Perception On Attitude Of Student Midwives On Community Experience Towards Pregnant Women

Project and Seminar Material for Nursing (Science)

Abstract

The Objective of this study was to make an assessment of women’s perception regarding antenatal care service they obtained from student midwives, in Eket Health Center, Akwa Ibom, Nigeria. The study design was a cross-sectional descriptive survey. As a sampling method, purposive sampling method was used, because this study seeks predefined groups, which are pregnant women. Total of 101 pregnant women participated in the study. Study obtained that; practice of information exchange, health advice and counseling less frequent, shortage of basic supplies, laboratory reagents and medical equipment detected, still clear gap and enormous missed opportunity in performance of some students’ midwives as a result 13% of pregnant women perceived the service as unsatisfactory and 27% of clients do not trust the service and they do not recommend the service to others or friends. To mitigate the identified gap the following recommendations provided: regular on job training for student midwives to provide service as per the standard, conducting continuous supportive supervision, mentoring and coaching on provision of client friendly service and adhering to professional ethics.

Table of Content

Chapter One:

Introduction

1.1 Introduction
1.2 Background of the Study
1.3 Statement of the Problem
1.3 Purpose of the Study
1.4 Objective of the Study
1.5 Research Questions
1.6 Test of Hypothesis
1.7 Significance of the Study
1.8 Scope and Limitation of the Study
1.9 Definition of Terms
1.10 Organization of the Study

Chapter Two:

Review of Related Literature

2.1 Conceptual Review
2.2 Theoretical Review
2.3 Summary of Literature review

Chapter Three:

Research Methodology

3.1 Introduction
3.2 Study Area
3.3 Research Design
3.4 Universe of the study
3.5 Sampling Method and Sample Size
3.5.1 Sampling Method:
3.5.2 Sample Size:
3.6 Data Collection: Tools and Procedures
3.6.2 Observation Guide:
3.7 Quality Control Measurement
3.8 Data Processing
3.9 Reliability of the Study
3.10 Validity of the Study
3.11 Ethical Consideration

Chapter Four:

Data Analysis and Result Presentation

4.0 Introduction
4.1 Introduction
4.2 Socio- Demographic Characteristics
4.3Data Presentation
4.4 Test of Hypothesis

Chapter Five:

Summary, Conclusion and Recommendations

5.1 Introduction
5.1 Summary
5.2 Conclusions
5.3 Recommendations
REFERENCES
APPENDIX

Chapter One

Introduction

1.1 Introduction

This chapter deals with introductory parts of the study, which includes the following: background of the study, statement of the problem, objective of the study, research questions, significance of the study, scope and limitation of the study and finally organization of the study. In the entire above stated sub topics adequate descriptions which are very pertinent for the study purpose incorporated.

1.2 Background of the Study

Maternal mortality is one of the most serious health problems in Nigeria. Its tragic feature is the greatest number and gap between risk of death during pregnancy and child birth in developing and developed countries.
Nigerian Demographic Health Survey (NDHS) showed that the maternal mortality rate was 673 deaths per 100,000 live births and infant mortality rate was 77 deaths per 1000 live births (NDHS, 2005). This shows us that there are many premature deaths which can be easily preventable and manageable with simple doable measures and actions, starting from the community to higher health facility level intervention.

Antenatal care service is one of the basic elements of Maternal and Child Health (MCH) service which improves health of pregnant woman and the new born, and reduces maternal morbidity and mortality. Therefore, service provision should be assessed to identify the strength and weakness of the ANC service and to find out the unmet needs of pregnant women who seek this service.

Currently, access to health service is improved. However, mere availability of service alone cannot warrant the effective provision of all necessary service elements which help to obtain the desired goals of pregnancy outcomes and to alter the present poor maternal health profile. It is good to introduce periodical and action oriented assessment to check practical situation and women perception about the service they obtained by student midwives (Olufemi T., Oladapo1, Christianah A. et al. 2008)

This study explored the practice and perception of pregnant woman on antenatal care services by Student midwives like: interpersonal relations with care providers, extent of counselling to fulfil ANC clients’ information needs and condition of birth preparedness and availability utilization of service elements.

1.3 Statement of the Problem

Conducting assessment on ante natal care service by Student midwives from women perspective and practice is important tool which reflects users’ opinion regarding quality of service they obtained. It helps managers and student midwives to pass informed decision in order to address unmet needs of pregnant women receiving antenatal care. According to Negussie, Tadele, Yemane, and Berhanu (1998) as a result of lack of assessment, most of the time the service being provided and the management system are not subjected to assessment and most managerial decisions are not assessment based management actions.

