Thesis (M.Sc. (Nursing)) -- University of Limpopo, 2016 / The aim of this study was to determine the adaptations of midwives to their work after maternal deaths at a tertiary hospital complex in Limpopo Province. Qualitative phenomenological, exploratory, descriptive and contextual research design was used. Snowball sampling was used to select 22 midwives who experienced maternal deaths. Semi-structured interviews with a guide and audiotape were used to collect data. Tesch’s eight steps of qualitative data analysis were adopted. The study revealed that the midwives had traumatic experiences after maternal deaths and were failing to adapt to their work. Strategies to enhance the adaptation of midwives to their work after maternal death were developed. The study recommends that support, debriefing session, group therapy and counselling should be provided to the affected midwives. There should be provision of adequate number of midwives and material resources in the maternity units to maintain acceptable midwifery care. Sufficient number of midwives should be trained for advanced midwifery to increase capacity in the maternity units. Keywords: Adaptations, midwives, maternal deaths, tertiary hospital

Thesis (M.Dev.) --University of Limpopo, 2007 / The study sought to develop guidelines that are aimed at improving Termination of Pregnancy (TOP) services that are rendered by public hospital based midwives. The researcher applied a qualitative and descriptive design. The study targeted midwives in the Bohlabela District, which has three hospitals. A non-probability purposive sampling was used to 6 midwives who are currently conducting TOP services in the hospitals. Data collection was both in-depth and conducted in face-to-face interviews with each participant. The findings of the study were analyzed, categorized into sub-themes, and revealed that midwives who conduct TOP services experience the following challenges, namely: inadequate human resource, poor infrastructure, lack of equipments, poor management support, and lack of support from doctors. Based on the findings of the study, it is imperative that all hospitals be designated centres for TOP services, so as to reduce the workload in the few hospitals that currently are inundated. The infrastructure needs to be improved, information about TOP services to the public has to be disseminated through awareness campaigns, and scarce skills allowances must be introduced. In addition, more staff members need to be employed. The study further recommends that the TOP policy guideline be reviewed in terms of allowing other competent health professionals to perform TOP. Chapter two discusses the literature review regarding the challenges that affect midwives who conduct TOP. In this study, theresearch compares the practice of TOP by the developing and developed countries, looks at related to laws at on TOP; gives an overview of sterilization Act in South Africa; mentions the amendments of laws on TOP; considers other legal restrictions; presents mandatory counseling for TOP clients; focuses on religious, cultural and traditional beliefs. The researcher has consulted different literatures, journals articles and website on challenges that affect midwives in rendering TOP in Limpopo, South Africa and world wild. Chapter three presents research methodology that consists of research design; area of study; population; sampling method; data collection method and procedure; ensuring trust worthiness; and ethical consideration, to be followed by limitation of the study. Chapter deals with data analysis and interpretation. Chapter five presents the researcher’s conclusions and recommendations.

Thesis (MPH.) -- University of Limpopo, 2014 / Legalising Termination of Pregnancy (TOP) in South Africa has given women the choice to decide to terminate an unwanted pregnancy. The implementation of the Choice on Termination of Pregnancy (CTOP) Act No. 92 of 1996 which was promulgated in 1997 engendered many challenges for the registered midwives performing TOP. A qualitative phenomenological study was conducted to explore and describe the experiences of registered midwives performing TOP at Polokwane / Mankweng Hospital Complex, which is one of the public hospitals in Limpopo Province. Registered midwives with 12 months or more experience in the TOP clinics participated in this study. Interviews were conducted with the participants. The audiotaped interviews and observational notes were transcribed and coded using Tesch’s qualitative and systematic approach of analysing textual data. The major themes that emerged from the data analysis include lack of resources, emotional and psychological trauma, lack of support, religious and cultural beliefs, blaming and coping mechanisms. Several sub-themes were identified that reflected the themes in greater detail. These were shortage of human and material resources, stress and frustration of midwives, rejection and labelling of midwives performing TOP, conscientious objection, cultural beliefs, lack of support by colleagues and management, failure by the community to use contraceptives, self-blaming, debriefing to assist registered midwives and self-acceptance. Guidelines based on contextualisation of these themes and sub-themes to improve identified challenges included retention of personnel through recognition and incentives, increase budgeting for essential equipment, planned debriefing sessions, promotion of positive attitudes by colleagues and intense training on reproductive health, including TOP.

