a community of practice approach to violence prevention. Recommendations include the national implementation of screening policy; mitigation of regulatory capture risk and professionalising responses through curriculum-reform. The proposed Risk-Need-Responsivity practice-model promotes clinical coherence in Emergency Care. This elevation of the emergency care discourse is likely to benefit the victim and emergency medicine community. Research is warranted in the evolving epidemiology of domestic violence, the acute/clinical needs of victims/perpetrators and the role of emergency medical systems and surveillance, in promoting health and preventing the associated morbidity/mortality, both as a forensic emergency care burden and as a social determinant of health.
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    Open Access
    Shaping the undergraduate pain management curriculum in prehospital emergency care education: toward a curriculum and competency framework for South Africa
    (2025) Matthews, Ryan; Hodkinson, Peter; Naidoo, Navindhra
    Introduction: Managing patients' pain is a common necessity in Prehospital Emergency Care. Research evidence suggests that pain and nociception are not optimally managed by Emergency Medical Services. One reason for this suboptimal management may be education that is misaligned with clinical and contextual needs. The knowledge gap is that Prehospital Emergency Care has not systematically developed evidence-informed competencies for pain management. Aim: This research aimed to develop a competency framework and provide recommendations for curriculum implementation to shape and guide the design of contextually relevant pain management curricula in South African Prehospital Emergency Care education. Methods: Subsequent to a narrative analysis of pain discourse, the research employed a scoping review of therapies to identify quality and therapeutic possibilities as evidentiary basis for competencies. Semi-structured interviews with educators explored contemporary education practice and documented knowledge broker perspectives on educational needs through thematic analysis. The initial competency framework was inductively derived from the above analyses. Content analysis of contemporary curriculum documents mapped key graduate attributes and identified deficient or absent learning intentions and related success criteria. An expert consensus panel provided critical input into the draft competency framework and made recommendations toward curriculum implementation. Findings: Contemporary curricula are fragmented and misaligned with pain assessment and management needs. Seven competency domains (given expression to by specific competency statements) should guide curriculum development: 1. Clinical Pain Praxis, 2. Foundational Sciences, 3. Practitioner Wellness and Safety, 4. Communication and Collaboration, 5. Duty of Care and Predisposition for Caring, 6. Ethical Practice, and 7. Scholarship. The expert panel made ten recommendations for implementing the framework in curricula, including the use of a ‘spiral' curriculum, focusing on the multidimensional nature of pain, and building relationships with clinical mentors. Conclusion: The novel output of the study is an evidence-based competency framework, compatible with micro credentialing or for local adaptation and progressive inclusion into emergency care curricula. This framework redresses the practice difficulties experienced by key stakeholders and enables higher education institutions and professional regulators to comprehensively and inclusively guide education providers in the noble pursuit of quality and equity in pain assessment and management across the lifespan and across clinical acuity and pain causation.