Changes in attitudes, behaviour and practices following an educational intervention for midwives using reflective writing journals
| dc.contributor.advisor | Jacobs, Cecilia | en_ZA |
| dc.contributor.advisor | Van Schalkwyk, Susan | en_ZA |
| dc.contributor.author | Ray, Sunanda | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Health Professions Education. | en_ZA |
| dc.date.accessioned | 2019-11-25T09:20:12Z | |
| dc.date.accessioned | 2019-12-11T06:41:05Z | |
| dc.date.available | 2021-11-30T03:00:11Z | |
| dc.date.issued | 2019-12 | |
| dc.description | Thesis (MPhil)--Stellenbosch University, 2019. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: Introduction: Inclusion of transformative learning techniques into the education of midwives and other health professionals, creates opportunities for improving health outcomes. Women in public and private sector health facilities in Southern Africa have experienced abusive behaviour and neglect from midwives. Negative birth experiences may deter women from seeking institutional care during labour, and lead to poor obstetric outcomes such as delayed progress in labour, higher risk of instrumental and surgical interventions and postnatal depression. Complex relationships between midwives and women in labour give rise to dissonance between the midwives’ sense of identity and pride as professionals, and their apparently disrespectful behaviour in their workplace, leading to possible negative outcomes. The aim of the research study was to explore from the midwives’ perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, as evidenced by entries in their reflective writing journals augmented by facilitated group dialogue. Methods: The qualitative research study comprised two facets: firstly, a document analysis of eighteen reflective journals written by the midwives and secondly, member-checking of the thematic analysis of the journal entries during follow-up discussions and a one-day participative workshop held a year later. Data were analysed using a phenomenology approach, which looks at how individuals make sense of social phenomena in their lived experiences. Transformative learning theory was used as a conceptual framework to explore the learning journey of the midwives. The a priori analysis identified patterns of changes within the pre-determined domains of attitudes, behaviours and practices. The comments and insights of the midwives during the member-checking process contributed further data for analysis. Findings: Overall the midwives reported gains in professional pride and stronger identification as patient advocates. Their stories in their reflective writing journals gave several examples of treating women in labour with empathy and compassion. Categories were constructed within the three domains of attitudes, behaviours and practices. Some of these categories aligned directly with the ten phases of transformative learning theory, such as self-examination of prior experience, building of competence and self-confidence into new roles and relationships. Other categories related to improving communications and teamwork, providing role-models of good behaviour and demonstrating competence in management of complex cases. Changes in practices were specific to this context and relate to changes in practices related to involvement of birth companions and encouragement to use different positions in labour and delivery. Discussion: This study demonstrated that participatory approaches to training on respectful maternity care may lead to changed attitudes, behaviour and practices in this context. The beneficiaries of these changes will be the midwives, as well as the women they look after in maternal health, their colleagues and the health system at large. The midwives have shown that even in adverse circumstances, they are able to share a common vision for the quality of service they want to provide and to progress with improving health outcomes. Sustainability and reproducibility to achieve the same results depends on continued investment in the participatory methodology to train midwives in respectful maternity care, with skilled facilitation of the reflective writing and dialogic approach. Pre-service and in-service training for midwives and medical students in maternal health could benefit from these new approaches, using reflective writing journals and dialogue as part of their educational methods and curricula. Conclusion: Promoting Respectful Maternity Care as part of the educational process opens the door to more empathy and compassion in healthcare, with better health outcomes and more rewarding relationships with their patients. This study shows that innovative educational initiatives have the potential to significantly change the way midwives work together, how they can continue to learn from reflecting on their experiences and to develop life-long learning skills. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Die insluiting van transformatiewe leertegnieke in die opleiding van vroedvroue en ander gesondheidswerkers, skep geleenthede om gesondheidsuitkomste te verbeter. Vroue in gesondheidsorgfasiliteite in die publieke- en privaat sektor in Suider-Afrika het mishandelde gedrag en verwaarlosing by vroedvroue ervaar. Negatiewe geboorte-ervarings kan vroue daarvan weerhou om institusionele sorg tydens kraam te soek, en dit kan lei tot swak verloskundige uitkomste soos vertraagde vordering in kraam, 'n groter risiko vir instrumentele en chirurgiese ingrepe en postpartum depressie. Komplekse verhoudings tussen vroedvroue en vroue in kraam gee aanleiding tot onenigheid tussen die vroedvroue se gevoel van identiteit en trots as professionele persone, en hul skynbaar oneerbiedige gedrag in hul werkplek, wat lei tot moontlike negatiewe uitkomste. Die doel van die navorsing was om vanuit die vroedvroue se perspektief, die invloed van 'n opvoedkundige ingryping in die houdings, gedrag en praktyke van 'n groep vroedvroue in Zimbabwe te ondersoek, soos blyk uit inskrywings in hul reflektiewe skryfjoernale, aangevul deur gefasiliteerde groepsdialoog. Die kwalitatiewe navorsingstudie bestaan uit twee fasette: eerstens, 'n dokumentanalise van agtien reflektiewe skryfjoernale wat deur die vroedvroue geskryf is, en tweedens, die lede-kontrole van die tematiese ontleding van die joernaalinskrywings tydens opvolgbesprekings en 'n een-dag deelnemende werkswinkel wat een jaar later gehou is. Data is ontleed met behulp van 'n fenomenologiese benadering, waarin gekyk word hoe individue sin maak uit sosiale verskynsels in hul ervarings. Transformatiewe leerteorie is gebruik as konseptuele raamwerk om die vroedvroue se leerreis te verken. Die a priori-analise het patrone van veranderinge binne die voorafbepaalde domeine van houdings, gedrag en praktyke identifiseer. Die kommentaar en insigte van die vroedvroue het tydens die lede-kontroleproses bygedra tot verdere data ontleding. In die algemeen het die vroedvroue toename in professionele trots en sterker identifikasie as voorstaanders vir pasiente gerapporteer. Hul verhale in hul reflektiewe skryfjoernale het verskeie voorbeelde van die behandeling van vroue in kraam, met empatie en deernis, gegee. Kategoriee is gebou binne die drie domeine van houdings, gedrag en praktyke. Sommige van hierdie kategoriee sluit direk aan by die tien fases van die transformatiewe leerteorie, soos selfondersoek van vorige ervaring, die opbou van bekwaamheid en selfvertroue tot nuwe rolle en verhoudings. Ander kategoriee het verband gehou met die verbetering van kommunikasie en spanwerk, die verskaffing van rolmodelle van goeie gedrag en die demonstrasie van bekwaamheid in die bestuur van komplekse gevalle. Veranderings in praktyke was spesifiek vir hierdie konteks, en hou verband met veranderinge in praktyke wat insluit betrokkenheid van geboorte-metgeselle en aanmoediging om verskillende posisies in kraam en bevalling te gebruik. Hierdie studie het getoon dat deelnemende benaderings tot opleiding in respek vir kraamversorging kan lei tot veranderde houdings, gedrag en praktyke in hierdie konteks. Die begunstigdes van hierdie veranderinge is die vroedvroue, sowel as die vrouens na wie hulle omsien vir moederlike gesondheid, hul kollegas en die gesondheidstelsel in die algemeen. Die vroedvroue het getoon dat hulle selfs in ongunstige omstandighede 'n gemeenskaplike visie kan deel vir die kwaliteit van die diens wat hulle wil lewer en om te vorder met die verbetering van gesondheidsuitkomste. Volhoubaarheid en reproduseerbaarheid om dieselfde resultate te behaal, hang af van die voortgesette belegging in die deelnemende metodologie om vroedvroue op te lei in respekvolle kraamversorging, met bekwame fasilitering van reflektiewe skryfwerk en 'n benadering wat dialoog insluit. Vooraf- en indiensopleiding vir vroedvroue en mediese studente, in moedergesondheid, kan baat vind by hierdie nuwe benaderings deur reflektiewe skryfjoernale en dialoog te gebruik as deel van hul opvoedkundige metodes en kurrikulums. Die bevordering van respekvolle kraamversorging as deel van die opvoedkundige proses maak die deur oop vir meer empatie en deernis in gesondheidsorg, met beter gesondheidsuitkomste en meer lonende verhoudings met hul pasiente. Hierdie studie toon dat innoverende opvoedkundige inisiatiewe die potensiaal het om die manier waarop vroedvroue saamwerk te verander, hoe hulle kan voortgaan om te leer uit refleksie op ervarings en om lewenslange leervaardighede te ontwikkel. | af_ZA |
| dc.description.version | Masters | |
| dc.embargo.terms | 2021-11-30 | |
| dc.format.extent | x, 53 pages : illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/106972 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Midwives -- Zimbabwe -- Attitudes | en_ZA |
| dc.subject | Midwives -- Training of -- Zimbabwe | en_ZA |
| dc.subject | Maternal health services -- Zimbabwe | en_ZA |
| dc.subject | UCTD | |
| dc.title | Changes in attitudes, behaviour and practices following an educational intervention for midwives using reflective writing journals | en_ZA |
| dc.type | Thesis | en_ZA |