YESTERDAY'S STUDENT NURSES, TODAY'S NURSES: COMPETENCIES OF NEWLY- QUALIFIED MIDWIVES

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1 YESTERDAY'S STUDENT NURSES, TODAY'S NURSES: COMPETENCIES OF NEWLY- QUALIFIED MIDWIVES Ms. Zanele Zwane (Masters: Nursing Education) KZN COLLEGE OF NURSING SECOND SOUTH AFRICAN Nurses Conference ICC-DURBAN 17 October 2013

2 Introduction This study was conducted in partial fulfillment of the requirements for the Masters Degree in Nursing (Nursing Education) at UKZN. The reduction of the maternal mortality ratio (MMR) is one of the major Millennium Development Goals (MDGs) (WHO, 2006). There is slow progress towards achievement of this goal due to shortages of professional midwives in many countries in Africa (UN, 2005). In the developed world the maternal mortality ratio averages around 21 maternal deaths per live births (WHO, 2006). By contrast, in developing countries, the ratio is 20 times higher-at 440 per 100,000 (WHO, 2006).

3 Introduction & Background (cont) The KZN province is reported as having the highest number of maternal deaths in South Africa (Taylor, 2008:2). About 27,8 are due to substandard management, problem with recognition of diagnosis, resuscitation, initial assessment of the patient and delay in referring the patient (Snyman; 2007; Fawcus, et al 2006:71). Appropriate preparation and skilling of health workers, including midwives, is viewed bywho (2006) as one of the solutions. Midwifery training differs in different parts of the world. In most developed countries midwifery programs are 3 years.

4 Introduction & Background (cont) In SA midwives are produced through 2 programs; 1 year midwifery program and a comprehensive 4 year nursing program. Concerns have been raised with the quality of graduates, in general, produced from the comprehensive 4 year programme as well as the midwifery content in a comprehensive program offered over a duration of 6 months (Lekhuleni, 2008; Morolong & Chabeli, 2005). The high maternal mortality rates, previous studies reflecting limitations in the competencies of graduates from the comprehensive nursing programme and the midwifery core content that is offered over a period of 6 months has prompted the need for this study.

5 Purpose of the Study To explore and describe clinical competencies of NQMs in selected hospitals which fall within the ethekwini Municipality Research Objectives 1. Identify and describe clinical competencies of NQMs as perceived by NQMs as well as their supervisors. 2. Explore the views of NQMs and their supervisors regarding the competencies of NQMs.

6 Research Methodology Quantitative approach, exploratory descriptive design. Maternity units of 5 hospitals in the ethekwini Municipality were research settings Data was collected through structured questionnaires from 48 NQMs & 26 supervisors Data analysis: Frequencies were computed to determine the for each item contained in the questionnaire. Cross tabulations for Chi-Square analysis was performed to test for differences in the ratings of the graduates competencies by themselves and their immediate supervisors.

7 Five-point Likert scale, based on-from Novice to Expert Model 1= no knowledge/experience, 2= some knowledge/experience, 3= competent and can perform most of the activities without support, 4= competent, experienced and able to function independently, 5= competent, experienced and able to teach others

8 Results Cognitive competencies Problem solving skills: NQMs rated themselves as having no knowledge or experience in obtaining adequate information from a client. Research skills: NQMs rated themselves higher than the supervisors did in a number of research-related skills Clinical judgment skills: Both groups revealed that NQMs were functioning at level 4. Teaching skills: NQMs were perceived by a majority to have skills that ranged from level 3 to level 4. Administrative skills: NQMs were not confident about their ability to produce clear and accurate report in this study as they rated themselves lower than their supervisors

