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NURSES' OPINIONS ON THE IMPLEMENTATION OF DIRECTED PRENATAL SERVICES IN THE DISTRICT HEALTH FACILITIES OF DAR ES SALAAMA. The purpose of this study was to explore and describe nurses' perceptions of the delivery of targeted antenatal care services in nine district health facilities in Dar es Salaam.

INTRODUCTION

Despite the high antenatal attendance of pregnant women at various health facilities in Tanzania, the maternal mortality rate is still high. Against this background, nurses in Tanzania were the first cadres to be trained in focused antenatal care services.

Table 1.1  Nurses trained in focused ante-natal care services in Dar es  Salaam health facilities
Table 1.1 Nurses trained in focused ante-natal care services in Dar es Salaam health facilities

RESEARCH PROBLEM

Statement of the research problem

What are the implications for nursing practice, education and research of the introduction of the focused maternity care services in Tanzania. What are the perceptions of nurses about the implementation of the focused antenatal services in the district health facilities in Dar es Salaam.

PURPOSE OF THE STUDY

Research questions

MDG target 5 was translated into two targets, namely reducing the maternal mortality ratio by three-quarters and achieving universal access to reproductive health by 2015 (WHO 2005a). Focused prenatal care is one of the strategies that nurses must use to achieve this goal.

Research objective

SIGNIFICANCE OF THE STUDY

DEFINITION OF KEY TERMS

  • Ante-natal care
  • Focused ante-natal care services
  • Implementation
  • Model
  • Nurse
  • Perception
  • Patient

In this study, focused antenatal care services refer to services provided by nurse midwives according to the FANC guidelines provided by the WHO, which focus on the assessment and actions needed to make decisions for each woman's individual situation. In this study, nurses are expected to perceive and express the delivery of targeted antenatal care services according to their own opinions, understanding and views.

THEORETICAL FOUNDATION OF THE STUDY

Theoretical framework

King's systems theory as cited by George explains perceptions in terms of the open system, which in this study includes nurses, midwives and patients. How the nurse sees or perceives the implementation of focused obstetric care will be influenced by social systems such as education, religious background and the health system of the country nationally (George 2002:247).

Assumptions

The social system is important from the nurse's and the patient's side because they both belong to this system. Assumptions affect the logic of the study, and the recognition of assumptions leads to more rigorous study development.

ETHICAL CONSIDERATIONS

Ethical considerations refer to procedures that are followed to protect the rights of respondents, that of the institution and scientific integrity (Polit and Beck 2008:170). These procedures include aspects such as informed consent, confidentiality, anonymity, respect, dignity, scientific integrity, the right to refuse participation in the study and permission to withdraw from the study.

RESEARCH DESIGN AND METHOD

Therefore, during the research, the researcher took into account the following principles, namely benevolence, respect for human dignity, fairness, anonymity, confidentiality, scientific integrity and avoidance of plagiarism when conducting the research (detailed discussions in chapter 3).

STRUCTURE OF THE DISSERTATION

CONCLUSION

INTRODUCTION

ANTE-NATAL CARE SERVICES

  • Approaches to ante-natal care (ANC) services in some African countries

Antenatal care is named as one of the pillars of the Safe Motherhood Initiative. The approach of the antenatal care program is the focused visit with a qualified provider.

FOCUSED ANTE-NATAL CARE MODEL

  • Goals of focused ante-natal care service
  • Implementation of focused ante-natal care

Clinic readiness to offer focused antenatal care reduced staff concerns about the working conditions. Focused antenatal care is provided by the district health system in the district health facilities.

DISTRICT HEALTH SYSTEM

  • Dar es Salaam districts

All this is happening in the three districts of Dar es Salaam namely Temeke, Kinondoni and Ilala. Figures 2.1, 2.2 and 2.3 show maps of health facilities providing antenatal care services in Kinondoni, Ilala and Temeke districts.

Figure 2.1   Kinondoni district
Figure 2.1 Kinondoni district

CONCEPTUAL FRAMEWORK

Nurses' perceptions form the internal system, and the external system is the implementation of focused prenatal care in the care of the pregnant woman and the unborn child. When providing targeted prenatal care, nurses communicate with pregnant women individually as well as with groups of women. On the other hand, if the nurse has training, guidelines, work spaces and an improved environment, she will perceive the implementation of FANC well.

