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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