assessment of the use of the new maternity case record in improving the quality of ante-natal care

145 Pages·2015·2.47 MB·English

by  Nokuthula Sibiya

ASSESSMENT OF THE USE OF THE NEW MATERNITY CASE
RECORD IN IMPROVING THE QUALITY OF ANTE-NATAL CARE IN
ETHEKWINI DISTRICT, KWAZULU-NATAL
Reginah Jabulisile Cele
Dissertation submitted in fulfilment of the requirements for the Degree of Master
of Technology in Nursing in the Faculty of Health Sciences at the Durban
University of Technology.
Supervisor : Prof MN Sibiya
Co-supervisor : Ms TSP Ngxongo
Date : July 2014
Declaration
This is to certify that the work is entirely my own and not of any other person,
unless explicitly acknowledged (including citation of published and unpublished
sources). The work has not previously been submitted in any form to the Durban
University of Technology or to any other institution for assessment or for any other
purpose.
_________________ __________________
Signature of student Date
Approved for final submission
_________________ ___________________
Prof MN Sibiya Date
RN, RM, D Tech: Nursing
_________________ ___________________
Ms TSP Ngxongo Date
RN, RM, M Tech: Nursing
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Dedication
I dedicate this dissertation to the Almighty God for giving me the power and strength to
start and finish this study, with Him everything is possible.
I would like to dedicate this study to my one and only son Melokuhle, my daughter
Thembi and my dearest partner Mr Sipho P. Mposula for their support and
encouragement throughout the study and being a source of my happiness.
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Acknowledgements
I would like to express my heartfelt gratitude to the following people who contributed to
the success of this study:
 Professor MN Sibiya for her continued dedication, mentoring and support over the
past two years to make this study successful, and for always availing herself at
any time for assistance, unconditionally.
 Mrs TSP Ngxongo for her motivation, guidance, mentoring, being motherly to me
and a pillar of my strength during difficult times. She did so passionately, always
making me come first rather than her family. Without her I could not have
completed my study.
 Special thanks to Ms DG Sokhela for her encouragement and contribution to my
study.
 I also acknowledge all the midwives from eThekwini Municipality who took part to
my study, and also the Head of Department and nursing service managers for
granting me permission to conduct the study in eThekwini Municipality PHC
clinics.
 Ms G Hendrys for assisting me with statistical data analysis.
 I would like to thank all the people who contributed to my study.
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Abstract
Brief background to the study
The national guidelines for maternity care in South Africa recommend that a standardised
maternity case record be used by all facilities at all levels of care in order to improve the
quality of care for pregnant women. According to the National Department of Health, this
will facilitate continuity and quality of care for women during pregnancy, labour and post-
partum.
Aim of the study
The aim of the study was to assess whether the implementation of the new maternity
case record has improved the quality of care for pregnant women.
Methodology
An exploratory, descriptive study using both quantitative and qualitative design was used
to conduct the study. Data was collected through a retrospective record review using a
checklist for the quantitative strand, and from midwives using unstructured interviews for
the qualitative strand. The quantitative data set was analysed using the Statistical
Package for the Social Sciences version 21.0 and the qualitative strand was analysed
using the Tesch’s method of data analysis.
Results
The results of the record review revealed that although the recording was done fairly
well, there were a number of activities and interventions that were recorded poorly or not
recorded at all in some primary health care clinic. The midwives verbalised that many
mistakes and mismanagement of ante-natal care clients emanated from the structure
and the design of the new maternity case record.
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Recommendations
Recommendations include the following: communication of policies and protocols to the
midwives should be done timeously, provision of in-service education and/or updates on
new developments, strengthening of supportive supervision, the Nursing colleges be
kept up-to-date with new developments in nursing practice and that a broader study
involving other districts and provinces be conducted.
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Table of contents
Declaration…………………………………………………………………………………………i
Dedication…………………………………………………………………………………………ii
Acknowledgements……………………………………………………………………………...iii
Abstract……………………………………………………………………………………………iv
Table of Contents………………………………………………………………………………..vi
List of Tables……………………………………………………………………………………...x
List of Figures……………………………………………………………………………………xi
Appendices……………………………………………………………………………………...xii
Glossary of Terms……………………………………………………………………………...xiii
List of Acronyms………………………………………………………………………………..xv
CHAPTER 1: OVERVIEW OF THE STUDY…………………………………………….......1
1.1 INTRODUCTION AND BACKGROUND TO THE STUDY………………………….1
1.2 IMPLEMENTATION OF THE NEW MATERNITY CASE RECORD………………6
1.3 PROBLEM STATEMEN ………………………………………………………………..6