Figure 2.4   King’s open systems framework   Source: Adopted from George (2002:244)  Social system
Figure 2.4 King’s open systems framework Source: Adopted from George (2002:244) Social system

CONCLUSION

Implementation of FANC includes following health policies, guidelines suggested by WHO (2008a:1-2) and protocols from the Ministry of Health. Perceptions formed about FANC result from the personal system which is the image of reality and the interpersonal system which deals with the dyadic relationship with the nurse, interaction and communication (George 2002:246). However, if the pregnant woman is not well received in the health institution and is not given the relevant information, she will have negative perceptions and the same applies to the nurse, if there is no support from the management and the work environment is not favorable. negatively perceive the implementation of FANC.

INTRODUCTION

RESEARCH APPROACH

  • Quantitative approach

In this study, the variables of nurses' perception of the implementation of focused antenatal care are nurses, pregnant women, implementation and perception. It is consistent with available resources, especially time, and is also the personal preference of the researcher.

RESEARCH DESIGN

  • Explorative design
  • Descriptive design
  • Survey
  • Research setting

This study was descriptive in the sense that the researcher collected and documented descriptions of nurses' perceptions about the implementation of the focused antenatal care service. The fact that surveys focus on what people feel or think enabled the researchers in this study to obtain information about nurses' perceptions of the implementation of focused prenatal care. Conducting a study in a natural environment means that the researcher does not manipulate or change the environment for the study.

RESEARCH METHOD

  • Population
  • Sample and sampling technique
    • Stratified random sampling
  • Data collection
    • Data collection method
    • Construction of the questionnaire
    • Structure of the questionnaire
  • Pre-testing the questionnaire
  • Data collection process

The population consisted of approximately 560 nurses providing antenatal care services in the three district health facilities (Dar es Salaam Region Health Services Information 2005:7). In the three districts nine (30%) health facilities providing antenatal care services were randomly sampled through stratified random sampling. Section B contained items on adequacy of human and non-human resources of district health facilities providing antenatal care services.

Table 3.1 Stratified random sample according to hospitals, health centres and  dispensaries
Table 3.1 Stratified random sample according to hospitals, health centres and dispensaries

VALIDITY AND RELIABILITY

  • Validity
  • Reliability

However, due to some new aspects that were added to the instrument, the test-retest reliability of the instrument was done with the assistance of the statistician to ensure reliability (Burns & Grove 2007:404). A pre-test using clients with similar characteristics to the study sample was conducted to determine clarity of the items and consistency of responses. The higher the item-to-item consistency, the higher the reliability of the questionnaire.

ETHICAL CONSIDERATIONS

  • Protection of the rights of respondents

The questionnaires were not accessible to persons who were not involved in the research (Polit & Beck 2008:173). Respondents have the right to expect that all information collected during the course of the study will be kept strictly confidential (Polit & Hungler 1999:139). Anonymity was ensured by being protected throughout the study by not allowing respondents' names or addresses to be attached to the questionnaires (Brink et al 2006:47).

DATA ANALYSIS

CONCLUSION .......................................................................................... 62 2

INTRODUCTION

ANALYSIS OF THE DATA

The research results from the statistical tests were discussed with reference to the sample characteristics of the respondents.

SECTION A: DEMOGRAPHIC DATA

  • Nursing category
  • Age
  • Trained in reproductive and child health
  • Training period
  • Experience in reproductive and child health
  • Trained in focused ante-natal care
  • Knowledge gained from training
  • Application of knowledge

The study conducted in Mtwara, Tanzania (Von Both, Flepa, Makuwani & Mpembeni 2006:2) also states that during FANC training, special attention should be paid to the acquisition of counseling attitudes and clinical skills by training program participants. These studies are in line with the result of this study as the majority of the participants received FANC training, implying good clinical skills in the care of pregnant women. The large number of nurses applying the acquired knowledge was a positive result of the training program offered and an advantage for pregnant women.

Figure 4.3 presents nurses trained in RCH.
Figure 4.3 presents nurses trained in RCH.

SECTION B: CLINIC RESOURCES

  • Adequacy of staff as human resources
  • Category of nurses to be added
  • Adequate provision of facilities

Almost all respondents were of the opinion that all nursing categories should be added. The result that all respondents wanted to add all categories of nurses is in line with the staffing shortage observed in the previously reported results. However, in this study, all nursing categories were rated as important and should be added regardless of level of education in providing ANC services.

