This phenomenological study was designed to explore the privacy needs of gynecological patients, as perceived by the clients during hospitalization, for the purpose of adding to knowledge and understanding of patients' privacy. Data were collected through sixteen in-depth interviews with eight recently hospitalized patients. The interviews were tape-recorded and transcribed verbatim for each participant. Data were analyzed using Giorgi's (1975) procedure. Analysis of participants' accounts revealed that privacy was important to participants' maintenance of their self-identity. Characteristics of privacy that participants identified as helping to maintain their self-identity included providing time alone for contemplation and helping to control interactions with others. Participants reported that privacy was important for their comfort during situations involving nursing care, basic needs and social interactions with others. Participants suggested that even though they reduced their expectations of privacy during the hospital stay, their privacy needs in hospital were at times still not met. Factors within the hospital setting that contributed or detracted from participants' hospital privacy included behavior of the nurses, doctors, roommates and the physical environment of the hospital. Participants indicated that nurses were the main factor in meeting privacy needs especially while caring for participants and participants' roommates. The findings of this study indicated that participants were willing to trade some privacy for health care. However, participants still valued privacy and considered it important during their hospital stay. There is a lack of research on privacy and acute care hospitalization. Recommendations for further nursing research, nursing practice, nursing education and nursing administration, based on the findings of this study, are presented in the final chapter of the study. / Applied Science, Faculty of / Nursing, School of / Graduate

