Midwives Attitude and Its Effect Towards the Clients at the Antenatal Clinic Unit in Ghana
CHAPTER ONE
Objectives of the Study
The aim of this study was achieved through the following objectives:
- To determine the available midwives in secondary healthcare facilities in Tamale, Northern Region State.
- To assess the midwives‘ level of knowledge on antenatal care in secondary healthcare facilities in Tamale, Northern Region State.
- To assess the midwives‘ level of practice on antenatal care in secondary healthcare facilities in Tamale, Northern Region State.
- To explore the level of women satisfaction with antenatal care in secondary healthcare facilities in Tamale, Northern Region State.
CHAPTER TWO
REVIEW OF LITERATURE
Conceptual Review
Concept of Quality of Care
Quality can be defined as a conformance to requirements. Also, it may be defined as doing the right thing right the first time and improving it every time (Abdallah, Elsabagh and El Awady 2012). Quality can be a simple action to achieve desired objectives in the most efficient and effective manner with the emphasis on satisfying the client. It is a health service that is acceptable, accessible, efficient, effective, safe, cost savings and that‘s continuously evaluated and upgraded (World Health Organization, 2000).Quality assessment means ―the process of measuring quality of care, including development of quality measures, implementation of quality measurement activities and monitoring of quality information over time to detect trends or to identify high-performance or low-performance” (Handady, Sakin and Alawad, 2015).Goodlee, 2009 in Austin et al 2014 defined quality care as ―clinically effective, safe and a good experience for the patient‖. More specific to the field of maternal and child health, Hultonalso in Austin et al 2014 defined quality as ―the degree to which maternal health services for individuals and populations increase the likelihood of timely and appropriate treatment for the purpose of achieving desired outcomes that are both consistent with current professional knowledge and uphold basic reproductive rights.‖ Quality maternal and newborn care according to the Institute of Medicine (IOM) is the care that is safe, effective, patient-centered, timely, efficient and equitable. The Institute of Medicine defintion of quality care is comprehensive and encompases three key components of quality: clinical (safe and effective), interpersonal (patient-centered) and contextual (timely, efficient and equitable) (Austin, Langer, Salam, Lassi, Das and Bhutta, 2014).
Quality of care is a normative concept, in that measuring quality, or improvements in quality, demands a set of standards to guage the impact of quality improvement efforts. For example, there are evidence-based guidelines for best practice in maternal and newborn care, such as those developed by the World Health Organization, or by the Royal College of Obstetrics and Gynecologists, among others. Adhering to best practice standards in clinical care would be the objective of any quality improvement effort. The Maternal Health Task Force (MHTF), the flagship program of the Women and Health Initiative at the Harvard School of Public Health, focuses its work on improving and measuring the quality of institutional care provided to women once they have accessed the health system. The work of the Maternal Health Task Force focuses on the third trimester, labor and delivery, as well as the immediate postpartum period, the most hazardous time for women and newborns. During this critical period, women and newborns face multiple risks: placenta praevia and other causes of pre and post-partum haemorrhage, pre-eclampsia/eclampsia, dystocia, infection, and other conditions that are most relevant in this timeframe. These conditions directly impact maternal and newborn survival. Effective detection and management of these complications require facility-based, skilled care (Austin et al, 2014).
Quality of care can be measured at three levels: the policy level; the service delivery level; and the client /outcome level. Outcomes have received special emphasis as a measure of quality. Assessing outcomes has merit both as an indicator of the effectiveness of different interventions and as part of a monitoring system directed to improving quality of care as well as detecting its deterioration. Quality assessment studies usually measure one of three types of outcomes: medical outcomes, costs, and client satisfaction. For the last mentioned, clients are asked to assess not their own health status after receiving care but their satisfaction with the services delivered (Abdallah et al, 2012). Quality aspects of maternity care: Maternity care services are different from other health care services in the following ways: 1. Most users of maternity care are well. Therefore, maternity services need to be conscious of over treatment as well as over – medicalizing pregnancy and childbirth, which can lead to complications and waste of resources. 2. Some users of the services will develop conditions requiring a high level of maternity care. Many of these conditions are unpredictable and life threatening. Maternity services, therefore, need to be wary of under treating some women. 3. Maternity care services targets at least two recipients, the mother and the baby. Outcome of both are very important, so pros and cons for each should be counter balanced. 4. Maternity services deals with the cultural and emotionally sensitive area of childbirth. To ensure that maternity care services are of good quality, it is important to acknowledge and incorporate evidencebased practices in the care of labouring and delivering women in health institutions (Jeng, 2008).