Olufemi T., Oladapo1, Christianah A. et al. (2008) argue that “In spite of the increasing importance of quality of antenatal care worldwide, detailed information about the quality or effectiveness of antenatal care practices is less often available or investigated in many of the population where they are most needed especially from medical trainees such as Student midwives” (p.72).

Misganaw F., Abubeker K., Assefa M. et al. (2000) on their Study which was done in Northwest Nigeria indicated that “there is little or no report concerning effectiveness of ANC services at different levels of the health care system in Nigeria by Student midwives” (p. 156).

Olufemi T., Oladapo1, Christianah A. et al. (2008) strongly suggests that “ at present, data about the quality of antenatal care service at the primary care level , as perceived by pregnant women , which could provide useful information to researchers and policy makers are lacking” (p.73).

As evidenced above, assessment of women’ perception about MCH components including ante natal care service is insufficient in Nigeria, and rarely carried out in southern region of Nigeria. So, such a study on women’s perception and experience on the antenatal care service is by Student midwives instrumental step to maintain standardized service delivery and quality.

1.3 Purpose of the Study

The purpose of the study is to investigate perception on attitude of student midwives on community experience towards pregnant women

1.4 Objective of the Study

Examine ANC clients’ perception about Student midwives approach during service provision.
Assess professional advice and counseling practice in addressing major information’s needed for ANC clients.
Describe ANC clients practice in terms of provided care and availability of service elements by Student midwives (like: HIV counseling and testing, laboratory investigations, prescribed drugs, immunization).
Identify gap in service delivery process by Student midwives

1.5 Research Questions

What are ANC clients’ perception about Student midwives approach during service provision.
What are professional advice and counseling practice in addressing major information’s needed for ANC clients?
What are ANC clients practice in terms of provided care and availability of service elements by Student midwives? (like: HIV counseling and testing, laboratory investigations, prescribed drugs, immunization).
What are the gaps in service delivery process by Student midwives?

1.6 Test of Hypothesis

H0 There is no significant relationship between attitude of student midwives and Health Centre recommendation
H1 There is no significant relationship between speaking attitude of student midwives and Health Centre recommendation

1.7 Significance of the Study

It is solid true that, this study aimed at exploring antenatal client’s perspective and experience regarding antenatal care service they obtained, in Eket Health Centre, Akwa Ibom, Nigeria help to carry out systematic assessment, problem identification and recommendation for action to strengthen the service and to fulfil any unmet needs of antenatal client’s if identified.

1.8 Scope and Limitation of the Study

The result of this study is only reflecting the client perception and experience regarding ANC service of only in Eket health center currently. It does not represent other service providing health facilities in that area. As a limitation, assessment conducted in very brief period of time, the respondents’ number is very limited and only simple statistical methods applied. So, it may not fulfill needs of complex studies in the field. As a result, this study believed to attract other more structured and organized technical studies in the area

1.9 Definition of Terms

MCH:

Maternal and Child Health care is the care provided to mothers (Women in child bearing age) and children.

ANC:

Antenatal care is the care given to a pregnant woman in order to have safe pregnancy, labor and health baby.

PHC:

Primary Health Care refers to an approach and spectrum of service beyond the traditional health care system that focus on health care service including health promotion, illness and injury prevention , and the diagnosis and treatment of illness and injury.

VCT:

It is an approach which help as an entry point to control HIV/AIDS pandemic; it include voluntary counseling and testing with provision of medical and psychosocial support.

FP:

Family Planning is a general term that applies to various methods that have been developed to help partners to determine the number and time of birth of children.

STI:

These are infections that have a realistic probability of transmission between human persons, by means of sexual contact; most commonly vaginal intercourse. Immunization: It is the process of protecting the susceptible host from a specified disease by administration of a living modified agent, a suspension of killed organisms or attenuated toxins.

ANC Packages (ANC Elements):

This includes examinations, blood test, and urine test, tetanus toxoid immunization, anti-malaria drug provision.

1.10 Organization of The Study

This study is organized into five chapters. The first chapter contains the background, statement of the problem, research questions objectives of the study, significance of the study scope and limitation of the study, Next, chapter 2 deals with both theoretical and empirical literatures addressing Definition of ANC, its components, paradigm shifts, focused ANC and it also deals with overview of practical conditions based up on study findings. Chapter 3 describes study area, research design, sampling method sample size. Additionally, chapter 4 deals with data analysis, interpretation and discussion of the result or findings of the study. Finally, chapter 5 includes summary of the research findings, conclusions and recommendations. Last but not least, following the above chapters, list of reference materials and annexes incorporated at the end of the paper.

Chapter Five

Summary, Conclusion and Recommendation

5.1 Introduction

Chapter 5 deals with research summary, conclusion and recommendation. Under the summary part, major finding of the study result presented, in short and simple way. Second, the conclusion part of this chapter, based up on the result and summary, clearly concludes major identified gaps and un-meet needs according to the research questions and objectives. Finally, this chapter putted basic recommendation in a categorized way to health facility, to the community, to end users and researchers.