Introduction: Bihar ranks among the most socio-economically disadvantaged states in India, and its public health system had long suffered from structural deficiencies which contributed to poor health outcomes. In November 2013, the Bihar government, with funding from Gates Foundation and technical support from CARE India, launched the state-wide Bihar Technical Support Program (BTSP) – seeking to address gaps in infrastructure, supply chain, and human resources, as well as the quality of service delivery, so as to improve reproductive, maternal, newborn and child health (RMNCH) and nutrition service provision. BTSP adopted a two-pronged strategy – conducting (i) periodic comprehensive facility assessments (CFAs) to identify and address the structural gaps; and (ii) nurse-mentoring programs to develop competency among nursing cadres in providing basic and comprehensive emergency obstetric and newborn care (BEmONC/ CEmONC) services. Through three inter-linked papers, the dissertation aimed to conduct an evidence-based assessment of this health system strengthening program. “Facility readiness” (structural readiness of public health facilities) was operationalized in terms of infrastructure, essential supplies, and human resources, while “facility performance” was operationalized based on the direct observation of normal vaginal deliveries and newborn care (including management of immediate complications if needed) and infection prevention practices in the labor rooms. The first paper describes the evolution of BTSP, and examines the initial progress made in facility readiness between 2015 and 2016. The second paper: (i) conducts a comparative assessment of facility readiness between 2017 (at end of the first four years of BTSP) and 2019, and describes the continuation of progress or lack thereof; (ii) quantifies facility readiness through a scoring system that reflects the readiness to provide maternal and newborn care (MNC) services; and (3) compares the change in this score over time (2015, 2017 and 2019) across different districts and levels of health facilities in Bihar. Thus, the first and second papers together examine the extent to which Bihar’s public health facilities were structurally strengthened in terms of physical infrastructure, supplies and workforce by utilizing data from all four rounds of CFAs conducted till date. The third paper asks the next logical question in a health system strengthening process – was facility readiness positively and significantly associated with facility performance? This is an important query, as it aims to provide evidence of synergistic progress, as envisioned under BTSP. First, the paper examines whether the facility-level performance changed, by comparing baseline (May-December, 2018) and endline (October-December, 2019) assessment data from the nurse-mentoring program (locally called AMANAT Jyoti). Second, it assesses the association of facility readiness (based on CFA 2019 data) with endline facility performance in providing MNC services. Methods: The first paper utilizes a structured, narrative review of scientific and grey literature to describe evolution of the BTSP since 2014, based on programmatic learnings through prior years (2011-2013) of collaborative vertical interventions. Subsequently, the paper measures the tangible change in select facility-level characteristics, utilizing quantitative data generated through two rounds of CFAs conducted by CARE India in 2015 (n=534 facilities) and 2016 (n=550 facilities). The second paper utilizes quantitative data generated through two rounds of CFAs conducted by CARE India in 2017 (n=550 facilities) and 2019 (n=552 facilities). Each CFAs covered all Level 2 (primary health centers) and Level 3 (higher-level facilities) public health facilities in Bihar that conducted at least 100 deliveries in the preceding year. Subsequently, the paper constructs a “facility-level MNC structural readiness score” – henceforth referred to as facility readiness score, based on a common set of indicators from CFA 2015, 2017 and 2019, to reflect human resources, infrastructure and essential supplies related to delivering MNC services. The paper uses this score to map the change at 2-year intervals, from 2015 to 2019, at both facility and district levels. The third paper utilizes quantitative data generated through two separate assessments conducted by CARE India – the 2019 CFA, and the 2018-2019 assessment of AMANAT Jyoti (nurse-mentoring program), which involved direct observation of normal vaginal deliveries, newborn care, and infection prevention practices in the labor rooms. The paper constructs baseline and endline facility-level MNC performance scores – henceforth referred to as facility performance scores based on data from AMANAT Jyoti assessments, and examines the association between endline facility performance and facility readiness scores. While descriptive statistics was used to present findings from the CFAs and AMANAT Jyoti assessments, paired t tests were used to test the mean change in scores over time and between the different levels of facilities. The association between endline facility performance and facility readiness scores was tested using simple as well as multiple linear and multinomial logistic regression modelling. Results: With a demonstrated intent to improve the ailing public health sector, the Bihar government in 2010 forged a collaboration with Gates Foundation to accelerate progress across RMNCH and nutrition programs. Through the Integrated Family Health Initiative program (IFHI, 2011-2013), outreach-based and facility-based solutions were implemented in eight programmatically-prioritized districts to address the stated goals. However, over this period, it became apparent that long-term success of such initiatives remained critically dependent on strengthening the foundational components of Bihar’s public health system –physical infrastructure, supply chain for drugs, consumables and equipment, and the skilled health workforce. These programmatic learnings motivated a re-think and consequent state-wide launch of the BTSP – characterized by a novel structure of health governance that was deeply embedded within the public health system, and a robust information management system that could generate, analyze and disseminate data on community- and facility-level services to support decision making. The quantitative analyses of CFA data (in first and second papers) provided an assessment of the changes that happened at the level of health facilities, likely supported by the policy-level modifications. There was a clear sense of prioritization of the limited resources – with constant focus on structurally preparing health facilities to deliver basic MNC services, more so at Level 2 (primary health centers). By 2019, at least 99% facilities at either level provided 24x7 delivery services and had designated labor rooms, 97% had designated newborn care corners which were mostly located inside the labor rooms, 70% or more had at least one functional fetal doppler, baby weighing machine, radiant warmer, and AMBU bag with neonatal oxygen masks. The improvement in availability of essential supplies like oxytocin, misoprostol, magnesium sulphate, antibiotics, and reproductive health commodities (condoms, intrauterine contraceptive devices, sanitary napkins, iron-folic acid tablets, contraceptive pills) were particularly notable during the 2017 and 2019 CFAs. However, the supply chain variably faltered for a number of other essential supplies like oral rehydration solutions, functional oxygen cylinders, normal saline and ringer lactate solutions. The data revealed that facility-level inefficiencies in utilizing the electronic inventory management system to accurately reflect actual status of supplies within the facility, likely compromised procurement and distribution. With regards to human resources, while a large number of auxiliary and general nurse midwives were available for service during CFA 2019, the BTSP faced continuing challenges (2015-2019) in recruiting and/or retaining physicians, especially the specialist physician cadres. By CFA 2019, these structural changes were also supported by remarkable improvements in two related services areas –availability of emergency transport, and laboratory services. The comparison of facility readiness scores (second paper) based on CFA 2015, 2017 and 2019 showed that while the mean scores increased sharply for both Level 2 (increase=1.51 (95% confidence interval: 1.39, 1.63)) and Level 3 (1.39 (1.1, 1.69)) facilities between 2015 and 2017, the progress was less pronounced at both levels between 2017 and 2019. 25 of the 38 districts in Bihar demonstrated a continuous increase in mean scores over the 3 CFAs. As for the remaining 13 districts, their 2019 mean scores remained higher than that during 2015. The analysis of AMANAT Jyoti assessment data (third paper) revealed improvements across 36 (80%) of the 45 performance parameters assessed through direct observation of deliveries between the baseline and endline. However, at least 80% compliance was observed for only 11 of 45 (24%) assessed parameters at baseline, and 16 of 45 (36%) at endline. The mean facility performance score increased significantly among both types and levels of facilities – but the increase was higher among Level 3 (mean increase = 1.56, p=0.0005, n=13) and CEmONC (1.82, p=0.0029, n=9) facilities, than among Level 2 (0.32, p =0.0288, n=121) and BEmONC (0.33, p=0.0168, n=125) facilities. The regression analysis failed to identify any linear relationship between facility readiness and performance scores. However, a significant positive association was observed between facility readiness score and the middle tertile of endline facility performance score (vs. lowest tertile as reference) in multiple multinomial logistic regression modeling (n=132 facilities). With increasing facility readiness score, the odds of a facility being in the middle tertile of the endline facility performance score relative to the lowest tertile was 1.68 (95% CI = 1.02, 2.76), after controlling for baseline facility performance score, mean delivery volume, and the facility level. Conclusion: The BTSP can be best described as a diagonal health system strengthening initiative –one that starts with a focus on specific programmatic (RMNCH) outcomes, but strives to achieve these through identifying and addressing bottlenecks across the health system. The efforts made to revamp health governance through creating structures for technical support from the state- to block-levels is particularly laudable, as is the remarkable capacity building in collecting and using facility-level data to inform programs and policies. The dissertation identified that BTSP has made appreciable progress in structurally preparing Bihar’s public health facilities to deliver basic MNC services – with improvements in related infrastructure, essential supplies, and supportive services like referral transport and laboratory facilities, as well as through recruitment of large number of ANM and GNM nurses. However, the process encountered a number of challenges, and it may be worthwhile to adopt a targeted approach to address some of these concerns. For example, it is important that the BTSP works to equip all facilities with electronic inventory management systems, while simultaneously training the personnel using such systems. To circumvent the chronic shortage of specialist physicians, a “task shifting” approach may help maximize utilization of existing health workforce to strengthen service delivery capacity. Further, the overall level of facility performance of MNC service delivery remained low at endline despite improvement from the baseline scores, and there was limited evidence of a significant positive association between facility readiness and performance scores. As these scores reflect the minimum essential requirements for a MNC service delivery setting, the BTSP clearly has challenges ahead. They must continue to address the persistent challenges in facility readiness and facility performance so that these two facility-level interventions will complement each other and influence outcomes. As the onus of this diagonal health system strengthening program incrementally shifts from development partners to the government, it will be important to recognize the significance and complexity of this effort.

