3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An audit of the labour epidural analgesia service at a regional hospital in Gauteng(2017) Leonard, Tristan Gavin AlexandraBackground Neuraxial analgesia in the form of continuous epidural infusion has been shown to be the most effective analgesic strategy for the labouring mother. In developed countries data are readily available as to the number of women receiving labour epidural analgesia as well as the complication rates of labour epidurals. Data for South Africa on labour epidural analgesia services are limited and there was no published data for Rahima Moosa Mother and Child Hospital (RMMCH). Methods A retrospective audit using consecutive convenience sampling was done reviewing all epidural records at RMMCH from 1 January to 31 December 2014. Results During the study period labour epidural analgesia was administered for 187 (1,6%) of 11 853 deliveries. Epidural records were collected for all labour epidurals administered. The most common indications documented were labour analgesia (41,7%) and primigravida (28,9%). Labour epidurals were not administered for specific medical conditions. The incidence of complications was 22,6% and these complications were minor and self-limiting. Hypotension was the most common complication (12,3%). Patient satisfaction with labour epidural analgesia, where documented, was high (98,4%). Conclusions This audit revealed a low incidence of labour epidural analgesia at RMMCH during the study period. The incidence of complications was in keeping with that seen in developed countries. Poor documentation was noted to be a problem.Item A determination of time spent on nursing activities in a labour ward in a midwife obstetrics unit(2017) Ngidi, Duduzile FlorenceDetermination of staffing needs is a priority for an organization seeking to provide safe patient care in an environment which is cost conscious. Registered nurses and midwives spend more time with patients than any other single category of health professionals and also provide 24 hour direct patient care. Activity based norms are recognized by the World Health Organization to be the most suitable way of determining staffing needs; establishing of time spent on activities is one of the key factors in determining activity based staffing norms. This study focuses on ascertaining the timing of activities of midwives during labour in maternity obstetrics units with the possibility of using the information at a later date to determine activity based staffing norms for midwives in the maternity obstetrics units. An adaptation of Hodnett’s (1996) five categories of labour support was used as a framework for measuring activities performed by midwives and nurses while supporting women in labour. This model was adapted from the previous work sampling study conducted in Toronto (McNiven and Hodnett, 1992:1). Purpose of the study The purpose of the study was to determine the time taken to perform nursing activities during labour in South African Midwife Obstetrics Units (MOUs) to inform the future process of developing nursing norms for labour wards in MOUs in the public sector. Research design This was an exploratory observational study using a mixed method design that included both qualitative and quantitative methods. Spot observations studies were conducted during patients’ first stage of labour, which constituted the quantitative part of the design, i.e. activities observed and measured during the observation period. Naive sketches were used in the qualitative part of the study. The study was conducted in the six Midwife Obstetrics Units in Ekurhuleni Metropolitan Health District of Gauteng. v Main findings Activities carried out by midwives in the MOUs were mainly reactive to the physiological processes of labour as they occur. Midwives in MOUs did not display the “soft skills” referred to in Hodnett’s categories of labour support. On the other hand, those skills that they managed to display were not easy to capture because they happen simultaneously with other activities e.g. touching and holding. Most of the categories of labour support were difficult to measure because they occurred very quickly and in “groups/batches.” The activities of midwives when caring for patients in labour were timed, and the calculation of the frequency at which nursing activities was carried out was particularly successful, but the researcher concluded that while the study was useful to provide insights into the quality of care, these results could not be used as a basis for determining activity based norms. This is due to the fact that the midwives did not practice quality care and the observation method was difficult to implement. The tool would need to be simplified and the possible use of technology such as videos should be considered if the study were to be replicated. Factors that influenced the time spent and the duration of activities relate to communication, relationships, resources and systems failures. Conclusion The categories of labour support can be used for improving patient care and, if adapted to the South African setting, could be fit for the purpose of developing activity based norms, but only once midwives are taught and encouraged to implement the “soft skills” in labour which are necessary but seldom practiced. Key concepts: Maternity obstetrics unit, workload, activity based norms, categories of labour support.Item Knowledge of epidural analgesia among labour ward nursing staff at Chris Hani Baragwanath academic hospital(2015) Nongqo, NezisaEpidural analgesia has become the gold-standard for providing labour analgesia. Internationally 40-60% of labouring women receive epidural analgesia. At Chris Hani Baragwanath Academic Hospital (CHBAH) currently less than 10% of parturients receive epidural analgesia. Greater involvement of nursing staff is needed for this service to expand. Nurses should have the necessary knowledge if they are to be involved in the provision of labour epidurals. All 50 nurses working in the CHBAH labour ward at the time of the study were invited to complete a previously validated, self-administered questionnaire. The questionnaire included demographic data and a knowledge test. The demographic section assessed personal and professional details and identified sources of knowledge related to epidural analgesia. The knowledge test was comprised of 22 questions divided into five knowledge subsections relating to epidural analgesia: spinal cord anatomy and physiology, epidural pharmacology, assessment of sensory and motor blockade, complications of epidural analgesia, and the general management of a patient receiving epidural analgesia. The data was collected during working hours. Of the 50 questionnaires handed out, 45 were returned resulting in a 90% response rate. Of these, 43 questionnaires were usable. The majority of the participants were in the 30-39 years age range. The median number of years worked in labour ward was 11 (range 0.5 - 30 years). Forty four percent of the nurses had a three year diploma in nursing and 33% had a four year diploma in nursing. Sixty five percent of nurses cared for less than five patients with epidurals per month. Eighty four percent of nurses