3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
3 results
Search Results
Item Forms of birth and care: experiences of women and midwives within a private birth clinic(2018) Jordaan, Cheyenne RoseThis research report is the product of an ethnographic investigation into the experiences of women and midwives from within a private birth centre in a major South African city. Its methods involve participating observation and interviews to collect narratives of birth at Wellspring clinic from women and midwives. This research report argues that private birth clinics are spaces that exist within a web of tensions. They are spaces designed to encompass a hybridisation of care practices and technologies. They are accessible to those who are able to afford private health care. They are used by women who are insistent in their resistance of an unnecessarily medicalised birth experience. Wellspring encompasses midwife-led care, where women feel in charge of their bodies and birthing experiences, in juxtaposition to private hospitals and their subsequent care under the gaze of the obstetrician. In essence, despite the glaring socio-economic disparities in which they are embedded, private birth clinics in South Africa present an amalgamation of home and hospital. The satisfaction and empowerment of this care presented below, is a provocation to start thinking about providing spaces for all women to benefit within maternal healthcare, and not the privileged fewItem Personal evaluuations of midwifery students regarding ethical competency(2017) Mpeli, MoliehiEthical competence, understood as the ability to identify and enact right actions within a specific spatial and temporal context, is ascribed to a nursing ethics educational approach that encourages self-reflection and guides toward personal growth. It is difficult for ethics educators to know whether the students who have undergone a specific training perceive themselves as confident and competent in handling ethical dilemmas. This knowledge is significant, especially for nursing and midwifery graduates who have undergone training that stipulates adherence to a code of ethics and professional norms. In the face of contemporary ethical challenges, the way that traditional codes of ethics or rule ethics are taught in midwifery practice without contextualization has been hotly debated by many authors. There is a consensus that rules or codes of ethics are inadequate in substantiating the moral decision making of the practising nurses and midwives. This study argues that current strategies that rely heavily on Principlism and codes in teaching nursing ethics without appraising the context of an ethical situation are ineffective in fostering ethical competence amongst students. The acquisition of ethical competence amongst the midwifery students in terms of the current approach of teaching Principlism and codes of ethics may be described in terms of compliance and limited reflection. This study makes use of a set of self-reflection reports in which the midwifery nursing students narrated their experiences in handling ethical issues. The reports detailing their experiences were analysed for evidence of ethical competence. The aim of the research report is twofold: first, to highlight the limitations of current nursing ethics education in fostering ethical competence; and second, to inform nursing ethics curricula regarding strategies to foster ethical competence amongst midwifery students, based on existing literature on the subject. Analysis of the reflection narratives revealed that one of the three dimensions of ethical competence was limited. There was evidence of moral perception, moral action and substandard moral reasoning. The principles selected by the majority were limited to autonomy and beneficence. The findings support the argument that teaching Principlism and enforcing a code of ethics without contextualising it, obligates the student to conform without arguing their assertions. The current teaching approach that consist of abstract concepts of ethical framework, limit the acquisition of ethical competence. It is recommended that nursing education institutions should consider approaches that are aligned with the goals of care, and pertinent to the practice of nursing and midwifery, if ethical competence is to be attained.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.