Volume 71, November 2023, 101379Author links open overlay panel, , , , AbstractBackground

Registered nurses are primary care providers during most patient transfers from rural areas. Various local conditions and circumstances impact the provision of nursing care prior to and during transportation. These include clinic staffing, uneven access to functioning equipment and other necessary infrastructure across settings, the wide-ranging clinical need for specialty care, and complex social and interpersonal circumstances that play a role in care-seeking and transport decision-making. This study explored the experiences of nurses with emergency patient transport in rural health facilities in Botswana.

Method

A qualitative descriptive approach was used using a semi structured interview. Twenty-six registered nurses from four remote, isolated rural health districts in Botswana participated in this study. Purposive convenience sampling technique was employed.

Results

The ten main themes under transporter were infringement of scope of practice, inadequate knowledge and skills, distressful practice, restriction from making decisions, challenges with staffing, Ineffective facilities clustering, lack of support from the managers, shortage of technology and tools, non-enabling infrastructure, and transport related tasks.

Discussion and Conclusion

The perceived ineffective emergency transfer of patients was associated with work system shortfalls. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance of patient transport.

Section snippetsBackground

Botswana ascribes to the Universal Health Coverage mandate treasured in the Sustainable Development Goal [1] and emergency treatment is an essential aspect of universal health coverage. Primary care must connect emergency care services to communities through communication, transportation, and referral channels for integrated people-centered service delivery. Critical shortages, inadequate skill mixes, and uneven geographical distribution of the health workforce, supplies and medications pose

Conceptual framework

The Systems Engineering Initiative for Patient Safety (SEIPS) model, published in 2006, builds on the Donabedian model and integrates it with Carayon and Smith (1989) work system model by expanding the structure component to include aspects of the work system and patient, employee, and organizational outcomes. [21]. This model was developed by Carayon and Smith in 2006 [21], [22].

The ontological and epistemic claims of the SEIPS model reflect one main worldview, balance. The SEIPS model

Results

In total, 26 nurses were interviewed, and only one of the recruited participants could not be interviewed because the potential participant needed to transfer the patient further to a higher level of care. More participants were female (61.5 %), and 57.7 % were from health posts compared to clinics. Most (53.8 %) participants were aged between 30 and 40. Most (76.9 %) of the participants had a diploma in nursing, and 23 % had a post-basic qualification. See Table 1. A higher percentage of

Discussion

This study explored the experiences of nurses with emergency patient transport in rural Botswana. The results of this study were consistent with five of the work components of the SEIPS model. This study confirmed that effective emergency patient transport is affected by components in the transport nurse's work system, which includes the five work elements of the SEIPS model: person, tasks, technologies and tools, environment, and organizational factors [21]. Patient transfers from rural

Limitations

Only nurses were interviewed; however, other personnel involved in patient transport, such as drivers and health care auxiliaries' perspectives, would have been beneficial in understanding emergency patient transport. The interviews were conducted in the private room at the receiving facility; it would have been great to conduct interviews at the participants' preferred location, most likely in their workplace, because that is the natural environment where most of the phenomenon's experiences

Conclusion

This study explored the experiences of rural nurses undertaking emergency patient transport. The effective emergency patient transport is affected by components in the transport nurse's work system, which includes the five work elements of the SEIPS model. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance.

Funding.

This study has received funding from the University of Botswana.

CRediT authorship contribution statement

Tebogo T. Mamalelala: Conceptualization, Data curation, Formal analysis, Writing – review & editing. William Holzemer: Conceptualization. Esther S. Seloilwe: Supervision, Formal analysis, Writing – review & editing. Emilia Iwu: Supervision. Mary Kamienski: Supervision.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors would like to thank the nurses at the study sites who participated in the interviews and shared their experiences.

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