Support needs of parents with preterm infants at resource-limited neonatal units in Limpopo province: A qualitative study.

BACKGROUND:  Preterm birth is often unexpected and life-threatening for the baby and/or the mother. When admitted to the hospital, midwives need to provide informational, instrumental, psycho-cultural and emotional support to enhance post-discharge care. OBJECTIVES:  This study aimed to explore and describe the support provided to parents of preterm infants in preparing for post-discharge care. The study was conducted in three district hospitals in the Mopani district, South Africa. METHOD:  A qualitative approach wherein explorative, descriptive and contextual designs were used. A non-probability, convenience sampling was used to select 23 midwives who were working in the maternity unit for at least 2 years. Data were collected through in-depth individual semi-structured interviews until data saturation was reached. The data were analysed through Tesch's open coding method. Trustworthiness was ensured through credibility, transferability and confirmability. Ethical principles adhered to were: informed consent, beneficence, right to self-determination, confidentiality and anonymity. RESULTS:  The findings revealed that parents need informational, instrumental direct supervision, and psycho-cultural and emotional support during preparation for discharge. CONCLUSION:  Parents were unsure of their ability to care for the preterm infants after discharge and manage their own needs. The provision of informational, instrumental, psycho-cultural and emotional support needs would play a vital role in their ability to cope with their parental roles and the relationship with their infant.Contribution: The support provided to parents could build parental confidence and act as an integral part of neonatal follow-up programmes.

Student to midwife transition: Newly qualified midwives' experiences in Limpopo province.

Background: Regardless of educational pathway, the transition from student to the registered midwife is a topic of increasing interest within the profession as this is likely to have implications for retention and attrition. Newly qualified midwives have reported that the reality of putting knowledge into practice in the midwifery field is often challenging and stressful. Aim: To explore and describe the experiences of newly qualified midwives with regard to the provision of midwifery services during transition from students to qualified midwives, in the Limpopo province, South Africa. Setting: The study was conducted in the maternity units of each of the five selected public hospitals in the Limpopo province. Methods: The researcher employed a qualitative approach with explorative and descriptive design. The population comprised all midwifery graduates working in the Limpopo province and have undergone a comprehensive nursing programme regulated by R425 of 19 February 1985, as amended. Five newly qualified midwifery graduates were sampled from each of the five selected hospital, using a non-probability purposive sampling method, resulting in a sample size of 25 participants. Data collection was carried out through unstructured individual interviews and was conducted until participants were no longer bringing new information. Results: Graduates reported excessive workload, which resulted in physical exhaustion. Challenges related to the roles and responsibilities of a new position as a qualified midwife were expressed. Negative collegial relationship displayed by experienced qualified midwives, negatively affected graduates' midwifery performance. Conclusion: Effective, transition from student to qualified midwife is a stressful and exhausting process because of unfavourable working conditions in the labour ward, administrative roles as well as negative collegial relationship and disrespect displayed by experienced midwives. Contribution: Strategies to effectively support newly qualified midwives may be developed, which may consequently help in improving newly qualified midwives' performance.

Exploring supportive relationship provided to newly qualified midwives during transition period in Limpopo province, South Africa.

Transition from midwifery training to professional practice is enhanced by positive support from experienced colleagues. The study explored experiences of newly qualified midwives regarding existence of supportive relationship during transition. The setting was a maternity unit of a selected hospital from each of the five districts of Limpopo province. Population was all midwives who completed a comprehensive nursing programme (R425 of 19 February 1985, as amended); and qualified as nurses (general, psychiatric and community) and midwives working in selected hospitals. Twenty-five participants selected from maternity units of the five selected hospitals using non-probability, purposive sampling method. In-depth individual interviews conducted until saturation was reached. Data analysed through Tesch's method. Ethical issues considered. Findings revealed negative unsupportive relationship experienced by participants resulting in poor performance. Graduates expressed dislike experienced from senior colleagues. Establishment and maintenance of positive relationship between experienced and newly qualified midwives should be enhanced to promote effective transition.

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa.

Background: Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose: The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods: Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings: Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion: Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa.

BACKGROUND:  Providing optimal care to critically ill patients poses challenges in resource-poor settings because of the lack of equipment, inadequately trained personnel and limited infrastructure. OBJECTIVES:  This study explored challenges experienced by health care professionals working in resource-poor intensive care units. METHOD:  A qualitative, explorative, descriptive design was used. The population comprised nurses and doctors working in an intensive care unit of one hospital in the Limpopo province of South Africa. A purposive sample was selected and 17 semi-structured interviews were conducted. Data were analysed using Tesch's method. Ethical considerations were adhered to. RESULTS:  Participants experienced challenges related to provision of suboptimal patient care, the challenge of non-adherence to protocols and/or instructions and the challenge of practising beyond the scope of practice. CONCLUSION:  Lack of resources resulted in providing suboptimal intensive patient care. Patients were prone to infections and their safety might be compromised.

Expected clinical competence from midwifery graduates during community service placement in Limpopo province, South Africa.

BACKGROUND: Community service nurses are placed in a hospital within the first year after qualifying to obtain clinical experience under the supervision of experienced professional nurses. When placed in clinical environments, new midwifery graduates are expected to be job ready, demonstrate competence in the provision of evidence-based care, practise independently and assume accountability and responsibility for their own actions. AIM: The study aimed at exploring the expectations of experienced midwives of clinical competence of newly graduated midwives during transition. SETTING: The study was conducted at the training hospitals of the five districts in Limpopo province. METHOD: The researcher used a qualitative approach which is explorative and descriptive in nature. The population comprised all the professional midwives with experience of 5 years and above working at the selected hospitals in Vhembe, Mopani, Capricorn, Waterberg and Sekhukhune districts of Limpopo province, South Africa. From each selected hospital, five experienced midwives were selected using non-probability, purposive sampling method. An in-depth individual face-to-face interview was used to collect data from the participants, until saturation was reached. The open-coding, Tesch's eight-step process was used to analyse data. RESULTS: Results revealed that newly graduated midwives failed to meet the perceived expectations by experienced midwives; this was reflected in sub-themes: limited sense of independence, limited participation in task sharing and commitment and competence versus incompetence to patient care. CONCLUSION: The experienced midwives expected newly graduated midwives to function as professionals; unfortunately, they expressed disappointment as graduates did not meet their expectations. Newly graduated midwives lacked sense of independence, commitment to patient care and did not display ability in task sharing.