A Descriptive Study of Clinical Midwives Experiences of Covid-19 During Shift Hours in Tamale Teaching Hospital
CHAPTER ONE
Objectives of the Study
The purpose of this study was to explore the experiences of nurses and midwives, including the decision making process involved in caring for patients during the Covid 19 outbreak in Ghana.
Specific Objectives of the Study
The specific aims of this study were to:
- To describe the experiences of nurses and midwives during the Covid 19 outbreak in Ghana.
- To analyse the work decision process used by nurses and midwives during the Covid 19 outbreak in Ghana.
- To determine the level of effectiveness of maternity operations by midwives during the Covid 19.
CHAPTER TWO
LITERATURE REVIEW
Overview of Coronavirus Disease
Coronavirus Disease is a contagious disease that first emerged in Wuhan, China in 2019. It was later coded “COVID-19” by the W.H.O which stands for Coronavirus Disease 2019. The Coronavirus outbreak remains one of the worst global pandemics for decades. The mortality rate soared and the easy of spread was upsetting. Research shows that older people and those with underlying medical problems like cardiovascular diseases, diabetes, chronic respiratory disease, and cancer were more likely to develop serious illnesses from coronavirus (W.H.O, 2020). Some of the symptoms of Coronavirus include; Sore throat, runny nose, constant coughing/sneezing, breathing difficulty and fatigue.
As at the time of this study, there were no reliable treatments for Coronavirus, but a series of researches were in the pipeline across the world towards finding a clinical vaccine for the contagion. However, recent events shows that behavioural change can help contain the spread of coronavirus. Some of the suggested measures to halt the coronavirus pandemic include; improved individual habits such as personal hygiene, including constant washing of hands with alcohol-based sanitizers, good respiratory attitude (close coughing and sneezing), and other personal protection practices like wearing of face mask, social distancing, avoiding touching of the face, and reducing contacts with people through self-isolation at home or avoiding nonessential travels or gatherings. Coronavirus is a global problem that requires more action coordination and global cooperation to successfully contain the outbreak and to deal with its aftermath effects. Consequently, the United Nations appealed for 2 billion dollars to support global response efforts towards tackling the coronavirus pandemic. The consequences of COVID-19 could be more severe; if people do not comply or adhere strictly to public health regulations and advice.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
The study used descriptive research design. A descriptive study involves collecting data that test the validity of the hypotheses regarding the present status of the subjects of the study. In this study, the design was used to determine the experiences of midwifes during Covid 19 in their shift hours in Tamale Teaching Hospital.
Research Population
The target population for a survey is the entire set of units for which the survey data are to be used to make inferences (Cooper and Schindler, 2001). Thus, the target population defines those units for which the findings of the survey are meant to generalize. Establishing study objectives is the first step in designing a survey. Defining the target population should be the second step. Target populations must be specifically defined, as the definition determines whether sampled cases are eligible or ineligible for the survey. The geographic and temporal characteristics of the target population need to be delineated, as well (Cox, 2008). Cox and West (1986) describe a population as a well- defined group of people or objects that share common characteristics.
A population in a research study is a group about which some information is sought. Most researchers cannot include all members of the population in their studies and must resort to limiting the number of subjects to only a sample from the population. The target population in this case were nurses/midwives in Tamale Teaching Hospital. The target population in this study was 205 in number.
Sampling Design
Sampling Frame
According to Currivan (2004) a sampling frame is a list of elements from which the sample is actually drawn and is closely related to the population. In the ideal case, the sampling frame should coincide with the population of interest. For this study, the sampling frame came from a list of health care workers in the facility.
Sample Size
A sample size allows the researcher to make generalizations about the population. A sample is a subset of a population, but that subset is only useful if it accurately represents the larger population (Cox, 2008). To ensure that the sample accurately represents the population, the researcher clearly defined the characteristics of the population, determined the required sample size and chose the best method members of the sample from the larger population.
CHAPTER FOUR
DATA ANALYSIS AND RESULT PRESENTATION
Table 4.1 discusses the experience of midwives during the Covid 19 pandemic in Tamale Teaching Hospital.
From the table above, 83.6% of the respondent indicated that they had to use personal protective equipment strictly, 78% of the respondents indicated that they faced an increased workload due to the virus outbreak, 75.4% indicated that they experienced discomfort in attending to pregnant women and going through Covid 19 prevention guidelines, 74% indicated that misinformation and lack of coordination and management was rampant in the hospital and 71% indicated that there were changes in the pattern and organization of health care in the facility.
The table shows that the covid 19 outbreak put a strain on the practice of midwifes due to the constant use of protective equipment and the increased workload they face due to the outbreak.
CHAPTER FIVE
DISCUSSION OF FINDINGS, RECOMMENDATION AND CONCLUSION
Discussion of findings
The nurses and midwives were living and working in fear and terror during the Covid 19 outbreak in Ghana; Their families’ lives and their own lives were endangered. Dickenson et al., (2013) described several concerns for HCWs during a disease outbreak similar to those identified in this study, also identifying the family as a concern for safety, psychological, emotional, and social support. Other research reports support the findings in this study; namely, that nurses and midwives who felt obligated by the nursing profession continued caring for patients during the Covid 19 outbreak (Twardowski, McInnis, Cappuccino, McDonald, & Rhodes, 2014). The nurses and midwives experienced stigmatization by the public during the outbreak. Some studies concur that health care workers engaging in the education of their families and patients, together with institutional influences, and government efforts eased the effect of stigmatization (Abramowitz et al., 2020; Kobayashi, 2020). Stratton’s (2014) finding supports the need for government efforts through policy development, provision of safe working conditions, and funding of training and educational programs in Covid 19 care.
