THE PRESENTATION AND INTERPRETATIONS OF THE FINDINGS OF PHASE TWO, THE PLANNING PHASE

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INTRODUCTION AND BACKGROUND

The choice of the study topic emanates from a belief that care is deteriorating in midwifery around the globe. This study intends to highlight what led to the belief that midwifery care is declining and that there is generally low work ethics in midwifery care. This assertion is supported by a Cooperative Inquiry (CI) research conducted in one maternity ward, in one hospital based in the Mpumalanga province of South Africa. At the selected hospital a number of sub-standard care complaints arose, the midwives-women relationship became intolerable and repeated reporting of negative and/or unpleasant experiences increased. As a result, the first principle of the midwives’ continuous efforts to “be with the woman” is sometimes forgotten (Royal College of Midwives, 2014:22) and therefore caring and responsive attitude is lost during childbirth.

PROBLEM STATEMENT

Midwives are at all times expected to observe and apply value-driven midwifery care in their interaction with women during childbirth. Notably, a decrease in value-driven midwifery care was observed in one maternity ward in one hospital in Mpumalanga. The hospital’s maternity ward was reported negatively by the community during an Imbizo (a community service delivery mass meeting with political leaders). Usually, during these meetings community members are given a platform to raise concerns about service delivery expectations and/or dissatisfactions. However, during this particular meeting community members diverted from the usual topics such as water, electricity and roads and raised their dissatisfaction about the care received by the women admitted for childbirth.

The Department of Health

The researcher believes the findings of the study will add to the body of knowledge of the DoH. The findings can also be used by the department to improve care and minimise clients’ dissatisfaction. The researcher hopes that the findings of this inquiry will highlight the need for the inclusion of professional value-driven midwifery care as the base for quality midwifery care in the country.

Nursing Education

The findings of this study will benefit nursing education. It is the desire of the researcher that healthcare professional educators’ reinforce value-driven care in nursing education, as this may lead to the realisation of quality care in all clinical areas.

