Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers

INTRODUCTION

Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers.

METHODS

A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9).

RESULTS

Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system.

CONCLUSION

Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges.

IMPLICATIONS FOR PRACTICE

There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

Exploring the implementation of role extension for Namibian radiographers: Perspectives on intravenous injection of contrast media

INTRODUCTION

Role extension to include intravenous (IV) injection of contrast media has been formally embraced by radiographers and their regulatory bodies in developed countries. The revised scope of practice, in our Namibian context, has formalised IV injection as an extended role for radiographers. This study aimed to explore the perspectives of radiographers regarding this new role of IV injection of contrast media.

METHODS

A qualitative design with a descriptive phenomenological approach was employed to collect data from 15 radiographers working in both public and private radiology facilities. Participants were purposively selected to participate in focus group discussions and individual interviews. An interview guide was used to facilitate the discussions and interviews, and a voice recorder was used for recording. Data were transcribed verbatim and analysed using Tesch's 8-step method.

RESULTS

From the 15 participants, three themes were developed: enhanced service delivery with two subthemes (improved departmental workflow and patient care), training needs with two subthemes (inadequate contrast media reaction training and standardised training requirement), and medical-legal issues with two subthemes (regulatory blurriness and role conflict distress).

CONCLUSION

The participants expressed mixed perceptions towards the IV injection role of radiographers, emphasising the benefits for the department and patients while raising concerns regarding standardisation of training and associated medico-legal issues. Furthermore, a large-scale evaluation is necessary to uncover the challenges and barriers to the successful adoption of this new role.

IMPLICATIONS FOR PRACTICE

The role extension for radiographers to include IV injections is a long-awaited development, but it should be accompanied by the necessary training and guidelines to fully realise its benefits.

Preparedness to assume professional roles: experiences of recently qualified radiographers: A qualitative study

INTRODUCTION

Recently qualified health workers including radiographers struggle with workplace integration. Similarly, in our local context, undocumented complaints were received from the various heads of departments and radiologists regarding recently qualified radiographers' ability to fully assume their professional roles. In light of the complaints, this study sought to explore and describe the lived experiences of recently qualified radiographers from one local University on their readiness to assume their professional roles.

METHODS

A qualitative, descriptive research design with a phenomenological approach was used to conduct the study. Ten (10) diagnostic radiographers who graduated between 2018 and 2020 from the local university were sampled using the snowball sampling technique. Telephonic interviews were conducted using a semi-structured interview guide. Data were analysed using Tesch's open coding method.

RESULTS

The findings of this study have shown a combination of positive and negative experiences by recently qualified radiographers. The positive experiences (satisfactory work engagement) emanate from increased confidence and creativity, responsibility consciousness and teamwork. Negative experiences (reality shock and professional role conflict) emanated from excessive workload, patient care impediments, the burden of student supervision and lack of professional trust.

CONCLUSION

Though the recently qualified radiographers from our local University experienced some contextual challenges upon assuming their professional roles, they appeared well-prepared for their clinical roles. Standardised induction and mentorship programmes should be implemented to facilitate the transition process from student to qualified radiographer.

Writing for reflection: Radiography students' experiences with reflective journaling

INTRODUCTION

Reflective journaling is a widely recognised method of engaging in reflective practice, whereby individuals document their critical analysis of past experiences or actions, focusing on the implications and lessons learned for future application. In radiography and other healthcare professions, reflective practice is considered essential for professional development and should be cultivated during training. This study aimed to explore the experiences of senior radiography students in utilising the reflective journal as a clinical learning tool.

METHODS

This study employed a phenomenological research design, with the study participants being third and fourth-year radiography students. Data collection took place after the introduction of reflective journaling, with nineteen participants having utilised the reflective journal daily, for a minimum of eight months. Individual interviews were conducted after obtaining the participants' consent. The collected data were analysed using Atlas. ti (version 9.3), guided by the content analysis framework.

RESULTS

The study revealed that participants experienced adaptation, characterised by reflective adaptation and process adaptation when utilising the reflective journal. Participants also encountered reflective barriers, including personal expression bias, inconsistent feedback, rumination overload, and impulsive practice dominance.

