Development of an Employee Assistance Programme (EAP) for midwives dealing with maternal death cases in the Ashanti Region, Ghana

Philosophiae Doctor - PhDGlobally, Employee Assistance Programme (EAP) has become the most effective workplace programme used to assist employees in the identification and resolution of performance and behavioural related problems. Employees, irrespective of the sector of employment are seen as the most valuable assets of any organization and therefore their wellness is as important as the organization itself. Employees' personal or work related problems may adversely affect their health as well as their productivity, thereby impeding the growth of an organization. It is for this reason that the EAP has increasingly become an important tool in addressing employees’ personal and work related challenges. Midwives as employees are prone to challenges such as maternal deaths at the workplace. They are more likely to undergo stressful situations for failing to meet the general goal of their profession, which, among others, include provision of adequate care for pregnant women until they safely deliver. These stressful conditions have negative effects on midwives' health, behaviour and productivity. However, there is no literature that has looked at how midwives in the Ashanti Region of Ghana are affected by maternal deaths and their coping mechanisms employed to address the effects of maternal deaths. Literature revealed that there is hardly any known work-related assistance programme designed to support Ghanaian midwives when faced with work-related challenges likely to affect their work-output. Hence, this study developed an appropriate EAP for midwives dealing with maternal deaths in Ghana based on the exploration and description of the effects of maternal death, coping mechanisms used and their experiences with the facility-based maternal death review (MDR). In order to meet the general aim of the study, a qualitative research approach, with a combination of exploratory, descriptive and contextual designs was used. Purposive sampling was employed to select participants; ward and unit managers (supervisors) (18) and midwives who met the inclusion criteria (39). A total of 57 participants were used in the study. Data were collected through semi-structured individual interviews and focus group discussions, as well as field notes. Thematic Content Analysis was used to manage data through transcribing, organizing, development of category and coding of data. Final data management was done with qualitative computer data analysis package (Atlas ti version 7.1.7). The full understanding of the effects of maternal deaths on midwives and the mechanisms of coping employed to address effects afforded the development of an EAP to support midwives dealing with maternal deaths. Five main themes emerged from the analysis of collected data, namely effect of death as a unique experience, multi-dimensional effects of MD on Midwives' personal life, effects of MD on the midwives’ associated environment, mechanisms of coping employed by Midwives and Perceived MDR process (Phase 1). Phase 2 considered the development of Employee Assistance Programme (EAP) for midwives dealing with maternal deaths in Ashanti Region of Ghana. The steps of developing occupational health service at the workplace by Acutt Hattingh and Bergh (2011) were applied to develop the EAP. Ethical practices pertaining to the study of human subjects as specified by the Research Ethics Committee of the University of the Western Cape and research guidelines of Ministry of Health- Ghana Health Service were observed. It is recommended that, all hospitals in Ashanti Region institute the EAP programme to assist midwives cope with challenges associated with maternal death

The role of midwives in the implementation of maternal death review (MDR) in health facilities In Ashanti region, Ghana

Magister Curationis - MCurBackground and Problem Statement: Maternal mortality is a global health issue, which mostly affects the developing countries. The United Nations (UN) member states have made a commitment to reduce maternal mortality by 75% by 2015. However, one of the biggest challenges in monitoring maternal deaths in Sub-Sahara Africa including Ghana, is the lack of adequate information for the accurate estimation of the maternal mortality rate (MMRate), and to identify causes of death. The World Health Organization (WHO) developed strategies and guidelines to assist countries to generate accurate information regarding maternal deaths. Maternal death review is one such strategy that was implemented in Ghana. Midwives are among the health workers who participate in the implementation of this strategy in different health facilities.However, what is not well understood is the role that midwives play in the implementation of Maternal Death Review (MDR).The purpose of the study: To explore and describe the roles that midwives play in the implementation of MDR in selected health facilities in Ghana‟s Ashanti Region.Methodology: A qualitative descriptive design was used to guide the research.Purposive sampling was conducted to select midwives who have been involved in maternal death review from the teaching, regional and district referral hospitals. Data was collected by conducting semi-structured individual interviews. Data saturation was reached after twenty interviews. Thematic Content Analysis was used to manage and analyse data. The Facility-based maternal death review model was used to assist the researcher to identify and organize the emerged themes. Ethical clearance was obtained from the University, as well as approval from the management of the health facilities prior to approaching the informants.Main findings: The results of this study indicate that midwives in Ghana‟s Ashanti Region are undertaking various activities and duties in all the stages of the Facilitybased maternal review model. The type of activities and duties undertaken by midwives varied according to their seniority and the level of the health facilities.Conclusion and recommendation: The findings of this study bring insight into the roles played by midwives in the implementation of the Facility-based maternal death review process in the health facilities in Ghana‟s Ashanti Region. These findings have a direct implication for the training and education of midwives. It is recommended that issues related to maternal death review methods and processes be included in the formal and continuing training and education of midwives. However, further research considering the training and practice development needs of midwives in respect of implementation of maternal death review is required

