D.Cur. / Health care professionals, in all settings, have become increasingly aware of the consumers' legitimate right to participate in decision-making regarding care to be received. Health professionals have also being criticised for planning and delivering care that does not take into consideration the client's perceived needs, wishes and expectations of such care. This study is undertaken primarily to explore and describe the expectations of both the care-givers (midwives, student-midwives and doctors) and the health care consumers (mothers and fathers). The focus of the study is the care to be provided to mothers by midwives during labour. It is the aim of the researcher to ameliorate lapses in the provision of comprehensive health care. The study design is exploratory, descriptive, qualitative and contextual in nature. The main purpose of this study is to formulate guidelines for implementation by the midwife during labour. In order to accomplish this purpose, the research study followed six (6) distinct phases in which different objectives were addressed. In Phase 1, the expectations of mothers and partners/fathers concerning the care to be provided by the midwives during labour were explored. These were described after conducting in-depth qualitative interviews with both the mothers and partners/fathers. In Phase 2, focus group discussions were conducted with the midwives and studentmidwives, to explore and describe their expectations concerning the care to be provided by the midwives during labour. In Phase 3, narratives were gathered from selected doctors, in which they explored and described their expectations concerning the care to be provided to the mothers by midwives during labour. The results of the interviews, focus group discussions and narratives were subsequently analysed based on categories of "Theory for Health Promotion in Nursing (Department of Nursing Science, RAU, 1998)". The results were also contextualised. A concept analysis was conducted in Phase 4 in order to identify the characteristics of the concept "Caring" using different situations where caring takes place, from literature sources (uses of the concept) as well as the two main themes which emerged from the research results. Thereafter, the identified characteristics of Caring were placed in comparison with the research results obtained from Phase 1, 2 and 3 and were reduced under the following headings: Prerequisites, Process and Consequences. From this process the concept "Caring" was defined. In Phase 5 of the study, a conceptual framework was developed out of all the characteristics determined from the concept analysis and was discussed in three phases namely, the initial, integration and termination. In the final phase, that is Phase 6, the guidelines for operationalising caring during labour were formulated from all the characteristics determined from the concept analysis and the following headings were maintained that is, Prerequisites, Process and Consequences. These guidelines were evaluated and refined by the midwives and student-midwives from the specific hospital where data was collected. The conclusions and trustworthiness of this study were discussed. Recommendations were made in terms of highlighting the possibilities of application of the guidelines for operationalising caring during labour in nursing education, nursing practise and nursing research.