M.Cur. / In this study a qualitative design which is explorative, descriptive and contextual in nature is followed. The objective of the study is three-fold: firstly, to explore and describe the opinions of members of the community about the reasons for the under-utilization of the Midwifery Obstetrical Unit ; secondly, to explore and describe the suggestions of the community for improving the utilization of the Midwifery Obstetrical Unit and, thirdly, to formulate intervention strategies for community nurses to improve the utilization of the MOU. Data was collected by means of focus group interviews, and was analysed using Tesch's method of data analysis. Trustworthiness was ensured by using the method of Guba and Lincoln. The participants in research were mothers who delivered their babies at the hospital, mothers who delivered their babies at the MOU, members of the Community Health Committee and MOU nurses.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Registered midwives are expected to practice their duties within the parameters of their scope of practice. Pregnant women have certain expectations about the midwife and their skills. If such expectations are not met, substandard care occurs. Such substandard care has a negative impact for both the pregnant woman and the Department of Health. Aim of the study The aim of this study was to explore and describe the experiences of midwives working in maternity units, concerning midwifery practice breakdown in maternity units at a public hospital in KZN. Methodology A qualitative research study that was exploratory, descriptive and contextual in nature was conducted. Semi-structured interviews were conducted with 13 midwives. Data was transcribed verbatim then organised into codes. Results The study revealed that the majority of the participants faced practice breakdown almost daily and most of the midwifery practice breakdowns start during antenatal care visits. Midwives who attended to pregnant women during antenatal care did not follow set protocols and guidelines and this resulted in complications during delivery. Most midwives were emotionally stressed and did not wish to continue practicing midwifery. Midwives were of the opinion that the management did not care about their challenges and did nothing to resolve the challenges. / M

