Development and validation of a model for midwives who care for sick neonates in neonatal intensive care units of public hospitals, Limpopo Province

Abstract

Background: Providing quality neonatal care is one of the most challenging health care services globally. Ensuring quality care during pregnancy and delivery is paramount to improving health outcomes and reducing mortality and morbidity among neonates. About 2.9 million neonatal deaths occur worldwide, accounting for 40% under 5 years’ deaths. Poor quality care in health care organisations is thought to be one of the factors for the slow progress the in reduction of neonatal deaths. Furthermore, poor quality care is not just about the availability of resources in a health institution, nor is it just about the absence of services. In South Africa, the midwives providing care to sick neonates usually lack experience and competence mainly because of shortage of midwives and lack of training in neonatal care, and neonatal intensive care. Purpose: The purpose of this study was to develop and validate a model for midwives who care for sick neonates in Neonatal Intensive Care Units (NICUs) of public hospitals in Limpopo Province. Methodology: An exploratory, sequential mixed - method design was used in this study. The study was conducted in all five districts of Limpopo Province using one hospital per district. The population was all the midwives allocated to the NICUs of the five hospitals. The total population size for the qualitative phase was 58 midwives. The total sample size of 12 participants (6 from each hospital) was selected purposefully for the qualitative phase. Qualitative data collection and analysis were done to explore the phenomenon, identify themes, design a data collection instrument, and pre-test it by pilot study. The findings of the qualitative phase were used to develop the quantitative data collection tools, to conduct the quantitative data collection and analysis. Measures to ensure trustworthiness were followed. The interview guide was used to collect data through one-to-one semi-structured interviews. Tesch’s eight steps in the coding process were used to analyse the qualitative data. The population for the quantitative phase included 82 midwives who were allocated in the NICUs in the four public hospitals. Slovin’s formula was used to calculate the sample size. The sample size was 68 participants for the quantitative phase. Reliability and validity were established. Quantitative data analysis was done through SPSS version 25. The collected data were coded and analysed through descriptive statistics. x Ethical considerations: The proposed study was approved and cleared by the Intradepartmental Review Committee. Ethical clearance was obtained from the Turfloop Research Ethics Committee (TREC). Permission to conduct the study was granted by the Limpopo Province Department of Health Ethics Committee. Further permission to collect data from public hospitals was granted by hospital managers. The interview guide and consent form were formulated in English. Scientific adherence to ethical principles was ensured. In qualitative processes, member checks, independent coding and the reviews were done by the supervisor. The study was language edited to ensure it is readable. Turnitin was done to minimise plagiarism. Development and validation of a model: A model was developed utilising the concept analyses and the findings of the study to ensure quality care by the midwives. Experts in the field of the study were given the validation tool to assess the model. Significance of the study: The findings from this study might increase the likelihood of desired neonatal health outcomes and identify the gaps in the knowledge of care of sick infants to be addressed in the neonatal care.