Declaration
Dedication
Acknowledgement
Abstract
CHAPTER 1 ORIENTATION TO THE STUDY NUMBER TOPIC
1.1 INTRODUCTION AND BACKGROUND
1.2 PROBLEM STATEMENT
1.3 RATIONALE OF THE STUDY
1.4 Significance of the study
1.4.1 The Department of Health
1.4.2 Nursing Education
1.4.3 Midwifery practice
1.4.4 Policy makers
1.5 AIM OF THE STUDY
1.6 OBJECTIVES OF THE STUDY
1.7 DEFINITION OF KEY CONCEPTS
1.7.1 Cooperative or a cooperative inquiry group
1.7.2 Cooperative inquiry
1.7.3 Ethics
1.7.4 Midwifery care
1.7.5 Value
1.7.6 Value driven care
1.8 RESEARCH PARADIGM
1.8.1 The origin of the critical theory paradigm
1.8.1.1 Major assumptions of critical theory as applicable to the study
1.9 RESEARCH DESIGN AND METHODS
1.9.1 The origins of cooperative inquiry
1.9.2 The development of a research group in cooperative inquiry
1.9.2.1 The application of Cooperative Inquiry approach in the study
1.9.2.2 Principles of a Cooperative Inquiry
1.10 ETHICAL CONSIDERATION IN THIS STUDY
1.10.1 Ethical approval
1.10.2 Ethical principles of research
1.10.2.1 Principle of beneficence
1.10.2.2 Principle of justice
1.10.2.3 Respect for human dignity
1.11 ORGANISATION OF CHAPTERS
1.12 CONCLUSION
CHAPTER 2 LITERATURE REVIEW
2.2.1 Creswell’s (n y) five steps was used to conduct literature review in this study
2.3 THE PURPOSE OF THE LITERATURE REVIEW
2.4 THE FOCUS OF THE LITERATURE REVIEW OF THE STUDY
2.4.1 The generic professionalism in nursing and midwifery
2.4.1.1 Characteristics of a profession
2.4.2 The enhancement of professionalism in midwifery practice
2.4.2.1 The midwife as a continuous inquirer
2.4.2.2 The midwife as an accountable professional
2.4.2.3 The midwife as an autonomous practitioner
2.4.2.4 The midwife as an inter-professional collaborator
2.4.2.5 The midwife as a competent practitioner
2.4.3 Incompetence in midwifery practice
2.5 VALUES IN MIDWIFERY PRACTICE
2.5.1 Description of the concept ‘value’
2.5.2 Professional values applicable to midwifery
2.5.3 Professionalism in midwifery practice
2.5.3.1 Definition of the concept midwifery
2.5.3.2 The midwife as a scientist and specialist
2.5.3.3 Midwives’ professional and ethical responsibilities
2.5.4 Attentiveness of a caring midwife
2.5.5 Responsibility of a caring midwife
2.6 RESPONSIVENESS OF A CARING MIDWIFE
2.7 MIDWIFERY AS A CARING PROFESSION
2.7.1 Caring during midwifery
2.7.2 Different authors’ perspectives on the concept of caring
2.7.2.1 Watson’s theory of care: The caritus factors
2.7.2.2 Leininger’s theory of care: Culturally competent care
2.8 VALUE-DRIVEN CARE
2.8.1 Value-driven midwifery care and values
2.8.2 Quality and professional value-driven midwifery care
2.9 CONCLUSION
3.1 INTRODUCTION
3.2 COOPERATIVE INQUIRY RESEARCH APPROACH
3.2.1 The type of cooperative inquiry of this study
3.2.1.1 Apollonian inquiry research
3.2.1.2 Internally initiated inquiry research
3.2.1.3 Closed system boundary inquiry research
3.3 THE CONTEXT OF THE STUDY
3.3.1 The geographic context of the study
3.3.2 The social-academic and the researcher’s topic-specific context level
3.3.3 The practice level context
3.3.3.1 The requirement of the National Department of Health
3.3.3.2 The maternal-child health providers’ level
3.4 RESEARCH METHODOLOGY
3.4.1 An outline of the phases of a cooperative inquiry research
3.5 A BRIEF DESCRIPTION OF THE PHASES OF THE COOPERATIVE INQUIRY
3.5.1 Reflection phase
3.5.2 Planning phase
3.5.3 Action phase
3.5.4 Observation phase
