ETD Collection

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Subject: search.filters.subject.Maternal-Child Nursing

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Now showing 1 - 3 of 3
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    Deliveries at maternity ward at Evander District Hospital in the Mpumalanga Province
    (2014) Hlatywayo, Nanana Glory
    Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.
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    Stress experienced by mothers of neonates in a private hospital NICU.
    (2014-03-28) Buys, Lauren Mildred
    Mothers of neonates admitted to neonatal intensive care units appear to suffer stress which may be related to the illness and treatments the neonate is undergoing, separation from the neonate and social and relationship issues. Nursing professionals employed in the neonatal intensive care unit (NICU) need specific preparation in order to assist mothers to cope with the experience of their neonate being admitted to the NICU. Research is required in order to adequately describe the nature of the stress and whether it changes over a period of time and to provide nursing professionals with information relating to the subject of stress suffered by mothers in this situation. A quantitative, longitudinal study of stress experienced by mothers of the neonate NICU patient was undertaken using the Neonatal Unit Parental Stress (NUPS) Scale (Reid, Bramwell, Booth & Weindling, 2007) (Reid et al., 2007). Mothers who met inclusion criteria were recruited to participate in the study. They were asked to complete the NUPS questionnaire at two time points. Correlations were examined between data obtained on the NUPS questionnaire and the mother and infant demographic data. The results of this study have shown that mothers experience the greatest stress as a result of neonatal suffering and their inability to perform functions of the mother role as a result of separation from the neonate. These findings have been used to make recommendations for the preparation of nursing professionals who work in the NICU.
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    Referral pattern for maternity patients in the Nkhensani district hospital in Giyani sub-district
    (2012) Mboweni, Agrey Ernest
    Background: Nkhensani Hospital is a level 1 district hospital which provides comprehensive and integrated health care for the Giyani sub–district population, which is estimated to be 270 000. The major services provided are casualty, medicine, paediatrics, maternity and surgery. The hospital is experiencing challenges in the maternity ward which is admitting more patients than the 47 allocated beds. Monthly, an average of 400 women are admitted for delivery from clinics. The causes are suspected to be due to a number of different factors like shortage of staff at the clinics, poor referral system, poor services at clinics and health centres, poor facilities, and pregnant woman not attending antenatal care and bypassing lower levels of care. Aim: To describe the pattern and appropriateness of referrals in patients attending the maternity ward at the Nkhensani Hospital. Methodology: A retrospective study was used to review and asses the patient records for the study (January to December 2009). Information was obtained from the Hospital Information System and secondary data from patients records will be used to assess the referral pattern in Nkhensani Hospital’s maternity ward. Results: The data showed that the patients admitted had a mean age of 26 years, with a range from 15 to 45 years. Patients were admitted for various reasons, which when categorised were found to have 57% of inappropriate referrals. Similarly 68% of referrals were found to have low risk pregnancies. About 85% of the deliveries were normal vaginal deliveries. Of the patients who attended the facility, 57% were referred from clinics, 19% from community health centres, 1% from general practitioners and 23% as self referrals. The source of referral was not found to be v associated with appropriate reasons for delivery, risk category, length of stay or mode of delivery. Conclusion: The research showed that the referral pattern in the maternity ward from clinics and health centres as well as self referrals indicated that policies were not being adhered to, which led to an over utilisation of the maternity ward in Nkhensani Hospital under Giyani sub-district