COMMITMENT TO CONTINOUS PROFESSIONAL DEVELOPMENT (CPD) BY RURAL RADIOGRAPHERS

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Number of radiographers working in rural areas

As was indicated earlier radiographers are an essential component of the rural health care team but their availability is also limited. Radiography, among other health professions, was identified by the then minister of health as a profession that was experiencing a shortage of staff (Tshabalala-Msimang 2004:50). According to the 2012/2013 HPCSA’s annual report there was a combined total of 6,868 registered radiographers in the country (HPCSA 2013:20). A combined total means that the number includes all radiographers across the four categories namely; diagnostic, radiotherapy, nuclear medicine and sonography.
Just like in many countries, such as Australia, rural hospitals in KZN have a daunting task of attracting radiographers to work in these hospitals. The current distribution of radiographers favours the urban hospitals. Just like in Australia the shortage of other health professionals in rural areas such as doctors and nurses is well documented, but this is not the case with regard to radiographers in rural areas and as such consistent data is not available both at provincial and national level (National Rural Health Association 2008:3). Even though the WHO reports that 50% of the world population lives in rural areas, there is still a widespread shortage of health professionals which includes radiographers in these areas (Keane, Lincoln & Smith 2012). This problem has a direct impact on the quality of rural radiographic services. The movement of radiographers from rural areas to urban actually cripples the already fragile rural health care delivery system. For instance, a study conducted by De Villiers and De Villiers (2004:23) on rural doctors’ views about working conditions in rural hospitals reported on the frequent unavailability of x-ray services after hours. This frequent unavailability of x-ray services after hours may be linked to the shortage of radiographers in rural hospitals.
Apart from social and infrastructure factors related with rural hospitals, the training of radiographers in South Africa is highly urbanized and centralized in city based universities just like in Australia (Smith, Brown & Cooper 2009:236). It is therefore essential to identify factors that may cause shortages in terms of what rural health practitioners, such as radiographers, need and then work towards meeting those needs (Mokoka 2007:12). This author identifies career development and professional recognition as motivation factors that may be used to keep radiographers in rural areas other than the usual financial incentives. On the other hand authors such as Ducket (2005:201) have argued that the future workforce planning for health professionals in the 21st century should be placed on different mix of responsibilities rather than trying to provide more of the same. This means that rural radiographers require an expanded competency base.

The practice of rural radiography

The importance of radiography as an integral component of the South African health care system and as an integral part of the PHC has already been mentioned above. Radiographers working in rural hospitals contribute significantly towards appropriate treatment of diseases and injuries through diagnostic imaging (Maru et al 2010). The existing scope of practice for radiographers however appear to be limited and the list of competencies required by radiographers working in the rural areas in the context of South Africa has not been compiled. Such a working environment where there is no clear scope of practice could cause radiographers to have low self-efficacy and poor belief in their own abilities (Minisini, Sheppard & Jones 2011:5). These authors further argue that the consequences of such a situation are that individual health practitioners, in this case radiographers, tend to believe that they lack skills and attributes which in turn lead to issues of incompetency. This, then, relates again to issues of not being sure of what they are supposed to do.
The demands of today’s rural radiography put increased pressure on both the radiographer and the hospitals that provide the service. Rural hospitals are pressured from both the government and communities to improve the quality of healthcare as it may be the case in cities. With this pressure for quality health care ever present, radiographers working in rural areas are required to do more (Akroyd, et al 2008:114). The researcher has observed that the challenge for most radiographers working in rural areas is that radiography practice is guided by protocols despite the increased responsibilities assigned. The professional Act of the radiographers, for instance, states that ‘‘a radiographer shall perform acts at the written request and under the supervision of a practitioner approved by the board for such purpose (Profession Board of Radiography and Clinical Technology 2006:1). Sim (2002:4) is however against blind adherence to protocol as this only suggests that the radiographer is not a thinker but merely a follower. Radiographers working in rural hospitals of South Africa need to possess competencies that allow them to be thinkers and be able to transcend discipline barriers.
The extra responsibilities for rural radiographic practice demand multi-skilling by these radiographers not just in diagnostic imaging capabilities. This might improve the capability of radiographers working in rural health care to adjust to the needs of the communities (Hardy, Poulos, Emanuel & Reed 2010:29). But in most situations the rural radiographic practice appears to be non-specific leaving radiographers confused. The field of conventional radiography as it is practiced particularly in rural radiography units is not similar to other specialised fields such as ultrasound and MRI with clear divisions of the recognised fields (Ferris et al 2009:e80). Therefore, it may not be an easy task to delineate radiography competencies especially when one moves from the radiographic theory to practice.
In view of the above, radiographers working in rural areas might need context specific competencies that will enable them to provide an effective diagnostic imaging service even if it might be basic. To this effect, the concepts identified by Ross (208:68) as being integral to the practice of a nurse in the rural setting may also be applicable to radiographers working in rural areas of South Africa. These concepts include:
 Maintaining personal and professional boundaries
 Maintenance of values and high standard of patient care
 Commitment to on-going education
 Accepting responsibilities related to the specific occupational context
Research conducted by De Villiers and De Villiers (2004:22) on working conditions in rural hospitals of the Western Cape Province found that a variety of problems encountered by rural doctors required broader knowledge and skills. This could be similar for radiographers in this context. It is therefore imperative for radiography graduates to be fully prepared and equipped by the training institutions to enable them practice efficiently in rural hospitals. Some of the concepts identified by Ross above are discussed in detail under subsections 2.5 to 2.6.