Fears associated with maternal death: Selected midwives’ lived experiences in the Ashanti Region of Ghana

Like the fear associated with the demise of loved ones, maternal deaths at any health facility equally illicit fear among midwives. This jeopardises their ability to achieve the quality of work expected of them. There is a depth of literature on midwives and fear associated with maternal death. Therefore, this paper seeks to explore the lived experiences of midwives who, in the discharge of their professional duties, have come face-to-face with maternal death in selected hospitals of Ashanti region in Ghana. The study applies a qualitative research paradigm and exploratory descriptive design in the overall collection and analysis of data. Purposive sampling was used to select 57 participants (18 supervisors and 39 ward midwives). The data was collected through semistructured interviews and focus group discussions, and managed by computer data analysis package (Atlas ti version 7.1.7). Content analysis was employed to analyse the data. Six themes emerged from the analysed data, namely fear of death, recurrence of death, fear of the Maternal Death Review (MDR) Process, fear of deceased family members’ reactions, fear of stigma from community members and fear of lawsuit/withdrawal of license. The study established that fear experienced by midwives as a result of maternal death may affect their quality of work life and the quality of services provided to patients under their care. It is therefore recommended that, all health facilities in the Ashanti Region should institute support programmes to assist midwives cope with challenges associated with death of patients.DHE

Coping with Maternal Deaths: The Experiences of Midwives

BACKGROUND: Life is said to be meaningful only when the individual is able to cope with challenges associated with it. Challenges at the workplace, whether physical, psychological or social, all contribute to occupational trauma. Coping with the challenges of work is an important part of achieving occupational wellbeing, irrespective of how difficult the job may be. Midwives are trained to be responsible for safe motherhood. However, when faced with maternal deaths, work becomes difficult as they have to cope with trauma resulting from their encounters with these deaths. Thus, the aim of this study was to explore and describe the coping challenges of maternal deaths among midwives in the Ashanti Region of Ghana.METHOD: An exploratory descriptive qualitative design was used in the study. Data were collected by means of semi-structured interviews (18) and focus group discussions (8) with inclusion criteria of being a midwife with at least one year working experience and having witnessed maternal death while on duty. Data were audio recorded, transcribed and analysed using thematic content analysis.RESULTS: Four themes emerged from the study: difficulty accepting maternal death, exhibition of grief reactions, difficulty forgetting the deceased and lack of concentration.CONCLUSION: The study concluded that since the midwife’s ability to cope with maternal deaths is challenged, occupational workplace programmes, for example, Employee Assistance Programme (EAP) should be employed in Ghanaian hospitals to help midwives get debrief after maternal death occurs

Physical Effects of Maternal Deaths on Midwives’ Health: A Qualitative Approach

Grief does not only affect human emotions but also impacts their physical health. Understanding physical grief of people can bring to bear the grip of its daunting nature, a situation where routines become challenging. A qualitative explorative descriptive research method was used. A purposive sample of 18 ward supervisors and 39 ward midwives was used to ascertain the physical effects of maternal deaths on these caregivers in the Ashanti Region of Ghana. Data were collected through semistructured and focus group discussions. Data analysis was done parallel with data collection till saturation was reached. Ethics was obtained from the University of the Western Cape, South Africa, and Ghana Health Service. The findings indicated that generally, as a result of grieving over the deaths of their patients, midwives experienced physical health sufferings. Therefore, reported depression is expressed as insomnia, appetite loss, exhaustion, and social isolation. There is the need to reduce the physical effects of patients’ death on caregivers in Ghana and therefore, the study recommends that all hospitals in Ghana utilize employee assistance programmes, a workplace intervention programme designed for such purposes

Perception of Dieners Regarding Social Acceptance and the Right to Work: A Qualitative Study

Globally, the right to work is a modest human right. It is a right acknowledged under the Universal Declaration of Human Rights which delineates the various types of work. As such, each person is at liberty to take up any job granted that one has the capacity and skills. This decision must be free from stigma or discrimination. However, this is not the case with mortuary attendants in Ghana. This study explored the viewpoints of Ghanaian mortuary attendants and how society perceives their rights to work. The study used a qualitative research approach, with exploratory and descriptive designs, that sought an in-depth understanding from sampled mortuary attendants on the perception of their community members toward their work. Saturation was attained with nineteen (19) participants from nine (9) health facilities located in the three regions. Semi-structured interviews were conducted and audio recorded with concurrent data transcription and analysis using content analysis. Purposive sampling was used. The study included male or female mortuary employees with at least 1 year of working experience. The themes that emerged were as follows; self-stigma, public stigma, stigma-by-association, and structural stigma. The results were structured according to a stigma model. The study reveals high levels of stigmatization and discrimination against mortuary attendants. Researchers recommend the need for public education, and policy changes to reverse the scornful stigmatization and discrimination against death care workers and those in related profiles