1.4 RESEARCH AIM………………………………………………………………………...7
1.5 OBJECTIVES OF THE STUDY………………………………………………………..7
1.6 SIGNIFICANCE OF THE STUDY……………………………………………………..8
1.7 CONCLUSION…………………………………………………………………………..9
CHAPTER 2: LITERATURE REVIEW………………………………………………………10
2.1 INTRODUCTION…………………………………………………………………….....10
2.2 GLOBAL CONTEXT……………………………………………………………………10
2.3 SUB-SABHARAN AFRICAN CONTEXT…………………………………………….12
2.4 SOUTH AFRICA………………………………………………………………………..14
2.5 COMPARISON BETWEEN THE NEW MATERNITY CASE RECORD
AND PREVIOUS MATERNITY RECORDS………………………………………………...17
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2.6 CONCLUSION…………………………………………………………………………19
CHAPTER 3: RESEARCH METHODOLOGY……………………………………………..20
3.1 INTRODUCTION……………………………………………………………………….20
3.2 RESEARCH DESIGN…………………………………………………………………20
3.3 DONABEDIAN’S MODEL AND ITS APPLICATION TO THE STUDY…………..21
3.4 AREA OF THE STUDY………………………………………………………………..25
3.5 IDENTIFICATION OF THE STUDY POPULATION………………………………..26
3.6 SAMPLING PROCESS……………………………………………………………….27
3.6.1 Phase one: identification of the PHC facilities…………………………………….27
3.6.1.1 Inclusion criteria……………………………………………………………….28
3.6.1.2 Exclusion Criteria……………………………………………………………...28
3.6.1.3 Sample size and sampling process…………………………………………28
3.6.2 Phase two: sampling of clinic record………………………………………………..30
3.6.2.1 Inclusion criteria……………………………………………………………….30
3.6.2.2 Exclusion criteria………………………………………………………………30
3.6.2.3 Sample size…………………………………………………………………….31
3.6.3 Phase three: Sampling of the midwives…………………………………………….31
3.6.3.1 Inclusion criteria………………………………………………………………..31
3.6.3.2 Exclusion criteria……………………………………………………………….31
3.6.3.3 Sample size…………………………………………………………………….31
3.7 DATA COLLECTION PROCESS…………………………………………………….31
3.7.1 Phase one: Retrospective record review……………………………………………32
3.7.2 Phase two: Interviews with the midwives …………………………………………...32
3.8 PILOT STUDY………………………………………………………………………….32
3.9 DATA ANALYSIS………………………………………………………………………33
3.9.1 Phase 1: Quantitative data analysis…………………………………………………33
3.9.2 Phase 2: Qualitative data analysis…………………………………………………..33
3.9.3 Data interpretation and triangulation………………………………………………..34
3.10 ETHICAL CONSIDERATION………………………………………………………...34
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3.11 TRUSTWORTHINESS AND RESEARCH RIGOUR…………………………....35
3.11.1 Credibility………………………………………………………………………………...35
3.11.2 Dependability……………………………………………………………………………35
3.11.3 Confirmability……………………………………………………………………………36
3.11.4 Generalisability………………………………………………………………………….36
3.11.5 Transferability……………………………………………………………………………36
3.11.6 Authenticity………………………………………………………………………………36
3.12 CONCLUSION………………………………………………………………………..37
CHAPTER 4: PRESENTATION OF RESULTS …………………………………………….38
4.1 INTRODUCTION………………………………………………………………………..38
4.2 PRESENTATION OF PHASE ONE DATA: QUANTITATIVE DATA……………..38
4.2.1 Gestational age booking……………………………………………………………….39
4.2.2 Recording of history taking at first visit……………………………………………….40
4.2.3 Plotting of gestation at first visit……………………………………………………….40
4.2.4 Examination……………………………………………………………………………..42
4.2.5 Further test statistics……………………………………………………………………44
4.2.6 Interpretation and decisions…………………………………………………………...45
4.2.7 Further test statistics……………………………………………………………………47
4.2.8 Bavariate analysis………………………………………………………………………48
4.2.8.1 Recording of each element by the facilities………………………………….48
4.2.8.2 Chi- square test of independence …………………………………………….49
4.2.9 Summary of quantitative phase……………………………………………………….50
4.3 PRESENTATION OF PHASE TWO DATA: QUALITATIVE………………………..51
4.4 THEMES THAT EMERGED FROM THE INTERVIEW DISCUSSION……………51
4.4.1 Theme 1: Accessibility of the maternity case record………………………………..52
4.4.1.1 Supplies of the maternity case record card in the clinics…………………..52
4.4.1.2 Process of ordering card……………………………………………………….53
4.4.1.3 Alternate means of making card available in clinics………………………..53
4.4.2 Theme 2: Structure of the card………………………………………………………..54
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4.4.2.1 Card size…………………………………………………………………………54
4.4.2.2 Card design……………………………………………………………………...55
4.4.2.3 Writing space…………………………………………………………………….56
4.4.2.4 Repetition………………………………………………………………………...57
4.4.2.5 Limited Questions……………………………………………………………….57
4.4.3 Theme 3: Consequences of the current design……………………………………..59
4.4.3.1 Communication…………………………………………………………………59
4.4.3.2 Referral system………………………………………………………………….59
4.4.3.3 Poor recording…………………………………………………………………..60
4.5 SUMMARY FOR THE QUALITATIVE PHASE………………………………………61
4.6 CONCLUSION…………………………………………………………………………..62
CHAPTER 5: DISCUSSION OF THE RESULTS…………………………………………..63
5.1 INTRODUCTION………………………………………………………………………...63
5.2 DISCUSSION OF THE RESULTS…………………………………………………….63
5.2.1 Structure………………………………………………………………………………….63
5.2.2 Process…………………………………………………………………………………..65
5.2.3 Outcome…………………………………………………………………………………74
5.3 SUMMARY OF THE STUDY FINDINGS…………………………………………….80
5.4 CONCLUSION…………………………………………………………………………..82
5.5 LIMITATION OF THE STUDY…………………………………………………………83
5.6 RECOMMENDATIONS………………………………………………………………...83
5.6.1 Policy development and implementation …………………………………………….83
5.6.2 Institution management and practice…………………………………………………83
5.6.3 Nursing education………………………………………………………………………84
5.6.4 Further Research………………………………………………………………………..84
REFERENCES………………………………………………………………………………….85
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