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.

Thesis (MCur)--Stellenbosch University, 2003 / ENGLISH ABSTRACT: It appears that registered midwives prefer not to cut episiotomies which results in an increase in perineal tears. This may be the case as a result of current controversies regarding episiotomies, lack of suturing skills due to insufficient training and evaluation, or the fact that the necessity of an episiotomy are not recognised timeously. In light of this the incidence of perineal trauma during deliveries in public healthcare institutions in the Western Cape was evaluated from a nursing perspective. The midwife can playa significant role in the prevention of unnecessary perineal trauma by applying particular precautions in practice. Triangulation was used as the research method. Seven public healthcare institutions in the Western Cape were included in this study. Nurses completed 45 questionnaires while 33 deliveries and 25 cases of suturing of perineal wounds were evaluated according to a pre-compiled checklist. Semi-structured interviews were conducted with registered midwives and medical practitioners involved in the training of nursing students. According to findings it appears that nurses do not recognise the risk factors to be contributory causes of perineal tears. Furthermore, it appeared that 46% of registered midwives did not feel competent enough to suture perineal wounds. Disparities were identified pertaining to the training of student nurses as well as the continuous training and evaluation of registered midwives regarding the suturing of perineal wounds. It is recommended that a uniform policy should be formulated concerning guidelines for the cut and suturing of episiotomies and lacerations. Furthermore, a uniform classification system regarding perineal trauma should be formulated as well as a uniform system to evaluate the competency of midwives. / AFRIKAANSE OPSOMMING: Dit blyk dat geregistreerde vroedvroue nie graag 'n episiotomie knip nie, met 'n gevolglike toename in perineale skeure. Dit is moontlik as gevolg van die huidige kontroversie betreffende episiotomies, óf hegtingsvaardighede wat nie voldoende is nie te wyte aan gebrekkige opleiding en evaluering, óf die noodsaaklikheid van 'n episiotomie word nie betyds ingesien nie. In die lig hiervan is die voorkoms van perineale trauma tydens verlossings in openbare gesondheidsinstellings in die Wes- Kaap vanuit 'n verpleegkundige perspektief geëvalueer. Die vroedvrou kan 'n beduidende rol speel in die voorkoming van onnodige perineale trauma deur die toepassing van sekere maatreëls in haar praktykvoering. Triangulasie is as navorsingsmetode gebruik. Sewe openbare gesondheidsinstellings in die Wes-Kaap is in hierdie studie ingesluit. Vyf-en-veertig vraelyste is deur verpleegkundiges voltooi terwyl 33 bevallings en 25 hegtings van perineale wonde volgens 'n voorafopgestelde kontrolelys geëvalueer is. Semi-gestruktureerde onderhoude is gevoer met geregistreerde vroedvroue en geneeshere wat by die opleiding van verpleegstudente betrokke is. Volgens die bevindings blyk dit dat verpleegkundiges nie die risikofaktore as aanleidende oorsake van perineale skeure herken nie. Hulle verkies ook om nie episiotomies te knip nie en sal eerder 'n perineale skeur heg. Dit het verder geblyk dat 46% van die geregistreerde vroedvroue nie bevoeg gevoel het om perineale wonde te heg nie. Leemtes is geïdentifiseer ten opsigte van die opleiding van studentverpleegkundiges asook voortgesette opleiding en evaluering van geregistreerde vroedvroue ten opsigte van hegtingstegnieke. Aanbevelings sluit in dat 'n eenvormige beleid geformuleer moet word ten opsigte van die riglyne vir die knip en hegtings van episiotomies en skeure, 'n eenvorminge klassifikasiesisteem van perineale trauma asook 'n stelsel van evaluering van geregistreerde vroedvroue se bevoegdheid.

