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Patient satisfaction with intrapartum and postpartum nursing care

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par Ngwingmechi MBEINKONG Chwinui
University of Buea, Cameroon - Bachelor in Nursing Sciences (BNS) 2009
  

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INTRODUCTION AND OBJECTIVES

1.0. INTRODUCTION

Health is not the mere absence of disease and infirmity but a state of complete physical, social and mental wellbeing of an individual and should be a universal human right [1]. Better health care outcomes will therefore include social aspects of pregnancy and childbirth [2]. A good outcome should be that every woman should be satisfied with the care and support she received during pregnancy, delivery and postpartum periods and to feel that she and her baby have been the center of care [3].

For many a woman, labour and childbirth is a time of excitement and anticipation alongside uncertainty, anxiety, fear, and pain. The memories and experience of childbirth remain with the woman throughout her life. Clearly, the support and care they receive during this period is critical [4].

Nurses have an important, enabling role to help the woman during childbirth. There must be a high percentage of interpersonal skills in the care of the woman in addition to being technically competent [5].

Postpartum period is significant for two important things: It is a time for physiological adjustments for both the mother and her baby; and a period of important social and physiological adjustments [6]. An emphasis on individualized client-driven postpartum teaching including self-care and newborn care is essential. Nursing care here should be flexible and organized in collaboration with the woman to address her individual needs [3].

Evaluation is one of the most critical phases of the nursing process because it supports the basis of the usefulness and effectiveness of nursing practice. Nursing practice is patient-driven and patient-centered. Accordingly, patient satisfaction has been strongly advocated for by nursing professionals worldwide to be an important indicator of quality nursing care delivery [7].

The purpose of measuring satisfaction here is to understand the patients' experience of labour and childbirth and access postpartum care in order to obtain information about the quality of nursing care and identify problem areas.

1.1. BACKGROUND

In accordance with international professional standards and guidelines, contemporary maternity care providers strive to create a childbirth experience that is safe for the mother and her baby which is positive and satisfying for the childbearing woman [8]. Researchers have focused on identifying factors that promote a positive experience. Beneficial outcomes of a positive childbirth experience include self-esteem, efficient and enhanced maternal attachment and compliance [9].

Research has demonstrated that a positive childbirth experience helps a woman develop a positive attitude towards motherhood, which helps facilitate transition into the maternal role [10]. The positive experience can also establish rich and successful family relations, encourage self-esteem, improve self-confidence and ensure positive development of the woman [11].

We need to accept that labour is a time for unique sensitivity to environmental factors. Events and the interactions occurring during labour have powerful psychological effects, therefore for the benefit of both the parturient woman and her child, a positive childbirth experience is desirable [9]. Studies also confirmed that the intrapartal nurse would be the deciding factor on whether the woman has a positive or negative experience during childbirth [5]. Postpartum women experience physical discomfort and psychological changes following delivery of their infants [3].

Several scientific studies have been carried out on postpartum care and it was found that parents valued the postpartum information they were taught [7]; also, mothers' satisfaction with postpartum care is dependent on their perceptions of the nurse's ability to place them at ease [11]. Nursing care qualities that contributed to the satisfactory experience include information sharing, calmness, demonstration of confidence and the anticipation of unstated needs [4]. These findings illustrated qualitative inquiry for understanding patient satisfaction with care.

The 2009 birth rate estimate in Cameroon, stood out at 31.4/1000 persons [12]. Latest survey indicated that 62% of such childbirths were assisted by a skilled birth

attendant [13]. This indicates that health practitioners are receiving more than half of the total births and hence a need for improved quality of nursing care.

It is known that nursing and midwifery services are the backbone of the healthcare system in almost all countries in the world [14]. They represent between 60-70% of the health personnel [15]. It is thus important that we assess quality of nursing care we offer in order to improve on it. Patient satisfaction is an important indicator.