9 Problem Solving Skills NQMs SUPERVISORS ) Obtain adequate information from a client 32.5 (13) 22.5 (9) 2) Assess client s needs 4.2 (2) 15 (6) 31.3 (15) 10 (4) 47.9 (23) 20 (8) 16.7 (8) 0 (0) 0 (0) 4 40 (10) (9) 56 (14) 24 (6) 20 3) Define a client s problem 4) Formulate a nursing care plan (17) 39.6 (19) (26) (2) (11) 32 (8) 36 (9) 44 (11) 16 (4) 20 5) Discriminate and synthesize information obtained from assessment (20) 43.8 (21) 12.5 (6) 4 52 (13) 24 (6) 20

10 Results (cont) Affective skills Adaptive skills: Supervisors rated NQMs lower (level 3) in confidence in midwifery ability, working under pressure and adjusting to the work environment Interpersonal Communication skills:the findings in this study also showed that NQMs communicated in a professional and ethical manner

11 Adaptive Skills NQMs SUPERVISORS 1. Sensitive to people's feelings 2. Accepts criticism from colleagues 3. Confident in my midwifery ability 4. Work under pressure 5. Adjust to work environment (6) (4) 6.3 (3) (14) (12) 29.2 (14) 31.3 (15) 42.6 (20) 45.8 (22) 40.4 (19) 45.8 (22) 47.9 (23) (18) 25.5 (12) 18.8 (9) 18.8 (9) 15.4 (4) (2) 11.5 (3) (8) 46.2 (12) 34.6 (9) 38.5 (10) 38.5 (10) 46.2 (12) (8) 30.8 (8) (6) 26.9

12 Results (cont.) Psychomotor skills Antenatal care skills: NQMs (53.2) rated themselves higher than their supervisors in screening high-risk pregnancies Intrapartum care skills: supervisors rated NQMs lower than the NQMs themselves in skills related to dealing with women in labour. Neonatal care skills:the NQMs were perceived to be competent or proficient in a number of skills related to neonatal care. Record Keeping: NQMs were not very confident with their skills relating to written communication with a patient, family, community and multi-disciplinary team. Medication used in obstetrics: Both groups perceived NQMs competent in skills related to administration of medication

13 Psychomotor skills 1. Antenatal care skills NQMs SUPERVISORS (8) 29.8 (14) 53.2 (25) 42.3 (11) 38.5 (10) Intrapartum care skills (9) 42.6 (20) 36.2 (17).0 (0) 42.3 (11) 30.8 (8) Neonatal care skills (10) 33.0 (11) 43.8 (21) (4) (14) 4. Record Keeping 25.5 (12) 23.4 (11) 19.1 (9) 17.1 (8) 7.7 (2) 46.2 (12) Medication used in obstetrics (12) 33.3 (16) 37.5 (18) 7.7 (2) (10)

14 Discussion and Recommendations At the time of graduation, it must be noted that the graduates are not yet at the level of being experts but they are in a process of becoming. They develop and grow with practice and they should be natured during the initial years of their employment. Nurturing requires support by skilled midwives as well as other health care workers who are part of the obstetric team Compared to the previous studies that were conducted after the first cohort of graduates from the comprehensive programme, the findings from this study reflect slight improvement in the level of competency of midwifery graduates.

15 Discussion and Recommendations (cont d) Special attention however should be given to history taking, intra-partum care skills, screening high-risk pregnancies, and record keeping. In-service education programmes to target these areas. Further research is recommended that will involve nonparticipant observation and interviews to observe competency elements as part of competency standards as these do not yet exist in the country.these may be used to guide the preparation of midwives

16 . Reference List Fawcus, S., Mbambo, N. & Mangate, E. (2006) Obstetric haemorrhage third report on confidential enquiries into maternal deaths in South Africa O & G Forum, 16, Lekhuleni, M.E. (2008) A model for mentorship of newly qualified professional nurses employed in community health care services. Ph.Theses, University of Venda andtechnology World Health Organisation. (2006)Working together for health. Geneva: Switzerland:WHO. Taylor. (2008) Saving mothers:will South Africa meet the Goals.

17 Acknowledgements UKZN School of Nursing staff Professor NG Mtshali (Research Supervisor) Participants

18 Thank you

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