D.Cur. / The midwife is the pivot around whom training activities in midwifery revolve. Her knowledge and skill form an inseparable part of the effectiveness of her practice. The external and internal environment of the midwife play a vital role regarding the demands placed upon her. The internal and external environment of the midwife is dynamic, and change continually. The external environment in the past ten years has undergone marked changes: health policy has changed; legal-ethical changes have occurred; the roles of the private sector and fee-for-service practitioners have changed; a new government with other objectives has placed the emphasis on new needs at professional and lay levels. These changes place new demands on the midwife's practice. Because the internal and external environments are in interaction, changes in the internal environment are continually being made, for example the knowledge and competency required by the midwife must continuously be improved so that she can comply with the new demands in her practice. The training of the midwife ought to be such that she is adequately equipped to fulfil the demands set by practice. The goal of this study is: an exploration and description of the knowledge and skill required by the midwife to be able to accept her responsibility in the new health care service of South Africa and set guidelines for the basic training of midwife who is to function independently.

In nursing education, experiential learning is an important part of the curriculum and accounts for almost half of the requirements for the nursing programmes. A positive relationship with and collaboration between the training institutions and clinical placement facilities are vital for student achievement. Nurse educators are also expected to involve themselves in clinical accompaniment to bridge the theory-practice gap. Student nurses placed in midwifery clinical learning environments experience difficulty in meeting their experiential learning outcomes and programme requirements. Due to the overcrowded clinical facilities, they compete for the limited learning opportunities and resources which make the integration of theory and practice difficult. Therefore, this leads to delay in the commencement of community service by some of the nursing students as they do not graduate because of not achieving midwifery clinical outcomes and programme requirements. The purpose of the study is to assess factors affecting experiential learning for midwifery students at the public college of nursing in the Eastern Cape and the main objectives of the study were to: • Identify the challenges affecting the quality of learning in the clinical learning environment. • Determine the nature of supervision for experiential learning of midwifery students. • Determine the role of a nurse educator in the experiential learning of student nurses in midwifery clinical learning environment. Methods and analysis A quantitative, descriptive survey was conducted by making use of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale. The CLES+T is a reliable and valid evaluation scale for the gathering of information on the clinical learning environment and supervision of student nurses. The CLES+T evaluation scale was completed by 115 student nurses within the selected sites. The CLES+T evaluation scale is subdivided into three main sections with additional sub-sections: (1) the learning environment (2) the supervisory relationship and (3) the role of the nurse teacher (lecturer).

The purpose of midwifery nursing education is to prepare midwives who are fully qualified to provide high-quality, evidence-based mother and child health care services. A quantitative descriptive explorative design was used to identify and explore midwifery students’ experiences of clinical teaching at Sovenga Campus, (Limpopo College of Nursing), Limpopo province. Structured questionnaires were used to collect data. The research sample consisted of fifty (50) midwifery students from Sovenga Campus. Ethical principles were adhered to. Validity and reliability were maintained. The findings showed that learning opportunities are being utilised and clinical accompaniment by tutors has improved. The findings indicated that clinical teaching in midwifery units does not include implementation of the maternity guidelines and protocols’ being used .A recommendation was that tutors be included in student orientation and the planning of monthly unit in-service programmes. / Health Studies / M.A. (Nursing Science)

The purpose of midwifery nursing education is to prepare midwives who are fully qualified to provide high-quality, evidence-based mother and child health care services. A quantitative descriptive explorative design was used to identify and explore midwifery students’ experiences of clinical teaching at Sovenga Campus, (Limpopo College of Nursing), Limpopo province. Structured questionnaires were used to collect data. The research sample consisted of fifty (50) midwifery students from Sovenga Campus. Ethical principles were adhered to. Validity and reliability were maintained. The findings showed that learning opportunities are being utilised and clinical accompaniment by tutors has improved. The findings indicated that clinical teaching in midwifery units does not include implementation of the maternity guidelines and protocols’ being used .A recommendation was that tutors be included in student orientation and the planning of monthly unit in-service programmes. / Health Studies / M.A. (Nursing Science)