3.6 DATA COLLECTION
3.6.1 Phase 1: Introductory phase of the study
3.6.1.1 Phase 1: The Preparatory phase, (stage 1): negotiating entrée into the setting
3.6.1.1.1 Objective of phase 1, (stage 1)
3.6.1.1.2 Sample of phase 1, (stage 1)
3.6.1.1.3 Data collection method used in phase 1, (stage 1)
3.6.1.1.4 Outcomes of phase 1, (stage 1)
3.6.1.2 Phase 1: The Reflection phase, (stage 2): the Hand Diagram image exercise
3.6.1.2.1 Objective of phase 1, (stage 2)
3.6.1.2.2 Sample of phase 1, (stage 2)
3.6.1.2.3 Data collection method used in phase 1, (stage 2)
3.6.1.2.4 The outcomes of phase 1, (stage 2)
3.6.1.3 Phase 1: The Reflection phase, (Stage 3): the Nominal Group Technique
3.6.1.3.1 Objective of phase 1, (stage 3)
3.6.1.3.2 Sample of phase 1, (stage 3)
3.6.1.3.3 Data collection methods used in phase 1, (stage 3)
3.6.1.3.4 Outcomes of phase 1, (stage 3)
3.6.2 Phase 2: The planning phase
3.6.2.1 Objective of phase 2
3.6.2.2 Sample for phase 2, the Planning phase
3.6.2.3 Data collection method, techniques and procedures used in phase 2
3.6.2.3.1 The process of conducting focus group discussions
3.6.2.3.2 Additional data collection techniques used in phase 2
3.6.2.4 Outcomes of phase 2
3.6.3 Phase 3: The action phase
3.6.3.1 Objective of phase 3
3.6.3.2 Sample of phase 3
3.6.3.3 Data collection methods used in phase 3
3.6.3.4 Outcomes of phase 3
3.6.4 Phase 4: The observation phase
3.6.4.1 Objective of phase 4
3.6.4.2 Sample of phase 4
3.6.4.3 Data collection methods used in phase 4
3.6.4.3.1 The process of audit tool development
3.7 DATA ANALYSIS
3.7.1 Cooperative inquiry data analysis
3.7.2 Thematic data analysis
3.7.2.1 The application of the thematic data analysis
3.8 MAINTAINING TRIANGULATION OF THE COOPERATIVE INQUIRY
3.8.1 Methods triangulation
3.8.2 Theoretical triangulation
3.9 PROMOTING RIGOR OF THE STUDY
3.10 SPECIFIC ETHICAL CONSIDERATIONS RELEVANT TO A COOPERATIVE INQUIRY RESEARCH
3.11 CONCLUSION
CHAPTER 4 THE PRESENTATION AND INTERPRETATION OF FINDINGS OF PHASE ONE, THE INTRODUCTORY PHASE OF THE STUDY
4.1 INTRODUCTION
4.2 THE INTRODUCTORY PHASES OF THE STUDY
4.2.1 The Preparatory phase, (Stage 1)
4.2.2 The Reflection phase (Stage 2), the hand diagram image exercise
4.2.2.1 The use of the hand diagram exercise: Values clarification exercise no.1
4.2.2.2 Clarification of the metaphor applied in the reflection phase
4.2.2.3 The application of the Hand Diagram image exercise
4.2.2.4 The process of conducting the Reflection phase (stage 2), Hand
Diagram image exercise
4.2.2.5 Description of the responses of the Hand Diagram figure exercise
4.2.3 The Reflection phase (Stage 3), the nominal group technique (NGT)
4.2.3.1 Values clarification exercise 2: Nominal Group Technique
4.2.3.2 Likert scale
4.2.3.3 Value ranking, a value-continuum form
4.2.4 The Planning phase: Phase 2
4.2.5 Action phase: Phase 3
4.2.6 The Observation phase: Phase 4
4.3 THE FINAL REFLECTION PHASE OF THE STUDY
4.4 CONCLUSION
CHAPTER 5 THE PRESENTATION AND INTERPRETATIONS OF THE FINDINGS OF PHASE TWO, THE PLANNING PHASE
5.1 INTRODUCTION
5.2 OPERATIONALISATION OF CHAPTER FIVE OF THIS STUDY
5.3 THE FINDINGS OF PHASE TWO
5.4 THE PRESENTATION AND THE INTERPRETATION OF THE FINDINGS OF THE SECOND PHASE OF THE STUDY
5.4.1 Theme 1: Providing quality midwifery care to the women during childbirth
5.4.1.1 Sub-Theme 1: The understanding of the concept of ‘quality’ midwifery care NUMBER TOPIC
