Midwives’ challenges in the management of postpartum haemorrhage at rural PHC facilities of Limpopo province, South Africa: an explorative study

BACKGROUND: Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives’ experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH. METHODS: Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation. RESULTS: After data analysis, one theme emerged “challenges experienced by midwives managing women with PPH” and five subthemes, including: “difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation”. CONCLUSION: The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease.https://www.ajol.info/index.php/ahspm2021Nursing Scienc

Factors facilitating trained NIMART nurses' adherence to treatment guidelines : a vital matter in the management of TB/HIV treatment in South Africa

BACKGROUND: Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses’ adherence to TB/HIV treatment guidelines. METHODS: The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. RESULTS: The singular theme of factors facilitating NIMART trained nurses’ adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. CONCLUSION: Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines.Atlantic Philanthropies and Thuthuka NRF.http://www.biomedcentral.com/bmcnurspm2020Nursing Scienc

A model for woman-centered childbirth

D.Cur.The overall objective of this study was to describe the model and criteria for woman-centered care that will serve as a theoretical framework for implementing the Batho-Pele Principles in order to facilitate mutual participation between mothers and attending midwives during childbirth at one hospital of the Capricorn district in the Limpopo Province. The phases followed in this study were as follows: Phase 1: Concept Identification The concept identification was achieved through the use of a qualitative research approach which was exploratory, descriptive, contextual and inductive. A sample of 24 mothers and 12 attending midwives participated in the study. Different data collection methods were utilized. Data obtained from unstructured in-depth interviews were analyzed according to the protocol by Tesch (1990; cited in Cresswell, 1994:155). Data analysis from participant observation using semistructured observation and VAS were performed quantitatively by using frequency distribution. The results of interviews indicated experiences that foster/promote dependency in midwifery care. Woman-centered care was identified as a core category and as a central approach that would enhance mutual participation during childbirth. To ensure valid results, a model of trustworthiness as proposed by Lincoln and Guba (1985: 301-318) was utilized. Phase 2: Concept Analysis Following the concept identification, the concept analysis of a core category ‘woman-centered care’ was conducted using the framework as described by Walker and Avant (1995). Phase 3: Development of the Model and Criteria This phase dealt with the description of the structure and process of the model. Strategies were proposed, described and recommended to implement the model where there is interaction of a mother (patient) and a midwife (nurse). Evaluation of the model was done by having dialogue with experts and by utilizing Chinn and Kramer’s (1995:134-135) guidelines for evaluating theory. The criteria for womancentered care were formulated. A unique contribution of this study is the concept analysis of woman-centered care, the development and description of the womancentered childbirth model and the formulation of criteria for woman-centered care

Becoming a mother : teenage mothers' experiences of first pregnancy

M.Cur.Teenage mothers who are pregnant for the first time at particular clinics and one hospital at the central region of the Northern Province experience lack of information regarding human reproduction, conception and signs of pregnancy. Reproductive Health services are poorly utilized. This, coupled with ignorance often leads to unplanned teenage pregnancies. There is also a delay in seeking of prenatal health care services, with minimal emotional and social support for family members, friends and partners. The research undertaken here were aimed at determining the needs of pregnant teenage mothers based on their experiences in order to facilitate the provision of services that will address such needs. The objective was to establish the experiences of teenage mothers during their first pregnancy and to describe and formulate guidelines from the information obtained. The research design used in this study was exploratory, descriptive and qualitative which is contextual in nature. A phenomenological approach was used. The study population sample was purposively selected at a particular clinic in the central region of the Northern Province. Fourteen (14) teenage mothers who are pregnant for the first time were interviewed until saturation was reached as was reflected in the repeating themes. In-depth unstructured interviews were conducted. All participants responded to an open-ended question "Could you please tell me about your experiences of first pregnancy?" To ensure trustworthiness Lincoln and Guba's model (1985) was implemented. Data analysis were according to the method Tesch (1990 in Creswell, 1994:155) based on the qualitative approach. A literature control was performed to verify the results. Five themes emerged as the experiences of teenage mothers, namely, lack of information, unplanned pregnancies, ineffective communication, minimal emotional and social support, and under-utilization of prenatal services. Guidelines and recommendations are proposed to assist midwives in meeting the needs of the teenage mothers who are pregnant for the first time

Barriers to Accessing Oncology Services for Effective Cancer Care in the Public Health Institutions in Limpopo Province, South Africa: A Qualitative Study

It is estimated that by 2030, 24 million people worldwide will develop cancer, and 13 million will die annually, with 75% of deaths in low- and middle-income countries. The management and effective control of care have not been fully achieved due to a lack of material and human resources exacerbated by poor governance and co-ordination of the services. The study aimed to explore barriers to accessing oncology services for effective cancer care in the public health institutions in Limpopo province. The study was conducted in the five district hospitals in Limpopo province. A qualitative exploratory descriptive and contextual approach was used to collect data that employed focus group discussions amongst healthcare professionals in different disciplines. Non-probability purposive sampling was used to sample participants from various sections contributing to oncology care. Five focus group discussions were conducted at the selected hospitals. The data were analysed using the eight steps of Tesch’s method. The findings revealed that Limpopo province has a shortage of high-technology medical equipment, poor coordination, and a lack of oncological and allied expertise. Governments should ensure that patients receive the care required as stated in the constitution to navigate cancer care pathways to improve patient health outcomes, particularly in rural areas where care is fragmented and poorly financed. Recommendations to support oncology patients involve psychosocial work and palliative care of the multidisciplinary teams to be put forward. The identified barriers regarding oncology care may contribute to changing the departments’ outlook and effective functioning by including interdisciplinary oncology teams at all levels of care

Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study

Preconception care (PCC) is the provision of biomedical, behavioural, and social health interventions to women and couples before they fall pregnant. The World Health Organization (WHO) developed PCC recommendations in 2013, which were included in the South African maternity care guidelines in 2016. The purpose of PCC is to lessen behaviours and environmental factors leading to maternal ill-health, thus reducing maternal and perinatal mortality rates. Objective: To determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo Province and the associated factors. Methods: A qualitative exploratory design was used. Nonprobability, purposive sampling was used to sample 29 professional nurses (PNs), and 51 women of childbearing age (WCBA) (19–35 years) from clinics and community health centres (CHCs). Data were collected through in-depth interviews with the professional nurses and focus group discussions with the WCBA. Data analysis was performed through open coding. Measures of trustworthiness were adhered to. Permission to conduct the study was obtained from relevant stakeholders, participation was voluntary and participants signed a consent form prior to data collection. Results: The findings of the study revealed that there was partial implementation of the PCC recommendations in the selected districts of Limpopo Province, PCC provision was dependent on clients’ initiation, a knowledge gap regarding PCC recommendations was identified from the professional nurses, and a lack of awareness regarding PCC from the WCBA. Conclusion: The preconception period is an important determinant of the pregnancy outcome; therefore, focus should be redirected to the pre-pregnancy period and not only to when the woman is already pregnant. However, to achieve this, professional nurses and WCBA should be empowered regarding PCC and its benefits