M.Cur. / The recently introduced fetal growth monitoring technique - the symphysis fundal height measurement (SFHM) - has brought along a few problems. This technique was introduced in conjunction with the new antenatal card system. With this system the card is no longer kept at the health institution but carried by the mother. This mother carried antenatal card (MCAC) has a gravidograph on which measurements of fundal height are plotted graphically. Midwives in most clinical settings have experienced problems when making recordings on the gravidograph. In some centres doctors were also complaining that the symphysis fundal height measurements (SFHM) are plotted incorrectly. Midwives started to feel inadequate when doctors were constantly complaining that the gravidograph is not plotted correctly. The SFHM technique then became unpopular with midwives and most of them decided to go back to abdominal palpation - an old system which was used to monitor fetal growth. The problem most commonly found with the SFHM technique was that different midwives performed it differently. There was no uniformity in performance. This resulted in vast discrepancies of fluidal height measurements. Due to this, many problems arose with regard to proper management of pregnancy. A lot of literature surveyed by the researcher supported the fact that the SFHM technique was the best method for monitoring fetal growth. The graviphical display of SFHM on the gravidograph also facilitated early identification of intra-uterine growth retardation (IUGR). IUGR has also been found to be a major contributory factor in perinatal mortality. The survival rate of infants who have suffered IUGR can be increased through early diagnosis of IUGR and prompt referral. A seminar was staged by the researcher at the initial stages of the study to obtain views and opinions from other stakeholders regarding the SFHM technique and the MCAC. A considerable'amount of input was gained at this seminar and this contributed a great deal to the data needed for the completion of this study. The goal of this study is, therefore, to assess the ability of midwives in: performing the SFHM technique; and making recordings on the gravidograph section of the card. A quantitative, descriptive and exploratory design was followed. The study population consisted of a total of 15 registered midwives and 45 pregnant mothers. Each midwife was allocated 3 mothers according to selected criteria. This study was done within the context of two specific hospitals and two specific clinics. Tools were first tested for validity and reliability in a pilot study. Testing of the tools was done with the assistance of an experienced midwife researcher. No major changes were made. Data was gathered in two phases. Phase I was completed by direct observation, using a checklist. Phase II was a semi-structured interview. The medium of communication was English. Informed verbal consent was obtained from both midwives and pregnant mother subjects. Their right to refrain from participation was also explained. Data was analysed according to descriptive statistics in the form of tables and graphs. The concerns of the researcher were validated by the results in that the findings revealed that both the SFHM technique and recordings made on the gravidograph were done incorrectly in most cases. The results of this study have highlighted the need to formulate the SFHM technique standard. This would serve as guidelines and also as criteria against which performance can be measured. Delays in standardizing the technique may result in increased instead of decreased perinatal mortality rates. There is also a need to ensure that the gravidogram section of the card is filled in correctly. It is recommended that midwives should be thoroughly in-serviced about new procedures before being expected to implement them. Standards which serve as guidelines for practice should also be formulated, together with new procedures, so that excellence in practice is achieved.

M.Cur. / Poor quality of midwifery care has been of major concern at St. Elizabeth's antenatal clinic in Eastern Cape. This has been attributed to a number of reasons which one of them is the high maternal mortality rate at St. Elizabeth's hospital. The research question has been, "Do midwives provide quality care to pregnant women at St. Elizabeth's antenatal clinic?" The question has been answered by auditing antenatal records, retrospectively of all the women who have been attending St. Elizabeth's antenatal clinic. Data was collected by means of the Phaneuf audit tool. Twenty antenatal records of women who have been attending antenatal clinic at St. Elizabeth's hospital were selected randomnly. Data analysis was presented in a descriptive way. From the findings, factors that contribute to poor quality care were identified. Beca se of the presence of more negative factors that contribute to poor quality care, the conclusion was that, midwives provide substandard care at St. Elizabeth's antenatal clinic. Recommendations for nursing education, nursing practice and recommendations for further research were outlined. Validity and reliability has been mantained throughout the study. Ethical standards, as stipulated by DENOSA have been considered in the whole chapter

D.Cur. / Every woman and unborn child has the right to quality antenatal care. Concern is expressed regarding the quality_ of antenatal care currently delivered in South Africa, but due to a lack of formal written standards for antenatal care, this concern cannot be addressed. In view of this, the aim of this study was to generate valid standards for antenatal care. A contextual, exploratory and descriptive research design had been used to complete the research in two phases. An extensive literature exploration was done during the first phase (Development phases 1 and 2) in order to describe a conceptual framework for antenatal care. Concept standards were formulated within this framework and refined with the assistance of a small group of experts. Following changes made to it, it was prepared for validation. The content validity of the standards was tested at national level (validation phase). The concept standards were sent to a group of domain experts in the form of a questionnaire. A purposive, non-randomised and stratified sample had been drawn. The participants were expected to evaluate the content validity of the standards and accompanying criteria and to propose amendments should they deem it to be necessary. A content validity index was calculated for each standard and criterion. A mean of 3,5 and a standard deviation of. 1,0 were regarded as sufficient proof of the content validity of each item. Thereafter, the standards were tested in the clinical practice on the basis of three case studies. Following the necessary adjustment and reformulation, the final standards were formulated. This research does not only make a valuable contribution towards the midwife's practice in the-form of valid standards for antenatal care, but also contributes towards extension of the theoretical basis of the subject discipline by means of the comprehensive description of a conceptual framework for antenatal care by the midwife.