5.1 Summary

Total of 101 respondents participated in this study, the majority of respondents were under the age category of 20-24 years, the mean age of the study subjects was 23.2 years, teen age pregnancy comprise of 12.8% of total respondents, These indicate that most of them are very young and with limited exposure and experience.
When we see the overall practice of antenatal care by student midwives, some major antenatal care service indicators practice ranges from 99% (Blood Pressure measurement) to 58.4% (Checking leg edema). The study indicates that, although some indicators are performed very optimally, up to 99%, there are still clear gap and enormous missed opportunity in performance of some other major indicators like height measurement, weight measurement, leg edema checking and HIV testing &counseling. As a result of these, the antenatal care service provided in Eket health center is in difficulty to addresses its objectives which are promotion, prevention and early detection of complication and prompt management.

The study revealed that, the antenatal care service by student midwives provided currently in Eket health center looks weak in equipping pregnant women in necessary knowledge, attitude and skill. This is reflected by low provision of health information on key issues like; advice on pregnancy related danger sign provided only for 44.6% pregnant women, information on post natal family planning given only for 46.5 %, counseling on place of delivery not addressed for 36.6% of pregnant women, and advice on exclusive breast feeding provided for only about half of interviewed pregnant women. Such an opportunity missing, can lead to poor identifications of complication and late coming to seek medical care, it also contributes to poor linking of pregnant women for subsequent care.
Very great majority, nearly 90% of respondents perceived that, the antenatal care service process (waiting time, technical competency, availability of necessary tests and drugs), student midwives’ friendliness and the health center infrastructure generally acceptable. However, on the other hand, even if they are minority, those ranges from 5 -13% are not comfortable about the service infrastructures, availability of necessary tests and drugs and student midwives’ friendliness.

On the main issue of attitude of student midwives, Very few, 8 out of 101 clients also critically commented that, some student midwives were not friendly, they are nagging clients, they do not have patience, they are verbally harassing pregnant women and lacking feeling of empathy towards pregnant women.

Finally, out of 101 clients who received antenatal care service, around 13% perceived the service obtained today as unsatisfactory or not acceptable and 27% of respondents did not developed trust up on the service they received to the level that, they do not able to recommend this service to others or friends

5.2 Conclusions

Based on the above summary, results and discussions, the study reached to concluded: In Eket health center practice of information exchange, health advice and counselling between clients and student midwives are less frequent; it looks that the health center antenatal care performance is technically dominant than provision of information education and counseling service. Second, the health center is also in shortage of basic supplies, laboratory reagents and medical equipment like sonography machine to provide complete service, which leads to missing basic services.
Thirdly, although major antenatal care indicators optimally practiced, there are still clear gap and enormous missed opportunity in performance of some indicators like; height measurement, weight measurement, leg edema checking, which are useful physical examination and missing such indicators can lead to poor identification of risk factors and pregnancy related complications in order to take prompt action.

Finally, during the exit interview participants commented that: student midwives, were not maintaining their privacy during examination, the waiting area is lacking adequate space, lack of shade and benches, it is with poor access of pipe water and the latrine is too far from service area and very unhygienic. This study also identified the major problem which need urgent intervention like : pregnant women obtained ANC service in Eket health center perceived and practiced that, student midwives are not only that they are not friendly, but also they are nagging, lacking patience, harassing pregnant women and lacking feeling of empathy towards pregnant women. Which leads the clients to perceived the service obtained today as unsatisfactory to the level they do not able to recommend the service to others or friends.

5.3 Recommendations

The approach to improve the quality of ANC to address un-meet of clients need should be based on:

Provision of regular on job training to student midwives and team leaders of the health center to provide service as per the standard
Conducting continuous supportive supervision, mentoring and coaching of staff in provision of client friendly service
Give priority to strengthen IEC/BCC activities of the health center to have more strong practice of health education provision and counseling service to pregnant women
Ensure availability of all necessary supplies and equipments through effective supply chain management to provide all necessary packages of antenatal care at once.
The health center need to make all necessary efforts to improve waiting area, pipe water supply and clean latrine in accessible position to pregnant women
Improve service provision by respecting all clients and strengthening professional ethics.
Actively participate during quarterly community health facility conferences to express concerns and un-meet needs which need corrective action by health facility managers and service users.
Provision of feedbacks to student midwives whenever they encounter any problem during the process of service provision.
Additional standardized operational research activities need to be carried out, to have more precise finding for information based managerial decisions.
Conducting Periodical Client satisfaction surveys and prepared and analyzed data for facilitation of data based decision-makings.