CONCLUSION

The findings demonstrate the benefits of reflective journaling in promoting critical thinking and reflective practice among radiography students. It is therefore recommended that this practice be fully embraced as a standard clinical component. Additionally, the frequency of reflections should be reviewed to ensure effectiveness and consistent feedback should be provided to enhance skills development.

IMPLICATIONS FOR PRACTICE

The findings contribute further evidence to support the incorporation of reflective journaling in clinical training to promote critical thinking and reflective practice.

Radiographers' experiences of image interpretation training in a low-resource setting

INTRODUCTION

Radiographers extend their roles through formal and on-the-job training to keep up with clinical practice changes. One area of role extension that is now incorporated into undergraduate programmes is image interpretation, although the training provided may vary between institutions. This study explored the experiences of graduates from one higher education institution in a low-resource context with regard to their image interpretation training.

METHODS

A qualitative phenomenological research design was employed to investigate the experiences of ten radiography graduates who were purposively selected from one higher education institution. Individual semi-structured interviews were conducted with each participant after obtaining their informed consent. The interview recordings were transcribed and analysed using Atlas.ti Windows (Version 9.0) software, following Colaizzi's seven-steps of data analysis.

RESULTS

From the ten interviews conducted, teaching approach, clinical education, and assessment strategy emerged as areas of experience within the teaching and learning theme, while practitioner role modelling, skill utilisation, and industry impact were sub-themes under the paradoxical reality theme. The participants' experiences indicated a theory-practice gap in image interpretation among radiographers.

CONCLUSION

The participants' experiences reflected a misalignment in the educational process due to inadequacies in the teaching approach, clinical education, and assessment strategies. Participants encountered significant differences between their expectations and clinical realities during and after training. Image interpretation by radiographers was recognised as a relevant area for role extension in this low-resource setting.

IMPLICATIONS FOR PRACTICE

While these findings are specific to the experiences of the participants, conducting similar research in comparable contexts and implementing competency-based image interpretation assessments could help identify gaps and guide interventions to address shortcomings.

Knowledge, attitude, and practices of infection prevention and control among radiographers in a resource constraint setting in Namibia

Background

Radiographers' role as healthcare workers places them at constant risk for hospital-acquired infections. Practical, evidence-based methods are necessary to reduce the transmission of pathogens to and from patients and healthcare workers.

Objective

The main objectives of this study were to determine knowledge, attitude, and practice levels regarding infection prevention and control (IPC) strategies among radiographers in Windhoek and Oshakati, and measure their relationships with other variables.

Method

A quantitative descriptive design was employed. To assess the knowledge, attitude, and practice levels among radiographers, a self-administered questionnaire was used. Twenty-seven radiographers took part in the study, producing a 68% response rate.

Results

The study revealed that the majority of the radiographers showed an appropriate level of overall knowledge and attitude toward infection prevention and control. However, the majority of their practice levels were poor. Pearson rank correlation test revealed that the radiographers' knowledge was significantly associated with attitudes (P= 0.004; r=0.53) and practices (P=0.03; r=- 0.41) with a moderate positive and negative correlation, respectively.

Conclusions

In conclusion, the study revealed that radiographers are knowledgeable about IPC strategies, and have good attitudes toward them. However, their practice was poor and inconsistent with the level of knowledge demonstrated. Therefore, it is recommended that healthcare service managers establish efficient and rigorous means of monitoring adherence to IPC strategies and improving practices to reduce incidences of health-acquired infections among radiographers, especially in the age of a pandemic.

Justification of radiological procedures: Radiographers' experiences at two public hospitals

BACKGROUND

Justification is a process conducted by the radiographer in consultation with the radiologist to evaluate radiological procedures ordered by doctors. The main purpose for justifying all radiologic procedures is to assess the benefits and risks of a requested radiographic procedure and determine whether exposure will continue. Furthermore, justification helps to prevent unnecessary radiation exposure and reduce the chances of harmful effects of ionizing radiation.