5.4.1.2 Sub-Theme 2: Creating a risk and harm-free midwifery environment
5.4.2 Theme 2: Preserving the holistic well-being of women who undergo childbirth
5.4.2.1 Sub-Theme 1: Addressing women’s physically safe midwifery care
5.4.2.2 Sub-Theme 2: Addressing the psychological aspect of care during midwifery care
5.4.2.3 Sub-Theme 3: Treating every woman as social being in need of support
5.4.3 Theme 3: Upholding professional practice to improve midwifery care
5.4.3.1 Sub-Theme 1: Recruitment of skilled and knowledgeable midwives
5.4.3.2 Sub-Theme 2: Conducting in-service training
5.4.3.3 Sub-Theme 3: Applying compassionate and committed care
5.4.3.4 Sub-Theme 4: Portraying acts worthy of professional image
5.4.4 Theme 4: Maintaining ethical midwifery care throughout childbirth
5.4.4.1 Sub-Theme 1: Promoting beneficence during midwifery care
5.4.4.2 Sub-Theme 2: Showing respectful midwifery care towards women admitted for childbirth
5.4.4.3 Sub-Theme 3: Promoting acts of justice towards women who undergo childbirth
5.4.4.4 Sub-Theme 4: Encouraging women’s rights during childbirth
5.4.4.5 Sub-Theme 5: Commitment towards women during childbirth
5.4.5 Outlining barriers towards professional value-driven midwifery care
5.4.5.1 Sub-Theme 1: Lack of resources
5.4.5.2 Sub-Theme 2: Outlining barriers towards the right to doula support initiative
5.4.5.3 The role of culture during childbirth
5.5 CONCLUSION
CHAPTER 6 DISCUSSION OF FINDINGS AND LITERATURE CONTROL: PHASE TWO
6.1 INTRODUCTION
6.2 THE UNIQUE NATURE OF THE FINDINGS OF THIS COOPERATIVE INQUIRY
6.2.1 The operationalisation of the chapter and literature control
6.3 DISCUSSION OF FINDINGS AND LITERATURE CONTROL OF PHASE TWO
6.3.1 THEME 1: Providing quality midwifery care to the women during childbirth
6.3.1.1 Subtheme 1: Understanding of the concept “quality” midwifery care
6.3.1.2 Sub-Theme 2: Creating a risk and harm-free midwifery environment
6.3.2 Theme 2: Preserving the holistic wellbeing of the women who undergo childbirth
6.3.2.1 Sub-Theme 1: Addressing the women’s physically safe midwifery care
6.3.2.2 Sub-theme 2: Addressing the women’s psychological aspect of care during midwifery
6.3.2.3 Subtheme 3: Treating every woman as a social being in need of support
6.3.3 Theme 3: Upholding professional practice to improve midwifery care
6.3.3.1 Sub-Theme 1: Recruitment of skilled, knowledgeable midwives
6.3.3.2 Sub-Theme 2: Conducting in-service training
6.3.3.3 Sub-Theme 3: Applying compassionate and committed care
6.3.3.4 Sub-Theme 4: Portraying acts worthy of professional image
6.3.4 Theme 4: Maintaining ethical midwifery care
6.3.4.1 Sub-Theme 1: Promoting beneficence during childbirth
6.3.4.2 Sub-Theme 2: Portraying respect towards the women who give birth
6.3.4.3 Sub-Theme 3: Promoting acts of justice towards women during childbirth
6.3.4.4 Sub-Theme 4: Encouraging women’ rights during birthing
6.3.4.5 Sub-Theme 5: Portraying commitment towards ethical midwifery care
6.3.5 Theme 5: Outlining barriers towards professional value-driven midwifery care
6.3.5.1 Sub-Theme 1: Lack of resources
6.3.5.2 Sub-Theme 2: Barriers towards the right to doula support initiative
6.3.5.3 Sub-Theme 3: The role of culture during childbirth
6.4 CONCLUSION
CHAPTER 7 THE DEVELOPMENT OF STRATEGIES TO EMPOWER MIDWIVES TOWARDS THE PROFESSIONAL VALUE-DRIVEN MIDWIFERY CARE
7.1 INTRODUCTION
7.2 AN OVERVIEW OF THE DEVELOPMENT OF STRATEGIES IN MIDWIFERY
7.2.1 The Introductory phase
