UWCScholar :: Browsing by Author "Nortje, Nico"

Browsing by Author "Nortje, Nico"

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The benefits of informed non-dissent when families have difficulty making a decision
(Université de Montréal, 2022) Nortje, Mila; Haque, Sajid; Nortje, Nico
Being a surrogate decision-maker is challenging for many people and having to decide to withdraw life sustaining therapies can be extremely difficult. Helping surrogates to refocus their decisions on informed non-dissent can greatly minimize unnecessary suffering for all involved. This case study describes how dignitary harm was minimized by using the concept of informed non-dissent.
Client confidentiality: Perspectives of students in a healthcare training programme
(Health & Medical Publishing Group, 2016) Nortje, Nico; De Jongh, Jo-Celene
BACKGROUND. Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties, as illustrated in keeping a patient’s medical information confidential, and having empathy with a family member’s need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students’ perspectives of confidentiality. METHODS. We aimed to explore healthcare students’ views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged. CONCLUSION. Confidentiality, as with other ethical principles, is an important obligation of a good client-therapist relationship as identified by students. However, the students’ responses illustrate that it cannot be absolute, and cognisance must be taken as to when it is acceptable, and even desirable, to override confidentiality because of conflicting, greater duties.
Cost of hospitalization associated with inpatient goals-of-care program implementation at a comprehensive cancer center: a propensity score analysis
(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Hui, David; Nortje, Nico; Huang, Yu-Ting
The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94).
Enhancing oncologists’ comfort with serious illness conversations: The impact of serious illness conversation guide (sicg) training
(Springer, 2024) Nortje, Nico; Adaji, Enefe; Johnson, Monica
Providers oftentimes need to have difficult conversations with patients facing a poor prognosis. Research indicates that providers generally feel ill prepared for these conversations and that bad conversations may lead to more anxiety for patients. Communication skills development training programs have shown improvement in providers’ skills. Our cancer center embarked on skills development training to help providers improve their skills and comfort in having serious illness conversations. During our phased approach, about 500 physicians and advanced practice providers in the Division of Oncology were trained for over a year. Their level of comfort with serious illness conversations was measured before and after the training by using both quantitative and qualitative methods. We found that mean and median comfort scores increased from pre-training to post-training. The findings suggest that the improved comfort and confidence observed among providers who undergo communications skills training can lead to better provider-patient communication, more patient-centered care, and improved patient satisfaction.
Ethical misconduct by registered physiotherapists in South Africa (2007– 2013): A mixed methods approach
(PubMed, 2015) Nortje, Nico; Hoffmann, Willem A
Background: The role of ethics in a medical context is to protect the interests of patients. Thus, it is critically important to understand the guilty verdicts related to professional standard breaches and ethics misconduct of physiotherapists. Aim: To analyse the case content and penalties of all guilty verdicts related to ethics misconduct against registered physiotherapists in South Africa. Methods: A mixed methods approach was followed consisting of epidemiological data analysis and qualitative content analysis. The data documents were formal annual lists (2007–2013) of guilty verdicts related to ethical misconduct. Quantitative data analysis focused on annual frequencies of guilty verdicts, transgression categories and the imposed penalties. Qualitative data analysis focused on content analysis of the case content for each guilty verdict. Results: Relatively few physiotherapists (0.05%) are annually found guilty of ethical misconduct. The two most frequent penalties were fines of R5000.00 and fines of R8000.00 – R10 000.00. The majority of transgressions involved fraudulent conduct (70.3%), followed by performance of procedures without patient consent (10.8%). Fraudulent conduct involved issuing misleading, inaccurate or false medical statements, and false or inaccurate medical aid scheme claims.
Operational framework for rural hospitals during a pandemic
(Taylor and Francis, 2021) Nortje, Nico; Jones-Bonofiglio, Kristen; Haque, Sajid
It is now evident that a second wave of the COVID-19 pandemic has developed. The unfortunate reality is that those in rural areas may be impacted the hardest. Ethical decision making may look the same for rural areas as urban areas, but this is far from accurate. This practice article is focused on why the challenges are different and how rural hospitals might manage their unique circumstances and constraints. A step-wise decision-making framework is also proposed.