OBJECTIVES

The study aimed to explore the experiences of radiographers regarding the justification of radiological procedures at two public hospitals in Namibia METHODS: This study made use of a qualitative, exploratory design. A total number of 13 purposefully selected radiographers from radiology departments in two tertiary public - hospitals in Namibia were interviewed using a semi-structured interview guide and audio recorder. All interviews were conducted face-to-face until data saturation was achieved. Data were analysed using Atlas.ti Windows (version 9.0 using Tesch's 8-step method of qualitative data analysis to generate themes and subthemes.

FINDINGS

The participants experienced an enhancement of patient care through enhanced radiation protection and optimised patient care. They also experienced defunct communication systems through deficient communication between radiographers and referrers, professional role conflict and incomplete referrals.

CONCLUSION

The study revealed that the justification of radiological procedures was linked to both negative and positive experiences. Enhanced patient-centred care was a positive experience related to the radiographers' job responsibilities. The defunct communication support system was a negative experience as it related to the limited availability and utilisation of communication systems that are meant to enhance and support justification by radiographers. The study recommends an in-depth study to quantify unjustified procedures in these two hospital departments. Continuous professional development focusing on justification and referral protocols must be conducted jointly between radiographers and referrers to create awareness and a platform for shared decision-making models.

Radiation risk-benefit communication during paediatric CT imaging: Experiences of radiographers at two public hospitals

INTRODUCTION

Radiation dose knowledge and effective communication skills are essential for both radiographers and radiologists to be able to appropriately fulfil their legal responsibilities to justify each medical exposure. Furthermore, they enable the optimisation of imaging protocols and techniques according to the child's characteristics and underlying clinical conditions. Previous studies have shown that radiographers do not provide paediatric patients and their parents/guardians with adequate information about doses and risks before a procedure. However, they have a legal responsibility to explain the radiation risk associated with performing the procedure as well as the associated risk of not performing the same procedure. There are several obstacles to describing ionizing radiation risk, including the ionizing radiation language that is not readily understood by non-imaging personnel. This study aimed to explore and describe the radiographers' experiences of radiation risk-benefit communication during paediatric CT imaging at two public hospitals. This is important to understand the effectiveness of the communication process and institute corrective action where shortcomings are evident.

METHODS

A qualitative, exploratory, descriptive research design was applied. The sample consisted of 12 purposively selected radiographers who were trained and working in the CT imaging department. Data were collected using face-to-face individual interviews. Tesch's 8 steps were used to analyse the data collected and generate themes and subthemes.

RESULTS

Two themes emerged from the data collected: (1)Positive experiences with two sub-themes (job satisfaction and mutual benefit) and (2) negative experiences with three sub-themes (.professional deprecation, ineffectual outcomes and communication impediments).

CONCLUSION

Positive experiences boosted radiographers' confidence and enhanced their participation in radiation risk-benefit communication with paediatric patients' parents and guardians while negative experiences hindered patient-centred care in the process of risk-benefit communication.

IMPLICATIONS FOR PRACTICE

Continuous education of radiographers and doctors on radiation risk-benefit communication before paediatric CT procedures is recommended, in line with their scope of practice, to improve patient-centred care.

Maternal factors associated with immediate low Apgar score in newborn babies at an intermediate hospital in Northern Namibia

BACKGROUND

All newborn infants are required to undergo the Apgar score/assessment immediately after birth and again at five minutes. This vital examination is performed to determine how well the infant is adjusting to the birthing process and the outside environment. Some newborns may have a normal Apgar score, while others may have a low score. The purpose of this study was to identify factors associated with low Apgar scores among newborns at an intermediate hospital in Northern Namibia.

OBJECTIVE

To identify maternal factors associated with an immediate low Apgar score in newborns at an intermediate hospital in Northern Namibia and to examine the association between maternal factors and an immediate low Apgar score. Quantitative, retrospective, descriptive research methodology was employed. A document review checklist was utilized to collect data at Onandjokwe Intermediate Hospital between August 2020 and October 2020.

