A Survey of the quality of nursing care in several health districts in South Africa.

From March to August 2002 a survey was done in six hospitals and six clinics in three health districts of the KwaZulu-Natal province of South Africa. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires.The average scores on the different aspects varied from 11% (for nursing records) to 73% (for management of chronic diseases). Specific problems became evident. In one district three out of four hand-overs between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%). While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts.The quality of care measurements identified specific training needs, but other management strategies are probably also indicated.South Africa is currently focusing much attention on developing the human resources of the country. A Skills Development Act passed in 2000 [1] makes it compulsory for all employers to develop their workers, and the Skills Development Levies Act [2] makes earmarked funding available for the development of the work force. The expected outcomes of such training are better service delivery or, in the case of the health services, better quality of health care. It seems logical that the evaluation of quality of care would be a useful way of directing such skills development strategies. Based on Booysens and Minnaars [3] description of quality control in health services, quality of care can thus be defined as a dynamic quality indicating that the right things are