Thesis ( Ph.D. ( Nursing)) -- University of Limpopo, 2016 / The purpose of this study was to develop an evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province. A mixed method sequential explanatory design was adopted. The study was conducted in four phases, namely: quantitative, qualitative, model development and validation of the model. Self-developed 4-point Likert scale questionnaires consisting of 81 item questions for learner midwives and 89 item questions for midwifery practitioners were administered. The questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of midwifery practioners was 174 and that of the learner midwives was 163. Data collected from respondents were analyzed quantitatively using descriptive and inferential statistics. Tables, pie and bar graphs were drawn to present the results. The results from the quantitative phase were utilized to formulate the interview guides that were used to explore the experiences of midwifery practitioners, experiences of learner midwives and perceptions of puerperal mothers. Phenomenological semi-structured individual interviews were conducted for midwifery practitioners (n=20), 3 Focus group discussions of learner midwives (n=18) and 3 focus group discussions of puerperal mothers (n=18) were held until data reached saturation. Data were analyzed qualitatively using Tesch’s open-coding method. Themes and sub-themes were coded manually. Results that emerged from the corroboration, comparison and integration of quantitative and qualitative results revealed the existence a sub-optimal midwifery practice environment, sub-optimal midwifery experiential learning environment and provision of sub-optimal midwifery interventions in the public hospitals of Limpopo province. Development of an evidence-based model emanated from the findings of numeric quantitative data and qualitative narratives. The evidence-based information from the existing situation as seen from the world of participants brought about a gap of optimal midwifery practice environment. The ideal situation was designed in a way of addressing the gaps identified. Experts were given the validation tool to assess whether the model was clear, simple, understood and that it can be utilized by any discipline in future.

Department of Advanced Nursing Science / MCur

MCur / Department of Advanced Nursing Science / See the attached abstract below

PhD (Health Sciences) / Department of Advanced Nursing Science / Preterm birth is an unresolved health issue; globally it is the largest contributor to mortality among children under 5 years of age. Worldwide, approximately 9.6% of all births are preterm which the World Health Organization (WHO) recognizes as one of the top ten causes of neonatal deaths. The alarming rates of preterm births and deaths may be directly linked to the shortage of resources and an inadequate database of midwifery care guidelines for midwives in South Africa resulting in poor maternal care in public health. This study sought to develop midwifery practice guidelines to promote quality care of preterm babies in resource-limited obstetric units of the Limpopo Province of South Africa. The convergent parallel mixed method was used, explorative, descriptive and contextual qualitative design were run concurrently with the descriptive quantitative approach. For the qualitative design, non-probability purposive sampling was used to select midwives and managers from Limpopo Province. In-depth one-to-one interviews were conducted with 11 midwives and 4 managers. Tesch’s eight steps of open-coding was used to analyze qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. For the quantitative approach, 31 midwives and 24 managers completed the Likert scale questionnaire. The non-probability method was employed to select midwives and managers to make up a sample size of 55 participants. Reliability and validity of the instrument was ensured through extensive literature review and a pilot study. Data were analyzed with the IBM Statistical Package for the Social Sciences (SPSS) version 23.0. Both quantitative and qualitative data analysis yielded three themes as follows: the role of midwives in reduction of preterm births and deaths in obstetric units; challenges faced by midwives whilst executing their role during preconception, antenatal, labour and v puerperium period; support needed by midwives during provision of maternal and neonatal care to reduce preterm births and deaths. In the discussion of the findings, qualitative findings were supported by quantitative findings. The WHO model (PICOS & GRADES) was adapted in the development of the guidelines. The group then validated the guidelines using a closed-ended checklist to verify whether the guidelines were congruent with practice. The results were analyzed through simple descriptive statistics where the data were summarized using frequency / NRF

The South African government promulgated the Choice on Termination of pregnancy Act (CTOP Act, 92 of 1996). This was a dramatic declaration of intent unprecedented in the African continent and globally. This act changed the outlook of the practice of termination of pregnancy by ensuring that services play a critical role in the delivery of the service. This study, which is qualitative in nature, explored the experiences of Termination of Pregnancy service providers working in three designated public health institutions in the Limpopo Province. Interviews were conducted with six service providers to look at how they construct their practice of providing termination of pregnancy services. The information was analyzed and interpreted by means of a thematic analysis method. Major themes that emerged from the participants’ experiences centred on their relationship with family, colleagues, management, clients, and the community reflecting a sense of alienation and lack of adequate infrastructural support. Inadequate support has been found to greatly contribute to the loss of interest in the work around abortion. / Psychology / M. A. (Clinical Psychology)

The South African government promulgated the Choice on Termination of pregnancy Act (CTOP Act, 92 of 1996). This was a dramatic declaration of intent unprecedented in the African continent and globally. This act changed the outlook of the practice of termination of pregnancy by ensuring that services play a critical role in the delivery of the service. This study, which is qualitative in nature, explored the experiences of Termination of Pregnancy service providers working in three designated public health institutions in the Limpopo Province. Interviews were conducted with six service providers to look at how they construct their practice of providing termination of pregnancy services. The information was analyzed and interpreted by means of a thematic analysis method. Major themes that emerged from the participants’ experiences centred on their relationship with family, colleagues, management, clients, and the community reflecting a sense of alienation and lack of adequate infrastructural support. Inadequate support has been found to greatly contribute to the loss of interest in the work around abortion. / Psychology / M. A. (Clinical Psychology)