had received no specific education regarding labour epidurals. The overall knowledge of nurses working in the CHBAH labour ward, labour ward high care and labour ward admissions was poor with a median score of 4 out of a total score of 22. The results for the subsections were as follows: anatomy and physiology of the spinal cord with a median score of 1 (range 0-4), epidural pharmacology with a median score of 1 (range 0-4), assessment of sensory and motor blockade with a median score of 0 (range 0-5), complications arising from epidural analgesia with a median score of 0 (range 0-3) and general management of epidural analgesia with a median score of 2 (range 0-3). Urgent educational programs and teaching need to be instituted in order to improve the nurses’ knowledge.Item Clinical procedures in the maternity unit of a district hospital(2015-03-26) Msiza, Lydia Lebohang PerseveranceBACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development Goals (MDGs). The 5th goal is focused on improving maternal health by reducing the maternal mortality rate by 75% by 2015. South Africa has aligned itself with the MDGs. The Gauteng Department of Health and Social Development has also embraced the MDGs and decided to improve its maternal health services. It has decided to target Intra-partum period for interventions to improve maternal health because intra-partum period is associated with a high rate of perinatal death from intra-partum hypoxia (4.8 per 1000 births) (National Department of Health, 2000), as well as a significant number of maternal death (8.7%) (NCCEMD, 2007). This study was planned to systematically study the clinical procedure performed during the intra-partum period at the Heidelberg Hospital (a semi - rural district hospital in the Lesedi Sub – district of Sedibeng District in Gauteng Province). AIM: To describe the clinical procedures and factors related to these procedures and maternal and neonatal health outcomes for the mothers admitted and delivered in the Maternity unit at Heidelberg hospital during one year period (1st April 2010 to 31st March 2011) METHODOLOGY: The setting of this study was the Maternity unit of the Heidelberg Hospital. A cross sectional study design was used based on retrospective review of routinely collected data for 12 months (2010 April 1st to 2011 March 31st). No intervention was done as a part of this study. The study variables included different clinical procedures (such as normal vaginal delivery, assisted vaginal delivery, caesarean section, evacuation of uterus, caesarean hysterectomy), socio-demographic profile of patients (such as age, gender, ethnicity, medical aid), clinical profile (such antenatal diseases, booking status, intra-partum complications, postpartum complications) and maternal and perinatal outcomes. RESULTS: The study found highest number of deliveries (78.6%) were normal vertex deliveries and a very few (1%) assisted and breech deliveries. The caesarean section rate was high (20.4%) as compared to the normal national target (12, 5%). Fetal distress and CPD was the main indications for caesarean section. The majority of women who delivered at Heidelberg Hospital maternity came from poor socio-economic class, mostly single, teenagers, and unemployed. They were the most vulnerable group in the Society. The majority of women were booked and referred from PHC clinic where they were booked for antenatal check-up. Pregnancy induced hypertension was the commonest obstetric problem encountered during antenatal period. Most women who delivered at Heidelberg hospital during the period were discharged without complications, no maternal deaths were reported. There were 8.1% preterm deliveries but a relatively high still birth rate which is of concern. CONCLUSION: The study was the first of its kind to be done at Heidelberg Hospital and the Sedibeng Health District. The study systematically analysed routinely collected data and identified high risk patients, who would require special attention. This study would hopefully assist the Hospital Management to realise the high rate of CS and to develop appropriate measures to reduce unnecessary C/S being done, and to strengthen referral systems. In addition, further study is necessary at clinic level in the sub-district to identify work-loads in the feeder clinics.Item Used of partographs in women in labour at Mulanje District Hospital in Malawi(2014-08) Jere, Joyce AtuweniIntroduction: A partograph is a tool that is used to monitor progress of labour, and its correct use and appropriate interpretation can assist in early identification of complications of labour. The aim of this study was to assess if and how the partograph was used at Mulanje District Hospital in Malawi. Methods: This was a retrospective review of records of women who delivered at the Mulanje District hospital from the 1st to the 30th of September, 2010. A total of 360 women’s files were reviewed. Data was collected from the delivery register, theatre register, case files and partograph charts. A Chi-square was used for statistical analysis and a p value of < 0.05 was considered significant. Results: The partographs were available in 93.3% (336/360) of women’s files. Forty eight percent (162/336) of women’s files had partographs with all three sections of labour monitoring documented, but only 10% (16/162) of the partographs had information correctly and completely filled in on each parameter of the three components of the partograph. Forty percent (64/162) of women delivered after crossing the action line, and 67.2% (43/64) who delivered after crossing the action line were referrals, while 32.8% (21/64) were women who came to the hospital in labour. Almost 40.6% (26/64) of women who crossed the action line suffered immediate adverse outcomes. There was no significant difference in maternal outcomes (post partum haemorrhage, ruptured uterus and maternal deaths) and foetal outcomes (low Apgar score of 5/10 or less at 1 minute and 5 minutes, fresh still births and deaths within 24 hours) between women that were from the primary care health centres and those that reported to the hospital in labour. The study found that 57.8% (37/64) of women who crossed the action line had spontaneous vertex delivery, almost 38% (24/64) delivered by caesarean section and 4.7% (3/64) delivered by assisted vacuum extraction. There was a significant difference in mode of delivery after v crossing the action line. More caesarean sections were performed on women from the primary care health centres as compared to those that came to the hospital in labour: 44.2% (19/43) vs 23.8% (5/21), p=0.049. Conclusion and Recommendation: Although partographs were available in women’s files, the partograph data were not completed adequately. While progress of labour was frequently documented, maternal and foetal condition were incompletely documented. Effective interventions such as in-service training, regular supportive supervision, regular audits of records of women in labour and intensification of use of guidelines for labour management are required to strengthen the use of the partograph for women in labour. Further research is recommended to highlight barriers for correct use of the partograph