For many years, nurses have dictated what is «good» for their patients and how much of it is «good» because the patient is usually entitled to receiving care. To evaluate and improve the quality of care provided, it is of vital importance to investigate the quality of care in the context of healthcare. Patient satisfaction is a significant indicator of the quality of care [5].

1.2. PROBLEM STATEMENT

During the natural course of childbirth, a woman's functional ability is limited and she is unable to control her body's natural physiologic process. The intrapartum and postpartum patients thus rely on the clinical assistance of the nurses and the clinical staff [16].

It is generally said that the primary reason why patients are admitted to the health facility is to receive care that cannot be gotten elsewhere. The major role of the nurse is to care. In our society and in most hospitals, nurses focus on other tasks leaving out the great aspect of care. This is revealed in their attitude towards patients, co-workers and even in the performance of their tasks.

Although special care needs to be given to the woman during and after the delivery periods, with the available resources manpower and time, nurses rather tend to give patients the care they deem worth giving and not necessarily what is required of them to meet the patients' needs. Sub-standard care is bound to be offered. More often than not, the patients' needs are not fully met and this makes some patients not to perceive the care as positive.

1.3. OBJECTIVES OF THE STUDY 1.3.1. General Objectives

To evaluate the quality of nursing care offered during intrapartum and postpartum periods using patients' satisfaction as an indicator.

1.3.2. Specific Objectives

· Evaluate nursing care offered during intrapartum and postpartum periods.

· Assess patient satisfaction with care.

· Identify ways of improving satisfaction hence quality of care.

1.4. RESEARCH QUESTIONS

The following questions were drawn up to respond to the objectives of the study.

? What nursing care is being offered during intrapartum and postpartum periods? ? How satisfied are the patients with the care they receive?

? How can patient satisfaction with care be improved?

1.5. HYPOTHESIS

Patients receiving intrapartum and postpartum care in BRHA are not satisfied with the nursing care they receive.

1.6. PURPOSE OF STUDY

This study is important in measuring and improving the quality of nursing care offered in the maternity service of BRHA. It is anticipated that the findings in this study will aid in:

1. Identifying the quality of nursing care offered during intrapartum and postpartum periods in BRHA.

2. Assessing patient satisfaction with nursing care.

3. Making recommendations on how patient satisfaction can be improved.

1.7. JUSTIFICATION

Numerous study findings indicate that nursing care is the key determinant of patient satisfaction [7]. To improve on the quality of care provided, it is of vital importance to evaluate the care.

Intrapartum and postpartum periods are delicate periods in the life of every woman. It is thus important that optimum care be given to the woman during this period without which complications may arise [17].

Nurses will never know the quality of care they offer until it is being assessed. This study on patient satisfaction, therefore, will provide a means of evaluating the care and will provide a spring board for its improvement.

1.8. LIMITATIONS OF THE STUDY

A number of factors limited the scope of this research project:

A) FINANCIAL DIFFICULTIES.

The lack of financial resources was a great problem, thus making it difficult to get enough information and carry out the research with ease.

B) TIME CONSTRAIN.

Time was also a problem the research had to take place simultaneously with other academic work.

C) INABILITY TO PROVIDE ADEQUATE PRIVACY.

The researcher was unable to provide adequate privacy when the patients were responding to questions. This made it more difficult since some of the responses were influenced by the presence of other patients.

Nonetheless, this study is a necessary preliminary step toward a better patient satisfaction with nursing care not only for those in labour but for all will-be mothers.

1.9. OPERATIONAL DEFINITION OF TERMS

PATIENT: A person receiving medical care.

SATISFACTION: A pleasant feeling which you get when you receive something you wanted or when you have done something you wanted to do.

NURSING: The art and science of assisting an individual, sick or well, by performing

those activities contributing to his/her recovery (or even to a peaceful death), that he/she will perform unaided if he/she had the necessary strength, will or knowledge to do this, in such a way as to gain independence as soon as possible.

CARE: The process of protecting and looking after someone

INTRAPARTUM: The period during labour and delivery

POSTPARTUM: The period following the delivery of the baby to approximately 6 weeks after delivery.

 

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