Healthcare providers in emergency departments encounter victims of violence and crime daily. Such victims of violence and crime enter emergency departments in need of medical attention, and they carry forensic evidence on their bodies. Healthcare providers offer medical attention, but, in the process, they may inadvertently destroy forensic evidence this may later deny a forensic patient the right to justice. The guidance available to healthcare providers in their training is often unclear, and the legislation and policies on forensic care are somewhat ambiguous, and are left open to the interpretation of the healthcare providers. In this context, this research provides insight into how emancipatory practice development transformed forensic care in three level-one emergency departments in Gauteng, South Africa. The research approach used was action research, in a critical realist paradigm. An emancipatory practice development conceptual framework was applied. The study was conducted with the participants, using collaborative, inclusive and participatory processes. The research commenced with an exploration and explanation of the existing forensic care practised in emergency departments. Then the actual and expected forensic roles and responsibilities were explored with healthcare providers. Next, action plans were developed and implemented. Finally, the outcomes of the research were collaboratively evaluated. The findings indicated that limited forensic care was already being provided at the time of the study. The research increased awareness of forensic care in the participating departments, as healthcare providers took the initiative to preserve evidence better, making use of the knowledge and resources acquired while participating in the research. The participants pointed out that the emancipatory practice development process followed required outsider initiation, combined with sustained support and fostering of relationships. Finally, they indicated that the research process had connected the research to the practice for them. This study demonstrated that emancipatory practice development may increase awareness of forensic care, and may encourage the healthcare providers involved to take ownership. It may simultaneously contribute to changes in existing practice. Based on the findings, healthcare providers' forensic roles and responsibilities were structured into a framework to guide their practice. Furthermore, the steps taken to follow a systematic approach, as required by the emancipatory practice development conceptual framework, have been clarified this may provide some guidance to other researchers who wish to use the same process. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)