Transforming Forensic Care in Level-One Emergency Departments in Gauteng through Emancipatory Practice Development

Violence and crime are escalating worldwide with South Africa as the eighth violent country in the world. Although death is often the outcome of violence many more victims survive the incident and seek medical attention in emergency departments. Therefore every patient in the emergency department is a forensic patient until otherwise proven. Healthcare providers – doctor or nurse - in the emergency departments however are inadequately prepared to recognize and care for the forensic population. Healthcare providers as custodians of human rights should be able to assist the criminal justice system to corroborate versions of statements provided to the police with the evidence found on the victim. The contributions made by the healthcare provider can assist with the realization of the human right to justice. The aim of the study was to transform forensic care in level-one emergency departments in Gauteng South Africa through emancipatory practice development.

In order to transform the forensic care, emancipatory practice development that emphasizes collaboration, inclusion and participation with action research was used as the methodology for this study. Emancipatory practice development staged the three phases of the study making healthcare providers aware of the changes that are required, acquiring information to act on the changes needed and to take action to change their practice in the work context. To start the process access to the level-one emergency departments were negotiated, informed consent was obtained, practice development facilitators volunteered per emergency unit, communication platforms was established and the terms of engagement was discussed. Afterwards a values and beliefs clarification was done with the nurses as they were the key drivers of the study in the emergency departments. The values and beliefs clarification was done to ensure that a shared vision was declared in an effort to enhance collaborative action. Action taken and learning that took place happened, in and from practice using systematic approaches to monitor and evaluate the progress made by the healthcare providers. Practice development facilitators were trained on using the talking wall, the modified nominal group technique, critical conversations and reflection to identify problems and start developing their practice within their own practice contexts. Data was analyzed through the utilization of the DEPICT model for collaborative data analysis.

Negotiating access took longer than initially anticipated and though no one opposed the study the healthcare providers were skeptical at the start. They were weary of the ideas that the research will be done with them and not on them as well as that they would had to take responsibility for the research in their departments. The values and belief clarification was an valuable exercise as it provided a shared vision and opened the floor for other important conversation needed for a conducive working environment. The practice development facilitators of one of the level-one emergency department used the data collection techniques to solve other issues in their unit with success.

Nurses working in the emergency department are so busy with their everyday practice that they can become desensitized to the changes that are required. All the healthcare providers involved in the study acknowledged that forensic care was a problem and mostly the nurses took responsibility and participated. Nurses are not used to being responsible for research as they are mostly just participants being studied and are rarely given direct feedback after a study is completed. Even though the start of the research was slow as the study progressed at least the practice development facilitators started taking on bigger responsibility for their part of the study. Nurses in practice need to be emancipated to enable them to research their own practice and reap the fruits of their initiative.