A practical approach to hospital visitation during a pandemic: Responding with compassion to unjustified restrictions
(American Association of Critical Care Nurses, 2021) Jones-Bonofiglio, Kristen Dawn; Nortje, Nico; Webster, Laura Bentley
During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals’ policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-oflife care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. A family-centered approach to care has been unilaterally relinquished to a secondary and nonessential role during the current crisis. This phenomenon violates a foundational public health principle, namely, to apply the least restrictive means to achieve good for the many. Instead, there has been widespread adoption of utilitarian and paternalistic approaches. In many cases the foundational principles of palliative care have also been neglected. No circumstance, even a global public health emergency, should ever cause health care providers to deny their ethical obligations and human commitment to compassion. The lack of responsive protocols for family visitation, particularly at the end of life, is an important gap in the current recommendations for pandemic triage and contingency planning. A stepwise approach to hospital visitation using a tiered, standardized process for responding to emerging clinical circumstances and individual patients’ needs should be considered, following the principle of proportionality.
Professionalism – A case for medical education to honour the societal contract
(Occupational Therapy Association of South Africa, 2017) Nortje, Nico; De Jongh, Jo-Celene
BACKGROUND: This study explores the concept of professionalism from the vantage point of a cohort of students as well as professionally qualified and practising occupational therapists. With the changes health care delivery is experiencing nationally as well as internationally, there is an urgent need to identify students and qualified professionals’ expectations of what influences the development thereof, as well as elicit perceptions of attributes which contribute to professionalism. METHODS: The study is primarily a descriptive study with a specific focus on a mixed method of quantitative and qualitative research designs, using interpretative phenomenological analysis methodology. Data were gathered from 56 final-year and 55 professionally registered occupational therapists, who participated in a pen-and-paper questionnaire consisting of three sections. RESULTS: The results of this study indicated a clear differentiation between the influence of both the formal and hidden curricula and that clinical competence, client-centred practice and professional standards contributed mostly to professional behaviour. CONCLUSION: This study brings to light the experiences of students and professional practitioners to what they expect would influence the professional conduct. The findings are open to theoretical generalizability and raise issues that may be used by academic staff in the preparation of students to become more professional, as well of future Continuous Professional Development training.
School tuck shops in South Africa—an ethical appraisal
(MedPharm Publications, 2017) Nortje, Nico; Faber, Mieke; De Villiers, Anniza
It can be postulated that schools have an ethical responsibility to protect children from an unhealthy food environment. Against the backdrop of stunting, overweight and micronutrient deficiencies prevalent in South African children, the aim of this scoping study is to review information available on foods sold to school children within an ethical framework. While some schools have a formal tuck shop, at other schools, food vendors sell food either on or outside the school premises. Ten studies, of which two were national, fit the selection criteria for this study. Available data show that mostly unhealthy food options are sold to South African school children; with low-nutrient energy-dense foods (e.g. chips, sweets) and sugar sweetened beverages being the most popular. The Integrated School Health Policy provide a policy framework for achieving healthy school food environments in South Africa, and several guidelines are available in South African to assist school tuck shops to sell healthier options. Children’s preference for unhealthy foods, the cost of healthier food options and a lack of proper facilities may however be barriers for implementing healthy tuck shops. An action stronger than merely providing guidelines may therefore be needed. Cognisance needs to be taken of conflicting value based arguments within ethical perspectives. Given these conflicts, the authors argue that an Ethics of Responsibility contributes to the debate of the best and supports the notion that society at large has a responsibility to protect vulnerable communities of which school children are part. Presently an ethical vacuum exists in terms of rights and responsibilities which this study hopes to address.