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Quality of radiographic services in rural district hospitals

The USA’s Institute of Medicine (2001:4) states that quality in health services is when the likelihood of the delivered health outcome for the community increases and that these outcomes are in line with the prevailing professional knowledge. The quality of health care services in rural areas faces many challenges. The rural population, for instance, presents a unique and varied need with regard to health care. Literature reveals that in America there is a high rate of chronic conditions in the rural population (Daniels, VanLeit, Skipper, Sanders & Rhyne 2007:62). This means that health care services provided to the rural community must be delivered to the fullest capacity to meet these varied needs. According to Health Systems Trust (1997:1) rural communities in South Africa bear the highest burden of disease mainly because of poverty.

Chapter 1 Orientation to the study
1.1 INTRODUCTION
1.2 THE RESEARCH PROBLEM
1.3 PROBLEM STATEMENT
1.4 PURPOSE, AIM AND OBJECTIVES OF THE STUDY
1.5 SIGNIFICANCE
1.6 DEFINITION OF KEY CONCEPTS
1.7 STUDY FOUNDATION
1.8 OVERVIEW OF RESEARCH DESIGN AND
METHODOLOY
1.9. ETHICAL CONSIDERATION
1.10. SCOPE AND LIMITATIONS
1.11 MIXED METHODS THESIS PRESENTATION
1.11.1 Structure of the thesis (Integrated model)
1.12 CONCLUSION
Chapter 2 Literature review
2.1 INTRODUCTION
2.2 PURPOSE OF THE LITERATURE REVIEW
2.3 RADIOGRAPHY IN SOUTH AFRICA
2.4 DISTRICT HEALTH SYSTEM
2.5 THE NEED FOR A FRAMEWORK
2.6 GLOBAL PERSPECTIVE OF COMPETENCY
2.7 SOME OF THE CORE COMPETENCIES THAT MAY BE
REQUIRED FOR RURAL RADIOGRAPHERS
2.8 COMMITMENT TO CONTINOUS PROFESSIONAL DEVELOPMENT (CPD) BY RURAL RADIOGRAPHERS
2.9 TRAINING OF RADIOGRAPHERS
CONCLUSION
Chapter 3 Research Methodology
3.1 INTRODUCTION
3.2 EPISTEMOLOGICAL ASSUMPTION
3.3 RESEARCH DESIGN
3.4 PROCEDURES FOLLOWED AND DEVELOPMENT
OF THE INSTRUMENTS
3.5 RESEARCH METHODS FOR DIFFERENT
PHASES
3.6 LAST PART OF PHASE I: SURVEY
INSTRUMENT DEVELOPMENT
3.8 ETHICAL CONSIDERATION
3.9 CONCLUSION
Chapter 4 Data analysis, presentation and discussion for Phase I
4.1 INTRODUCATION
4.2 ANALYSIS, RESULTS AND DISCUSION OF THE
QUALITATIVE DATA
4.3 CONCLUSION
Chapter 5 Data analysis, interpretation and presentation of findings of Phase II of the study
5.1 INTRODUCTION
5.2 DATA ANALYSIS PROCESS
5.3 RESPONDENT’S BIOGRAPHICAL CHARACTERISTICS
5.4 THE ENVIROMENT IN WHICH RURAL
RADIOGRAPHERS PRATICE RADIOGRAPHY
5.5 SOME OF THE COMPETENCIES THAT MAY BE
REQUIRED BY RURAL RADIOGRAPHERS
5.6 RELATIONSHIP BETWEEN RESPONDENTS’ DEMOGRAPHIC VARIABLES AND THE SIX CONSTRUCTS
RELATED TO CORE COMPETENCIES
5.7 SECTION 3: RADIOGRAPHY TRAINING AND
RURAL RADIOGRAPHY
Chapter 6
Curriculum audit and the development of CPD strategy proposal