The experiences of the nurse and midwives include change in organization care, constant use of protective equipment, routine self Covid 19 checks etc. Through training and provision of protective equipment the nurses and midwives regained their confidence. The nurses and midwives then created methods to touch their patients while using the personal protective equipment and fully conducted nursing procedures, improving the relationship between the nurses and their patients. Results from another study concur with this finding (Connor, 2020). The spiritual dimension of health care was identified as crucial to enhancing nurses’ well-being. Other authors have also reported that faith-based health care institutions and services are the vehicle used to drive spiritual health care (Marshall & Smith, 2020). This study is distinguished from other studies in that, the decision process involved in the nurses’ and midwives’ choices either to render care or not to render care for patients were made on the basis of emotional connections between nurses, their families, and society. The decision process also was based on their value system, including professionalism and spirituality. As a distinguishing feature, the findings of this study highlight the spiritual dimension of the nurses’ and midwives’ experiences. The findings also indicate the influence of the spiritual resources of nurses and midwives on their decision to work. Previous studies on health care workers’ willingness to work during disease outbreaks have not captured the spiritual dimension.
Given that the experiences of these nurses and midwives are significant in ensuring that they continue in their role during a disease outbreak, the grounded theory approach provided the avenue for exploration of their experiences and work decision process. The strength of this study is that the findings were grounded in the perspectives of the nurses and midwives.
Women felt isolated, alone and unsupported by the evolving changes. These changes had led to higher levels of anxiety, concern and distress which were further exacerbated by preexisting health issues. Women openly expressed that they were fearful of the impacts that the restrictions and changes would have on their mental health. Women commonly voiced concerns about the decline in access to a health care provider and how this would impact not only their physical, psychological and emotional wellbeing but also the health of their baby. In light of this, they called for reconsideration of what they viewed were reactive decisions to the pandemic; they specifically called for their needs and preferences to be considered and respected. In some situations, women expressed that the restrictions had resulted in lack of autonomy over decision making and choices with some even suggesting that their choices with respect to mode of birth had been decided for them. There was also significant concern held for the possibility of unnecessary interventions in order to see them “pushed” through the system.
While there has been some discussion relating to this growing trend over the last decade, the numbers of women seeking this option have remained relatively low. However, our results reflect an increase in response to the pandemic and we suspect that the number is likely to be higher based on women suggesting that there had been a lot of discussion in pregnancy and birth forums about women intending to freebirth. It is clear that women will seek freebirth where they feel their selfdetermination and autonomy are threatened. This appeared to be further exacerbated by the lack of availability to PPMs and the significant costs associated with employing a PPM. While there are ongoing discussions about insurance and Medicare rebates with respect to homebirth, to date there remains no available solution. Despite there being a number of extensions to the homebirth insurance exemption that remains in place until December 2020, it is unlikely that this exemption will be extended further. As such, there is pressing need for a solution prior to this exemption ceasing in order to safeguard the future of private midwifery practice and women’s choice to birth at home.
Conclusions
The Covid 19 outbreak in Ghana caused unimaginable devastation and deaths. The role of HCWs in containing disease outbreaks cannot be overemphasized. The nurses and midwives were living in fear and terror during the Covid 19 outbreak in Ghana. The family was the key determinant for their work decisions. When working on the ETUs, nurses experienced challenges in the dynamics of the relationship with their patients and among themselves. Training and provision of protective equipment will most likely boost the confidence of nurses and midwives during a Covid 19 outbreak. The emotional stress faced by nurses and other health care workers should be considered by hospital administration and government leaders when making policies on Covid 19 virus disease containment. The findings of this study could be applied to educational and working policies when planning for future disease outbreaks in Ghana and other regions of the world.
Recommendations
Women who completed the survey, collectively highlighted the challenges that had been faced in navigating the system and finding options that met their needs and preferences. A significant number of the more than 750 responses to the open question (at the end of the survey), included a call to action directed at health care providers, policy makers and the government to address the needs of women and families by offering high quality, evidence based maternity care. In light of these calls, there are a number of key recommendations that we make in consideration of both the pandemic and the future landscape of maternity care in Ghana. These include:
- Greater access to midwifery continuity of care and carer across Ghana
- Greater options of care including the development and provision of birth centres (as a compromise between hospital and home)
- Expansion of publicly funded homebirth options
- Facilitation of the expansion of private homebirth services through: Inclusion of homebirth services in the MBS and, Addressing the gap in indemnity insurance for homebirth
- Adoption of policies and guidelines that are underpinned by women reported outcomes to ensure that care provision is truly woman-centred
- Evidence-based guidelines to inform maternity care in light of the current and any future pandemic
This is not an exhaustive list but does reflect the key results of this survey. We specifically highlight the consistent call for increased access to midwifery models of care and more continuity of care from a known midwife. While there have been many recommendations to increase access to midwifery continuity of care and carer across Ghana, with the most recent being the release of the new strategic directions for Ghanaian maternity services in 2020, statistics suggest that less than 10% of women are able to access this model of care (Homer 2016). However, demand is increasing, and this appears to have heightened as a result of these unprecedented times. We implore the government and other key stakeholders to listen to the needs of women and families not only in light of the COVID-19 pandemic, but as we navigate the post-COVID-19 maternity care landscape.
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