In India, globalized flows of bio-medical discourse, practices and technologies are reshaping the field of reproductive healthcare, and the performance of childbirth more specifically. These projects aim to produce institutional delivery rooms that are "safe and modernized" by equating the utilization of westernized, obstetric techniques for managing delivery with better birth outcomes. Yet, these projects often evoke dynamic tensions between the imagined labor rooms NGOs seek to produce and the lived realties of labor in a local context. In this thesis, I examine the ways NGOs market and disseminate state and global discourses around safe, institutional delivers to local communities through a case study of one NGO working in rural southern Rajasthan. Drawing on data from participant observation and in-depth, semi-structured interviews with NGO staff and skilled-birth attendants employed by community health centers, I argue that at the interface of NGO, state, and global relations of power, a commodified discourse in the form of Evidenced-based Delivery (EBD) practices is emerging. This discourse is marketed through a political economy of hope that promotes EBDs as essential for safe delivery. In this system, NGOs function as conduits for transmitting idealized notions of the safe and modern delivery room, and thereby affect a shift in what skilled-birth attendants and communities come to expect from their childbirth experiences -- expectations that I argue are often difficult to meet given current training levels, limited economic resources, and a diverse set of cultural values around childbirth. My findings indicate that while Evidence-based Delivery practices may improve birth outcomes in some contexts, in the delivery rooms of rural Rajasthan, they are functioning essentially as technologies that capitalize on the political economy of hope by evoking the medical imaginary. / Graduation date: 2012

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

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.

Health Studies / M. A. (Health Studies)

Health Studies / M. A. (Health Studies)

Mini-thesis submitted in partial fulfilment of the requirements for the degree Master of Technology: Public Management in the Faculty of Business at the Cape Peninsula University of Technology 2014 / Maternity service in South Africa faces particular problems in the provision of care to birthing mothers. Violence and abuse have been reported and maternity death rates are high, being related to inadequate provision of care (Myburgh, 2007:29). Ethical conduct plays a significant role in service delivery in Midwife Obstetrics Units (MOU) in general. This is of particular importance since every patient, especially pregnant women, should to be handled with the utmost care, respect and dignity. The research problem emanates from nurses’ behaviour towards patients in MOU labour wards, where women continue to be victims of abuse. Ironically, it is regrettable that they are abused by those who are supposed to be their advocates. The objectives of the study were to assess if nurses in MOU labour wards conduct themselves ethically when dealing with patients, to determine the perceptions of patients towards nurses during child birth stages, as well as to examine factors in maternity wards that may influence a nurse’s performance when dealing with patients. The study adopted the quantitative research method to answer the research question and data interpretation was based on statistical analysis. This method was deemed to be the most effective for collection of a large quantity of data and numerical (quantifiable) data is considered objective. A Likert-type questionnaire comprising closed-ended questions was the measurement instrument. This was considered to least inconvenience nurses and postnatal patients to whom these questionnaires were administered. Answer choices were graded from 1 to 4, being strongly agree, agree, disagree and strongly disagree. The population comprised nurses and postnatal patients in MOUs in the Western Cape, South Africa. Consecutive sampling was conducted in two selected MOUs, being Michael Mapongwana (MM) and Gugulethu (GG), with 311 questionnaires being distributed to both nurses and postnatal Patients in these two facilities. The findings indicated that the ethical conduct of nurses in both MM and GG maternity wards was relatively good. However, some survey findings revealed some unsatisfactory gaps that exist in what both hospitals currently offer to patients in the areas of individual patient care, communication and baby security certainty. Furthermore, the findings indicated that a significant number of patients who chose to make use of MM and GG hospitals, are satisfied with the standard of service received during their stay. However, there were some discrepancies in terms of senior management service where excellence in the monitoring role emerged as being lacking. There is a need for improvement in the current levels of ethical conduct of nurses in both the MM and GG labour wards. These needs for improvement relate to working conditions, especially linked to the human resource (HR) function, leadership and management functions, and improved monitoring and control mechanisms.