Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study

Background: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. Aim: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. Setting: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. Methods: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: ‘How is it for you to be a midwife in South Africa?’ Transcribed interviews were analysed using thematic coding. Results: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. Conclusion: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. Contribution: This research provides evidence of the midwifery experience with implications for needed health policy change

Characteristics of strong midwifery leaders and enablers of strong midwifery leadership:An international appreciative inquiry

Objectives: This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. Design: In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022.Setting: Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. Participants: An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218).Measurements: Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. Findings: Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. Key conclusions and implications for practice: This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools

Characteristics of Strong Midwifery Leaders and Enablers of Strong Midwifery Leadership: An International Appreciative Inquiry

Objectives This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. Design In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. Setting Responses were received from many countries (n=76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. Participants An international population (n=429) of English-speaking, and ethnically diverse midwives (n=211) and nurse-midwives (n=218). Measurements Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. Findings Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives’ clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. Key conclusions and implications for practice This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools

Home delivery of medication as part of reducing congestion in primary healthcare in Tshwane District Health Services

BACKGROUND. Congestion at health facilities poses the risk of extensive spread of the severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) to patients at high risk for severe illness and death due to this infection. During the lockdown to control the spread of the virus, many patients with chronic conditions are not visiting health facilities and not collecting their chronic medication. To improve adherence to medication, home delivery of medication was instituted for patients with chronic diseases who had been receiving care at the Skinner Street Clinic in Tshwane. OBJECTIVE. To support patients with chronic diseases who were unable to collect their medication, by remotely consulting (telehealth) and delivering their medication during the lockdown due to the COVID-19 pandemic. METHODS. Patients were identified for potential home delivery of medication from the clinic appointment book. Their files were retrieved, and they were telephoned and offered the option of receiving medication through home delivery instead of attending a health facility. For those who qualified and accepted home delivery, files were sent to the clinic pharmacy. Medication parcels were prepared and sent to ward-based outreach teams to deliver to patients. Relevant information was captured on the Qualtrics platform. RESULTS. A total of 1 727 files were evaluated. Of these patients, 60% were on treatment for HIV infection, and 19% for hypertension. A total of 32% (n=547) were eligible for home delivery of medication, but only 25% of the 1727 patients accepted the home delivery of medication. Almost 25% could not be contacted. Compared with those with non-communicable diseases (NCDs) or a combination of HIV and one or more NCDs, a higher proportion of HIV-positive patients with no other diagnosis chose not to have their medication delivered at home. Patients using the service expressed their appreciation and requested that it be extended to others. CONCLUSION. Home delivery of medication has significant advantages for patients. It can ensure that patients continue to adhere to their chronic medication in the midst of the COVID-19 epidemic, without increasing their risk of contracting the virus. Expanding the home delivery of medication to more facilities while aligning it with the Centralised Chronic Medicine Dispensing and Distribution programme has the potential to alleviate the congestion and workload of primary care facilities while these are under severe pressure owing to the COVID-19 pandemic.http://www.samj.org.za/index.php/samjam2021Family Medicin