7.2.2 The Planning phase
7.2.3 The Action phase
7.2.4 The Observation phase
7.3 THE PROCESS OF DEVELOPING THE STRATEGIES
7.3.1 Initial plans to develop the strategies
7.3.1.1 The meeting for developing strategies
7.3.2 The approach followed to develop the strategies
7.3.2.1 The mini-workshop
7.4 AN OVERVIEW OF THE GLOBAL STRATEGIC DIRECTIONS
FOR STRENGTHENING NURSING AND MIDWIFERY 2016-2020
7.4.1 A Brief description of the Global strategic directions for strengthening nursing and midwifery 20116-2020
7.5 GUIDING PRINCIPLES THAT REINFORCE THE DEVELOPMENT OF STRATEGIES IN THIS STUDY
7.6 THE ALIGNMENT OF THE PRINCIPLES OF WHO (2016) TO THE DEVELOPMENT OF THE STRATEGIES
7.6.1 PRINCIPLE OF QUALITY AND THE FINDINGS OF THE STUDY
7.6.2 Principle of partnership and the findings of the study
7.6.3 Principle of relevance and the findings of the study
7.6.4 Principle of ethical action and the findings of the study
7.6.5 Principle of ownership and the findings of the study
7.7 PHASE 3: STRATEGIES TO EMPOWER THE MIDWIVES IN A MATERNITY WARD
7.7.1 The name of the strategies
7.7.2 The aim of the strategies
7.7.3 The scope of the strategies
7.7.4 Description and the structure of the strategies
7.8 MAINTAINING RIGOUR DURING THE DEVELOPMENT OF STRATEGIES
7.8.1 Appropriateness of the strategies
7.8.2 Regular interaction of the CIG
7.8.3 Regular consultative process
7.9 REVIEW OF AND UPDATING OF THE STRATEGIES
7.10 IMPLEMENTING AND SHARING OF THE STRATEGIES
7.11 CONCLUSION
CHAPTER 8 SUMMARY OF THE STUDY FINDINGS, RECOMMENDATIONS, IMPLICATIONS, LIMITATIONS AND CONCLUSIONS
8.1 INTRODUCTION
8.2 AN OVERVIEW OF THE STUDY AND SUMMARY OF THE FINDINGS
8.2.1 The findings of Phase 1: The Introductory Phase
8.2.1.1 Phase 1, stage 1: the Preparatory phase
8.2.1.2 Phase 1, Stage 2: the 1st Reflection phase of the Values clarification exercise no.1
8.2.1.3 Phase 1, Stage 3: the 2nd Reflection phase: Values clarification Exercise no. 2
8.2.2 Phase 2: The Planning phase
8.2.2.1 Theme 1: Providing quality midwifery care to women during childbirth
8.2.2.2 Theme 2: Preserving the holistic well-being of women who undergo childbirth
8.2.2.3 Theme 3: Upholding the professional practice to improve patient care
8.2.2.4 Theme 4: Maintaining ethical Midwifery care throughout childbirth
8.2.2.5 Theme 5: Outlining barriers towards professional value-driven midwifery care
8.2.3 Phase 3: The Action phase
8.3 8.3 DEVELOPMENT OF STRATEGIES TO EMPOWER THE MIDWIVES REGARDING THE PROFESSIONAL VALUE DRIVEN MIDWIFERY CARE IN A MATERNITY WARD
8.3.1 Methodology for developing the strategies
8.3.1.1 Population of phase 3: The Action phase
8.3.1.2 Data collection and analysis
8.3.2 The development of strategies in midwifery
8.3.2.1 The aim of the strategies
8.3.2.2 The name and the scope of the strategies
8.3.2.3 The structure of the strategies
8.4 RECOMMENDATIONS OF THE STUDY
8.4.1 Recommendations for future research
8.4.2 Recommendations for service delivery improvement
8.5 IMPLICATIONS OF THE STUDY
8.5.1 For midwifery practice
8.5.2 For the Department of Health
8.5.3 For nursing education
8.6 LIMITATIONS
8.7 CONTRIBUTION TO THE EXISTING BODY OF MIDWIFERY KNOWLEDGE
8.7.1 The development of strategies to empower midwives to render professional value-driven midwifery care so as to improve quality care during childbirth
8.7.2 The development of an Assessment Tool
8.8 FINAL CONCLUSION
References

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