School of Nursing

Permanent URI for this community

http://hdl.handle.net/11660/86

Browse

Browsing School of Nursing by Author "Bekker, E."

Now showing 1 - 2 of 2
  • Thumbnail Image
    ItemOpen Access
    South African midwives’ knowledge of placental triage
    (University of the Free State, 2021-02) Van Rensburg, Amori; Bekker, E.
    The placenta is an underexplored and underappreciated organ. Examining the placenta is routine after birth. It is given a glance-over, but never a second thought. Placental histology provides a valuable in-depth investigation into placental pathology. Abnormalities can be identified by a macroscopic examination of the placenta. This investigation can be considered as a triage of the placenta to determine if histological investigation is required. One of the biggest contributors to litigation in obstetrics comprises to children with Cerebral Palsy (CP). Factors contributing to the development of CP can be shown to be present in utero, rather than during labour, by sending the placenta for histology. Litigation costs in South Africa in the field of maternal and child health is increasing exponentially. This increased risk for litigation and the high number of unexplained stillbirths are the drivers behind the value of macroscopic placental examination and histology. This research focussed on answering the research question: What is the existing knowledge of midwives educated in South Africa regarding placental triage? To answer this research question, a quantitative research approach was chosen, and a survey method used. A questionnaire was developed to determine and describe the knowledge of South African midwives. The total number of participants were 157. Of all participants, 64% stated that they always examine placentas. The Department of Health South Africa (DoHSA) require a basic examination of the placenta to always be performed. The regulation relating to the conditions under which registered midwives may carry their profession, R2488, also stipulates that a placenta must be inspected for completeness of the disc and membranes. This finding confirms non-conformity to the guidelines for submission of placentas for histology. The overall median for the questionnaire was 61.9%. The lowest obtained score was 14.3% and the highest score was 81%. This indicated that the participants had 60% knowledge of the macroscopic placental examination. Little literature is available regarding investigated placental examination or knowledge within South Africa. The DoHSA admits to constraints in the education system leading to poor competency and limited clinical exposure. As most participants were employed in the public sector, it was expected that they complied with the procedures described in the in the documentation prescribed by the DoHSA. Yet, through the study findings it became clear that some midwives were not compliant. Only 61% of participants answered that there were placental histology services available in the units they worked in. That left a gap of 40% of institutions that did not have these services available and raises the question of what was being done in these facilities when an abnormal placenta was identified. In conclusion, forty per cent (40%) of participants did not know what the histology report of the placenta could be used for. This proved that more awareness should be shared on this subject and the benefits it provides, for midwives. A staggering 97% of participants stated that the institution they worked at could benefit from further education regarding placentas and placental histology. It is reassuring that 88% stated that they could benefit from advanced training regarding examination of placentas. It is evident that examination of the placenta is paramount in the prevention of litigation cases and for future treatment of the mother and baby.
  • Thumbnail Image
    ItemOpen Access
    Strengthening the system of Confidential Enquiry into Maternal Deaths (CEMD) in Lesotho
    (University of the Free State) Ramaili-Letsie, Tlalane; Bekker, E.
    English: The purpose of this study was to describe through Appreciative Inquiry (AI), the strengths, opportunities and aspirations of all stakeholders involved in the Confidential Enquiry into Maternal Deaths (CEMD) system in Lesotho. This was done with an intention of supporting and strengthening the work of this system. The study was conducted using a qualitative descriptive design and Appreciative Inquiry as a research technique. AI draws from the principle of positivism, where by strengths base, rather than problems are a point of focus to resolve problems. The researcher was seeking to appreciate the best of what the system is, by discovering its strengths. The participants used their strength base to envision the best of what the system could be. They also drew strategies that will enable them to attain the envisaged future CEMD in Lesotho. Data collection along with primary data analysis was conducted in a one day AI workshop. The participants for the study were selected using non-probability selection and comprised of representatives of all stakeholders of CEMD in Lesotho. The sample size was 20 participants comprising of four (4) members of QMMH maternal mortality review committee, ten (10) Maternal Mortality Assessors each representing one of the ten districts in Lesotho and six (6) members of the LCCEMD, two of which also represented the MOH. The results of the study reflected five main themes that portray the strengths of the CEMD system in Lesotho; namely government commitment to CEMD, an effective feedback mechanism, strong communication system, a strong support system following maternal death and Maternal Death Review (MDR) and lastly an effective training and monitoring system. The participants used these strengths as the base to map out an envisaged ideal system of CEMD in five years, which was reflected in a collage form. The dream phase depicted more government commitment where a revolution against maternal deaths was declared, urging government to commit more resources to CEMD. Interlinks and integration of the efforts of other disciplines in curbing maternal deaths was encouraged. Strengthening communication, Advocacy for MDR and dissemination of key messages about safe motherhood are seen as crucial in strengthening CEMD in Lesotho. Participants lobbied for support of the carers of the diseased mother as well as those involved in MDR. They recommended a system of trust with an element of debriefing and counseling to avert psychological impact of MDR. Training and monitoring need to be more decentralized for capacity building on both MDR processes and skills acquisition in caring for pregnant mothers. During the design phase participants realized that with only one year to 2015, the target of reducing maternal deaths by 75 % may not be realized. They however realized that it is possible to prevent primitive maternal deaths; those that are avoidable. They drew a bold affirmative statement “Lesotho amazes the world: Primitive Maternal deaths down to zero by 2015”. A plan to realize this included: strengthening information sharing, improving the infrastructure for Maternal and child health (MCH) services, ensuring availability of Human resources and commodities. The researcher concluded that with the positive attitude, the stakeholders of CEMD in Lesotho were able to realize the strengths of the system and used them as a platform of improving it. An improved system is likely to yield recommendations that will enable Lesotho to improve maternal health and curb maternal deaths. The study was concluded with recommendations for clinical practice, pre-service and in-service education, research, the LCCEMD, and regulatory bodies for health professions.