Factors affecting quality of care in a midwifery practice

[摘要] 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.

[发布机构] Stellenbosch University