Seven year overview (2007-2013) of ethical transgressions by registered healthcare professionals in South Africa
(AOSIS, 2016) Nortje, Nico; Hoffmann, Willem
A move has taken place internationally in the delivery and "consumption" of health care where if clients and patients (health care consumers) hold the opinion that the health care professionals/providers' behaviour has had a negative effect, impact or outcome on them, they may lodge a complaint with the relevant health professional regulatory body. Ethical transgressions of health care providers can generally be clustered into the following three categories: a) Competence and conduct with clients (e.g. abandonment, sexual intimacies, dishonesty, disclosure of information); b) Business practices (e.g. billing, reports, documentation); and c) Professional practice (e.g. referral upon termination, obtaining appropriate potential employment opportunities, nonprofessional relationships). The primary objective of this study was to analyse the ethical transgressions of registered members of the twelve professional boards in the Health Professions Council of South Africa (HPCSA) in the period 2007 to 2013. A mixed methods approach was followed in this study which specifically focused on a historical research approach. The results indicate that the boards with the highest number of transgressions per the registered practitioners were firstly the Medical and Dental practitioners, closely followed by the Optometry and Dispensing Opticians Board. The predominantly complaint made against members of both these boards was for fraudulent conduct (collectively totalling to 85% of all fraudulent cases during the period) and included actions such as charging for non-rendered services, issuing false statements and submitting fraudulent medical aid claims. Cognisance needs to be taken that the South African public will increasingly demand better services and that since they are being better informed via the media of their rights and have access to a broader database of knowledge (rightly or wrongly so the internet) practitioners' opinions will not necessarily be accepted outright and that they (the public) will challenge it accordingly. This raises the concern that practitioners need to take on the responsibility to communicate with their patients/clients in order to educate them and keep them informed.
The perception of measures to reduce the push factors of juvenile crime in South African schools: A Case study of two schools
(University of the Western Cape, 2018) Matsilele, Justice; Nortje, Nico; Erasmus, Charlene
The African Charter on the Rights and Welfare of the Child (2000) emphasizes that all actions which pertains to children should be in their best interest and this includes the welfare of learners in schools. This study sought to explore the perception of measures to reduce the push factors of juvenile crime in two South African schools. A Social Learning Theory was employed as the theoretical lens for this study and a qualitative case study approach, which is explorative and descriptive in nature, was also used. An interview schedule was used to collect data focusing on in-depth interviews and focus group discussions with participants as well as key informants. Convenience sampling, which is a non- probability type of sampling that entails the selection of samples based on their convenience and accessibility was used given the sensitive aspect of this particular study, especially on the identification of research participants. A sample of seven focus groups consisting of seven participants was drawn from the entire population of two selected schools in order to have a minimum of 49 representatives from each school. Audio recordings and transcribed verbatim were analyzed by the researcher as data collection technique. A thematic analysis, which looks across all data to identify common issues and recurring themes, was used. This research sought to be ethically considerate, adhering to codes such as confidentiality, informed consent, voluntary participation and others. Findings indicate that five crimes (substance use, stealing, bullying, physical fights and gangster activity) identified as recurring themes during the general preliminary investigation of juvenile crimes were also identified as common crimes at the two selected schools. Another observation in this study was that school juvenile offenders are generally cognisant of push factors of juvenile crime in schools, but are less informed when it comes to assimilating push factors with measures to reduce juvenile crimes.
Treating an intervention level 1 patient: futile or brave?
(Medpharm Publications (Pty) Ltd, 2013) Solomons, Nasheetah; Nortje, Nico
An ethical dilemma describes conflicting opinions by different members of the care team. This article focuses on AJ, a five-year-old child with cerebral palsy, who was born deaf and blind as a result of having contracted rubella in utero. The case is examined against Sokol’s four-quadrant analysis of ethical issues, giving a framework designed to facilitate the systematic identification and analysis of clinical ethical problems. The issue is whether the medical team should have palliated AJ, or continued with invasive therapy and feeding. The conclusion is that paediatric palliative care is often difficult, but that the dietitian has a duty to contribute his or her knowledge to benefit the patient.

Browsing by Author "Nortje, Nico"

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