RESULTS

Gravidity (p0.021), parity (p0.029), haemoglobin after the first ante-natal care visit (p0.011), ante-partum haemorrhage (APH) (p0.004), membrane status (p0.000), duration of labour (p0.000), type of delivery (p0.000), and caesarean section type and indication (p0.000) were found to be associated with an immediate low Apgar score.

CONCLUSIONS

The study identified maternal factors that influence an infant's initial low Apgar score. Strengthen maternal health education regarding gravidity and parity, diet, and recognizing danger signs during pregnancy. In addition, strict monitoring of patients with a partograph, cardiotocography, accurate record keeping, and prompt referral of patients with risk factors is strongly advised.

Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Namibia: a policy landscape analysis

Background: Nutrition-related non-communicable diseases contribute to approximately half of the premature deaths in Namibia. Westernisation and urbanisation of communities have resulted in changing dietary patterns that see people eating more refined and high sugar content foods that are a risk for nutrition-related non-communicable diseases. Sugar-sweetened beverage taxation has been found to influence consumer purchasing behaviour and to raise revenue for health-promoting activity in other low- and middle-income countries.

Objectives: To analyse Namibia’s non-communicable diseases prevention policy landscape and assess the readiness of the Government to adopt sugar-sweetened beverage taxation policies for public health.

Methods: Government policy documents relating to nutrition-related non-communicable diseases were analysed, utilising predetermined variables based on policy theory. Thirteen key informant interviews were conducted with stakeholders from Government, non-governmental organisations and academic institutions. Data sets were analysed utilising Kingdon’s analytical theory for agenda setting.

Results: Nutrition-related non-communicable diseases are an increasing problem that requires immediate action. Diet and lifestyle are recognised as major contributors to non-communicable diseases. The Government has adopted a multisectoral approach to the control and prevention of non-communicable diseases in Namibia. A sugar-sweetened beverage tax is envisaged in policy, but there is no progress towards its enactment. At the highest level of Government, the Ministry of Finance has ruled out immediate action towards sugar-sweetened beverage taxation. There is little publicly available information about the Namibian beverages industry, but it is closely tied to the South African drinking industry and is influenced by policy action in that country.

Conclusion: The Government of Namibia has taken positive steps and the policy environment is friendly towards an SSB tax. The proximity of trade and the competitive nature of the Namibian drinks industry with South Africa suggest that a regional perspective to advocacy would be of value.

The legal feasibility of adopting a sugar-sweetened beverage tax in seven sub-Saharan African countries

Background: A number of countries have adopted sugar-sweetened beverage taxes to prevent non-communicable diseases but there is variance in the structures and rates of the taxes. As interventions, sugar-sweetened beverage taxes could be cost-effective but must be compliant with existing legal and taxation systems.Objectives: To assess the legal feasibility of introducing or strengthening taxation laws related to sugar-sweetened beverages, for prevention of non-communicable diseases in seven countries: Botswana, Kenya, Namibia, Rwanda, Tanzania, Uganda and Zambia.Methods: We assessed the legal feasibility of adopting four types of sugar-sweetened beverage tax formulations in each of the seven countries, using the novel FELIP framework. We conducted a desk-based review of the legal system related to sugar-sweetened beverage taxation and assessed the barriers to, and facilitators and legal feasibility of, introducing each of the selected formulations by considering the existing laws, laws related to impacted sectors, legal infrastructure, and processes involved in adopting laws.Results: Six countries had legal mandates to prevent non-communicable diseases and protect the health of citizens. As of 2019, all countries had excise tax legislation. Five countries levied excise taxes on all soft drinks, but most did not exclusively target sugar-sweetened beverages, and taxation rates were well below the World Health Organization's recommended 20%. In Uganda and Kenya, agricultural or HIV-related levies offered alternative mechanisms to disincentivise consumption of sugar-sweetened beverages without the introduction of new taxes. Nutrition-labelling laws in all countries made it feasible to adopt taxes linked to the sugar content of beverages, but there were lacunas in existing infrastructure for more sophisticated taxation structures.Conclusion: Sugar-sweetened beverage taxes are legally feasible in all seven countries Existing laws provide a means to implement taxes as a public health intervention.