CHAPTER THREE
MATERIALS AND METHODS
Study Design
Cross sectional descriptive research design was adopted for this study. It‘s an observational study that analyses data collected from a population at a specific point in time. This type of design describes what exists and help to uncover new facts and meanings. The purpose is to observe, describe and document aspects of a situation as it naturally occurs (Polit and Hungler, 1999). According to Polit and Beck (2010) cross-sectional design involve the collection of data at one point in time or multiple times in a short time period. It describes the status of phenomena or relationships among phenomena at a fixed point.It involves the collection of data that will provide an account of individuals and situations. Instruments used to collect data in descriptive studies includes questionnaires, interviews (closed questions) and observation (checklists). This design will help to provide information about attitude of midwives‘ towards antenatal care and client’s satisfaction with the care received during antenatal period.
Target Population
The target population of this study has two folds: the midwives working in the labour wards of the three secondary health care facilities and mothers who had spontaneous onset of labour and delivered in the three secondary health care facilities.
CHAPTER FOUR
DATA ANALYSIS AND RESULTS PRESENTATION
Data Analysis and Results
The aim of this study was to assess the attitude of midwives‘ towards antenatal care and client’s satisfaction in secondary healthcare facilities in Tamale, Northern Region Ghana. A total of 43midwives and 240 mothers were recruited in the study. The response rate was 95%, 81% and 100% for midwives‘ knowledge, practice and women satisfaction respectively. This chapter will present the data analysis related to the socio demographic characteristics of the two samples and the research questions of the study.
Table 4.1 describes the distribution of the midwives according to their socio demographic characteristics. Majority of the midwives were within the ages of 26 to 35 years with a mean age of 35.2. This shows that the women were within the active ages of service. The table shows the professional qualification of the midwives whereby 19 midwives (46.3%) had RN/RM. It indicates that the majorities of the midwives were qualified and had one form of professional qualification or the other. The table equally reflects the rank of the midwives and it shows that majority of the midwives were Nursing Officer I (36.5%).
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary
The aim of this study was to assess the attitude of midwives‘ towards antenatal care and client’s satisfaction in secondary healthcare facilities in Tamale, Northern Region Ghana. Five objectives were stated which include: to assess the available midwives for antenatal care, to assess the available material resources for antenatal care, to assess the level of knowledge of midwives on antenatal care, to assess the level of practice of midwives on antenatal care and to assess the level of women satisfaction with antenatal care. Review of related literature, similar researches and studies, theoretical framework and summary of literature review was included. One of the first systematic framework for the quality of healthcare services developed by Donabedian, who divided the production of quality services into structure, process and outcome was adapted for the study.
A cross-sectional descriptive design was adopted for the conduct of this study. The three secondary healthcare facilities in Tamale were selected for data collection: State Specialist Hospital, Muhammad Shuwa memorial hospital and Umoru Shehu Ultramodern Hospital. A total of 43 midwives and 240 mothers were recruited in the study with response rate of 95%, 81% and 100% for knowledge, practice and satisfaction respectively. All the samples for midwives were used and a convenient sampling technique was used to select the women for the study. A facility checklist was used to collect information on the availability of human and material resources, the midwives were assessed of their knowledge using questionnaire and observed of their practice using observational checklist while for the women administered questionnaire were used to assess their level of satisfaction. The data was collected from August to November and was analysed using descriptive statistics.
The result of the study were presented in tables and charts. Table 4.1 revealed the distribution of the midwives according to their socio-demographic characteristics with a mean age of 35.2 years. Table 4.2 showed the availability of midwives(midwives) for antenatal care in the three healthcare facilities which buttressed that the midwives were available but inadequate for antenatal care. The material resources were also inadequate for antenatal care. According to their level of knowledge on antenatal care, majority (78%) of the midwives have high level of knowledge. Table 4.3 buttressed the distribution of the midwives according to their level of practice, 53.9% of the midwives‘ practices was high. Table 4.4 revealed the distribution of the women according to socio demographic characteristics. Table 4.5 showed the distribution of women according to their level of satisfaction, 64.4% of the women were satisfied with the level of care during the antenatal period with a mean of 2.4/4.
Conclusion
Based on the results of the study, the researcher can conclude that:
- The midwives were available but inadequate for antenatal care
- The material resources were available but inadequate for antenatal care
- The level of knowledge of midwives on antenatal care was high
- The midwives‘ level of practice during the antenatal period was high
- The women were moderately satisfied with the level of antenatal care.
Recommendations
Based on the findings, it can be recommended that:
- Adequate midwives should be provided by the State government through the hospitals management board to meet the ever increasing demands of the population.
- The Hospitals Management Board and the government should ensure that drugs, equipments and other supplies are adequate in the maternity wards.
- Periodic in-service training for midwives to upgrade the techniques necessary to assess, evaluate and improve the quality of care rendered to women in labour.
- Women expectations on the quality of care rendered during labour should be assessed by the management with a view to rendering satisfactory services during the antenatal period.
- Midwives should adhere to their code of ethics so as to ensure constant self- improvement.
- Hospital administrators should employ more midwives into the labour room so that one on one support is encouraged, hence improving the overall satisfaction of labour for any woman.
- Regular monitoring and supervision of midwives with/without notice to assess their practices will be beneficial for ensuring safety of lives and improving quality of care.
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