Browsing by Subject "Audiologists"

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    Open Access
    Audiologists' perceptions of ethical climate and level of moral distress in the provision of amplification services in South Africa
    (2024) Budden, Anne; Rogers, Christine
    Moral Distress (MD) has attracted significant attention among researchers, with most research focused on nurses. South Africa has an unequal distribution of resources between the public and private healthcare sectors. Private practices depend on hearing aid sales to generate income, making the profession vulnerable to ethical concerns, which may affect the ethical climate and lead to MD. In public services provided by the state, audiologists have inadequate resources and funding; therefore, only some patients who warrant a hearing aid receive one, likely causing ethical and moral tensions. MD has negative consequences for professionals such as compassion fatigue, poor physical and psychological well-being, work dissatisfaction, turnover of staff, early retirement, and absenteeism. For patients, the consequences of MD can negatively influence service delivery, patient care, and satisfaction. Ethical climate or environment refers to shared perceptions of what is considered the right behaviour in an organisation when ethical standards need to be upheld and ethical reasoning is required. There is limited research on the level of MD among Hearing Healthcare Professionals (HHPs) and their perceptions of the ethical climate in their workplace, especially in developing countries, as most studies focusing on HHPs were conducted in well-resourced healthcare settings. This study aimed to close the gap in the literature and contribute to the existing global body of MD and ethical climate research among HHPs. An exploratory sequential, mixed-method approach was used to conduct a rigorous and methodologically sound study and reduced potential biases which arise from single data collection methods. Phase one included an online questionnaire consisting of a demographic questionnaire, the Moral Distress Appraisal Scale (MD-APPS), which measured the level of MD among HHPs, and the Ethics Environment Questionnaire (EEQ), which measured HHPs' perceptions of ethics within their workplace. Phase two comprised of online semi-structured interviews to obtain descriptive data about HHPs' perceptions and past experiences of MD and the ethical climate in their workplace. Quantitative data were analysed using one-way ANOVAS, linear regression tests, and Pearson correlation. Qualitative data were analysed via thematic analysis. Triangulation enabled the research question to be explored from different angles and strengthened the validity and reliability of the findings. Eighty-four HHPs completed the questionnaires, most of whom (59) worked in the private sector, and the remaining 25 worked in the public sector. The majority of respondents (44%) were relatively new to clinical practice with less than five years' experience. Seventeen participants participated in phase two. Again, most (14) worked in the private sector, of whom, five were private practice owners. Outcomes of the study indicate that most n=80 (80%) HHPs experienced no to mild levels of MD, and all HHPs perceived their ethical work environment as either neutral or positive. Interestingly, whether they worked in the public or private sector did not influence the ratings of ethical climates with a p-value of 0.1. Workload impacted perceptions of MD and ethics in the workplace, with participants experiencing high caseloads of (≥ 9 patients/ day) reporting higher levels of MD and perceived their work environment as poorer compared to those who saw between 0-5 and 6-8 patients per day. Most HHPs felt comfortable discussing their concerns with management and sought advice from colleagues rather than professional bodies. As expected, a negative linear relationship (r=-0.34) was found between MD and EEQ scores, therefore, participants who experienced higher levels of MD perceived their ethical work environments more poorly than those with lower MD scores. Age and gender did not impact levels of MD or the way in which HHPs perceived their ethical work environments; however, with more years of experience, participants reported lower levels of MD, which may suggest that work experience enables the development of moral resilience. HHPs with more work experience may also have a larger network of supportive colleagues. Work experience enabled HHPs to navigate ethical issues, while university ethics training was reported insufficient for the workplace. The interviews with respondents suggested that obstacles and external constraints which HHPs had to navigate included lack of support from professional bodies, disagreements clinical practice guidelines, expectations to achieve financial targets, and pressure to buy bulk and fit hearing instruments from certain hearing aid manufacturers. Issues related to patients concerned high caseloads, patient finances, and dealing with medical insurance companies. This research study explored MD levels among HHPs and the perceptions of their ethical work environment. Quantitative data showed HHPs experienced no to mild levels of MD and perceived their ethical work environment as neutral to positive; however, qualitative data raised additional concerns. For example, and of relevance for both training curricula and continuing professional education purposes, personal semi-structured interviews raised the need for more advanced ethics training to address dilemmas that are unique to the public and private healthcare sectors. This study hoped to start conversations with HHPs concerning MD and the ethical climate in their workplaces. Future research about MD interventions and ways to improve ethical climates could prevent adverse consequences as well as benefit HHPs and the population seeking hearing healthcare
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    Open Access
    Sustainable workforce: South African Audiologists and Speech Therapists
    (2020-07-01) Pillay, Mershen; Tiwari, Ritika; Kathard, Harsha; Chikte, Usuf
    Background Audiologists and Speech Therapists play a vital role in addressing sustainable development goals by supporting people who are marginalised due to communication challenges. The global burden of disease and poor social living conditions impact negatively on the development of healthy communication, therefore requiring the services of Audiologist and Speech therapists. Against this background, we examined the demographic profile and the supply, need and shortfall of Audiologists and Speech Therapists in South Africa. Methods The data set was drawn from the Health Professions Council of South Africa (HPCSA) registers (for 2002–2017) for the speech, language and hearing professions. This demographic profile of the professions was created based on the category of health personnel; category of practice, geographical location, population group (race) and sex. The annual supply was estimated from the HPCSA database while the service–target approach was used to estimate need. Additional need based on National Health Insurance Bill was also included. Supply–need gaps were forecast according to three scenarios, which varied according to the future intensity of policy intervention to increase occupancy of training places: ‘best guess’ (no intervention), ‘optimistic’ (feasible intervention), and ‘aspirational’ (significant intervention) scenarios up to 2030. Results Most (i.e. 1548, 47.4%) of the professionals are registered as Audiologists and Speech Therapists, followed by 33.5% registered as Speech Therapists and 19.1% registered as Audiologists. Around 88.5% professionals registered as Audiologists and Speech Therapists are practising independently, and 42.6% are practising in the Gauteng province. The profession is comprised majorly of women (94.6%), and in terms of the population groups (race), they are mainly classified as white (59.7%). In 2017, in best guess scenario, there is a supply–need gap of around 2800 professionals. In the absence of any intervention to increase supply capacity, this shortfall will remain same by the year 2030. By contrast, in aspirational scenario, i.e. supply is increased by 300%, the forecasted shortfall for 2030 reduces to 2300 from 2800 professionals. Conclusions It is clear that without significant interventions, South Africa is likely to have a critical shortfall of Audiologists and Speech Therapists in 2030. Policy-makers will have to carefully examine issues surrounding the current framework regulating training of these and associated professionals, in order to respond adequately to future requirements.