Factors affecting quality of care in a midwifery practice

Gcawu, Luleka Patricia (2012-12)

Thesis (MCurr)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: The midwives are the backbone of midwifery practice with needs and opportunities to create a tradition of caring in midwifery. However, there are problems that affect the midwifery practice. These problems include the increased maternal and perinatal mortality rate, shortage of material and human resources and poor implementation of policies and guidelines. The purpose of this study was to investigate factors that affect quality of care in a midwifery practice at a hospital complex in the Eastern Cape Province, South Africa. The objectives of the study focused on the structure and process standards. - 1 Structure Standards: To determine whether • policies and procedure manuals are available and updated • support from the supervisor is available • there is adequate staff • the required qualifications were available • the required experience of registered midwives were available • in-service training was being given - 2 Process standards : To determine whether • patients were assessed according to the national guidelines for maternity care • patients were diagnosed according to the national guidelines for maternity care • patients’ care plans were formulated according to the national guidelines for maternity care The descriptive research design with a quantitative approach was applied in this study. The target population (N=172) were the registered midwives working in the maternity department at a particular hospital in the Eastern Cape Province. A specific sampling method was not applied in this study as the total population of 155 was included and17 in the pilot study with a response rate of 81.3%. A self-administered structured questionnaire was used to collect the data. The researcher distributed the questionnaires personally to all respondents who met the criteria. Reliability and validity were assessed by means of a pilot study and the use of experts in Nursing Education, Midwifery, Research Methodology and Statistics. Ethical approval was obtained from Stellenbosch University and all other relevant parties. Computerized data analysis software namely the SPSS programmes and Stastica version 9 were used to analyze the data. The results of the study were interpreted, discussed and presented in tables and frequencies. The data was predominantly presented in a quantitative form with responses to a few close-ended questions. A confirmatory analysis to test the quality of properties across a level of variables was carried out. The Chi-square test was used to test association of variables between demographic data and the responses of midwives to factors affecting quality of care. A p-value of p< 0.05 represents statistical significance in hypothesis testing and 95% confidence intervals were used to describe the estimation of unknown parameters. Results showed that the majority of respondents had an experience of 2 to 5 years (n=34/27.0%) and (n=32/25.4%) more than 14 years working in the maternity department. The minority of respondents were those that are highly skilled. Only (n=4/3.2 %) of the midwives were registered in neonatology nursing and (n=9/7.1%) in advanced midwifery. The majority of respondents (n=118/93.7%) recorded that there was not enough staff to provide quality nursing care. Some respondents recorded that comprehensive in-service education was not offered in the hospital (n=18/14.3%). Recommendations include improvement of staffing, adherence to policies and guidelines, proper implementation of staff development and quality improvement programmes. In conclusion, in order to reduce high infant and maternal mortality rates and to reach the millennium development goals, shortcomings in midwifery should urgently be addressed.

AFRIKAANSE OPSOMMING: Die vroedvroue is die ruggraat van die verloskunde-praktyk met behoeftes en geleenthede om ’n tradisie van versorging in verloskunde te skep. Nietemin is daar uitdagings wat die praktisering van verloskunde beïnvloed. Hierdie uitdagings sluit in die toenemende moeder en perinatale mortaliteit, ’n tekort aan materiële en menslike hulpbronne, en die swak toepassing van beleid en riglyne. Die doel van hierdie studie was om die faktore te ondersoek wat die kwaliteit van sorg in ’n verloskunde-praktyk by ’n hospitaalkompleks in die Oos-Kaap in Suid-Afrika, beïnvloed. Die doelwitte van die studie was op struktuur en proses standaarde gefokus. - 1 Struktuur standaarde: Om te bepaal of • beleid en prosedure handleidings beskikbaar en opgedateer is • daar ondersteuning van die toesighouer is • daar voldoende personeel is • daar voldoen is aan die vereiste kwalifikasies • die vereiste ondervinding van geregistreerde vroedvroue teenwoordig • is indiensopleding gegee - 2 Proses standaarde: Om te bepaal of • pasiënte assesseer is volgens die nasionale riglyne vir verloskunde • pasiënte gediagnoseer is volgens die nasionale riglyne • pasiëntversorgingsplanne geformuleer is volgens die nasionale riglyne vir verloskunde. Die beskrywende navorsingsontwerp met ’n kwantitatiewe benadering is in hierdie studie toegepas. Die teikenbevolking (N=172) is die geregistreerde vroedvroue wat in die kraamafdeling van die spesifieke hospitaal in die provinsie van die Oos-Kaap werk. ‘n Spesifieke steekproefmetode is nie vir die studie toegespas nie maar wel die hele populasie is betrek van 155 en 17 in die lootsstudie met ‘n respons van 81.3%. ’n Self-geadministreerde gestruktureerde vraelys is gebruik om die data te versamel. Die navorser het die vraelyste persoonlik aan al die beskikbare respondente wat aan die kriteria voldoen het, versprei. Betroubaarheid en geldigheid is geassesseer deur middel van ’n loodsondersoek en deur gebruik te maak van spesialiste in Verpleegopleiding, die Navorsingssentrum en Statistiek. Etiese goedkeuring is verkry van die Universiteit Stellenbosch en al die ander relevante partye. Gerekenariseerde data-analise sagteware, naamlik die SPSS programme en Statistica uitgawe 9 is gebruik om die data te analiseer. Die resultate van die studie is geïnterpreteer, bespreek en aangebied in tabelle en frekwensies. Die data is oorwegend in ’n kwantitatiewe formaat aangebied met response op ’n paar geslote vrae. ’n Bekragtigingsanalise om die eienskappe oor ’n vlak van veranderlikes te toets, is gedoen. Die Chi-kwadraat toets is gebruik om assosiasie van veranderlikes te toets tussen demografiese data en die response van vroedvroue vir faktore wat die kwaliteit van versorging beïnvloed. ’n P-waarde van p<0.05 verteenwoordig statistiese beduidendheid in hipotese-toetsing en 95% sekerheidsintervalle is gebruik om die beraming van onbekende parameters te beskryf. Resultate dui aan dat die meerderheid van respondente 2 tot 5 jaar werkervaring (n=34/27.0%) het en (n=32/25.4%) meer as 14 jaar in die kraamafdeling het. Die minderheid respondente is diegene wat hoogsbekwaam is. Alleenlik (n=4/1.0%) vroedvroue is in neonatale verpleging gereistreer en (n=9/7.1%) in gevorderde verloskunde geregistreer is. Die meeste respondente (n=118/93.7%) het aangedui dat daar nie voldoende personeel is om kwaliteit verpleegsorg te gee nie. Sommige respondente het aangedui dat omvattende indiensopleiding nie in die hospitaal aangebied is nie (n=18/14.3%). Aanbevelings sluit in die verbetering van personeelvoorsiening, die nakoming van beleid en riglyne, behoorlike implementering van personeelontwikkeling en gehalte verbeteringsprogramme. Ten slotte, om die hoê insidensie in moeder en kind mortaliteit te verminder en die millennium ontwikkelingsdoelwitte te bereik, moet die tekortkomings in verloskunde dringend aangespreek word.

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