Table 4.4  Type of nursing category to be added (N=143)
Table 4.4 Type of nursing category to be added (N=143)

SECTION C: INFORMATION PROVIDED TO PATIENTS DURING ANTE-

  • Information

Although the implementation of the FANC is seen as positive, this finding indicates that there seems to be an insufficient number of nurses with the essential skills and knowledge, especially about the FANC, to train pregnant women, especially with regard to critical aspects such as birth preparation and complication readiness. This is concerning as it may indicate that birth preparation information could have been provided by a less skilled or informed category of nurses. In The Gambia (Anya et al 2008), the researchers concluded in their findings that information, education and communication during antenatal care seemed to be poor.

SECTION D: INFORMATION PROVIDED ON HOW TO RECOGNISE

  • Information on how to recognise complications during pregnancy

Almost all respondents confirmed that they provided information about complications during pregnancy, 4.54% of them were unspecified regarding all complications and 7.89% did not provide information. The area in which the most information was provided by the nurses who agreed to provide information about complications during pregnancy is fetal rupture, namely. The findings of this study suggest that there are gaps that need to be identified and addressed, as not all aspects of essential information about pregnancy complications are available to women.

Table 4.6   Information provided on recognising complications during  pregnancy (N=142)
Table 4.6 Information provided on recognising complications during pregnancy (N=142)

SECTION E: PERCEPTIONS ABOUT IMPLEMENTATION OF FANC

This is a cause for concern, as the respondents indicate that sufficient time was spent with the women, which is a low response rate. In other words, one could assume that not enough time is spent with the women. Langer et al (2002) also conclude that women and caregivers (nurses) generally accepted the new FANC model.

SECTION F: PERCEPTION OF NURSES ABOUT THE OUTCOME ON

However, the findings confirm that nurses have a positive opinion about the implementation of FANC services in their clinics. Some women from the ANC's new model group expressed concern about the timing of the visits. The average response of the respondents showed a positive perception of the outcome of FANC implementation in all clinics or health centers that participated in the research.

CONCLUSION

This conclusion is supported by the highest response to agree that the FANC guidelines were properly followed. According to this result, there appear to be institutional obstacles that need attention. This conclusion may be related to the finding about a shortage of staff reported earlier.

INTRODUCTION

OBJECTIVE OF THE STUDY

SUMMARY OF FINDINGS

  • Demographic data
  • Clinic resources
  • Information provided to patients during ante-natal visits
  • Information provided on how to recognise complications during pregnancy 89
  • Perceptions about the outcome on the implementation of FANC

Pregnant women still go to the laboratory to have blood taken for syphilis. Respondents also indicated that they inform pregnant women about how to behave during childbirth. In this study, nurses gave pregnant women information about what drugs they should or should not take during pregnancy and also about the dangers of tobacco.

SCOPE AND LIMITATIONS

RECOMMENDATION

Extensive recruitment and employment of nurses and midwives should be done by the district health authorities to reduce the shortage. It needs to be strengthened and monitored so that women and children can get the expected services to reduce mortality rates. Some form of evaluation on how the FANC guidelines are followed and adhered to seems necessary to strengthen the already scarce skills of nurses to provide valuable information to pregnant women.

CONCLUSION

REQUEST TO CONDUCT A SURVEY OF NURSES' PERCEPTION OF THE IMPLEMENTATION OF TARGETED ANTE NATAL CARE IN THE HEALTH FACILITIES DISTRICT OF DAR ES SALAAM. Title: Nurses' perceptions of the implementation of targeted prenatal care in the district health centers of Dar es Salaam. RESEARCH: NURSES' PERCEPTION OF THE IMPLEMENTATION OF TARGETED ANTE NATAL CARE IN DAR ES SALAAM HEALTH FACILITIES.

Implementation of focused antenatal care services is considered acceptable, targeted and of. Pregnant women attending this clinic/health center since the implementation of focused antenatal care services are satisfied.

Figure

Table 1.1  Nurses trained in focused ante-natal care services in Dar es  Salaam health facilities
Table 1.2  Outline of the study
Figure 2.1   Kinondoni district
Figure 2.2   Ilala district
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