nursing facilities

The goal of the majority of nursing institutions is to provide patients with dependable and high-quality medical services. The services offered must be cost effective, with no or as few faults as possible (Burns & Grove, 2014). Yet, due to differing management styles, this has not been the case. Every health facility has a varied personnel mix, different information collecting techniques during new patient admission, different drug administration procedures, and different follow-up mechanisms for the client. Guided by the need to increase the nurse patient ratio and observe the outcome, this paper reviews a qualitative study that was done on the impact of shortages of staff on maternal outcomes in Malawi, as a case study for low-income countries. The interest to cover this topic stems from the fact that there are increasing mortality rates even though the government has put effort to increase the number of health workers (Bowser & Hill, 2010). The study is carried out from the viewpoint of the health worker and used to inform policy options that can lead to a better working environment for the staff and quality care for Malawi women.

Problem Statement

Even though numerous studies have been carried out to expound on the consequences of inadequate human resources for health, there minimal information regarding the effects on obstetric care providers in low-income countries. This means that most of the studies done previously have focused largely on the high-income countries (Bradley et al., 2015). In most of the high-income countries, the nurses emphasize so much on practice environment. Their value level leads them to advocate for an increase in the number of nurses resulting into adequate patient care. However, in the sub-Saharan Africa, there is still limited evidence regarding negative impacts of staffing levels and workload on nurses hence prediction of outcomes still remain a mirage. In this research, various variables such as staff perceptions of insufficient human resources or the amount of time to carry out the tasks are instrumental in the prediction of variables regarding motivation and attrition. It is evident that the variables or factors identified lead to poor quality clinical care and disrespect. The results are that most women are discouraged from the facility-based delivery, or even at times delay in seeking care, exposing most of them when in critical condition. This worsens the challenges that face the health workers and only increases the risk to maternal health and in the end result in demoralization and burnout among the obstetric staff.

It is against this backdrop that the paper seeks to understand the perceptions emergency obstetric care (EmOC) providers on the impact of staff shortage on maternal health care in different health facilities in Malawi. The paper focuses so much on the effect rather than just looking at the dissatisfaction. The insights that are gained will help in informing the different policy decisions.

Purpose and Research Questions

The principle purpose of this paper is to find out the impact of staff shortage on maternal health care in different facilities in Malawi. In attempting to address the research purpose, the researcher used different questions that guided the study. However, the research questions can only be implied. These questions include:

How do the shortage of emergency obstetric care ( EmOC ) providers affect the outcome of maternal health care?

Does the amount of workload to the EmOC affect their motivation? In which way?

Using the primary research question (1), the researcher addresses the main objective of the study.

Literature Review

The literature for this study was mainly reviewed in the background section. The author used both quantitative and qualitative studies when doing the review. For instance, when explaining the shortage of HRH in Malawi as severe, the author uses a quantitative study on the postoperative outcome of caesarean sections and other major emergencies obstetric surgery as done by both clinical officers and medical officers in Malawi (Chilopora et al., 2007). Official information from the Ministry of Health is also relied on while carrying out the literature review. The author uses this kind of information to effort that the Malawian government has put in place addressing the shortages that arise from the workforce in the health sector and the Emergency Human Resource Program (EHRP) in 2004 (Carlson et al., 2008).

The effects of increasing the numbers are also discussed. The author notes that the strategies put in place by the government led to scaling up of several pre-service training of principle cadres. However, owing to the emergency nature of the intervention, minimal attention was paid to the quality and performance. In reviewing the literature, the author infers to quantitative data. In explaining the substantial gains that have been made, the author notes that vacancy rates still remain so high and way below the EHRP targets. The percentages noted include 72% for the clinical officers, 53% for the registered nurses and 60% for the nurse-midwife technicians.

Notably, the research papers that the author uses for review are old. The papers are as old as 2004. The most current paper that has been used in the study is just one, which was published in 2013 (Rawlins et al., 2013). The current publication was used in explaining the effect of scaling up the number of nurses on the quality of care. The findings of the study incorporated are all significant for this inquiry. The author, however, did not indicate the weaknesses of the studies mentioned neither were the strengths mentioned. Nonetheless, the information included in the review of literature was useful in building a logical argument hence forming the study background.

Conceptual / Theoretical Framework

In this study, the researcher applied the qualitative research design. While advancing the research design, the researcher used critical incident interviews. This method allowed the researcher to get the deeper meaning and full insight on the experiences of the participants. The critical incident technique is a type of qualitative research tool that is applied in most areas of the health science. It is usually preferred because of the flexibility as it can be modified and adapted to meet a given situation. Given that this study has been getting experiences from the nurses, gathering of information directly from the nurses or respondents is highly encouraged. Follow-ups can also be made and the flexibility allows many people to be interviewed concerning the same incident at the same time to ensure that there is a complete perspective on the matter gained.

While undertaking the study, the eligible participants carried out at least one of the emergency obstetric care signal functions in the past three months and had witnessed a demotivating critical incident within the said time. Analysis of the data was further done using the Nvivo software. However, in this study, the researcher did not come up with a certain framework or diagram of findings. This study was qualitative and the findings were grouped in accordance to the themes. This would then allow for thematic analysis.

Conclusion

From the study, the researcher reached a conclusion. The study established that even though there has been numerous increase in the total staffs engaged in Malawi, the maternal mortality ratio still remained high. The study established the tough situations under which the maternity staff operates and the professional as well as emotional toll that the work constraints inflict. The findings are that system failure and inadequacy in human resource management are the principle contributors to the gaps as far as the provision of the obstetric care is concerned. The thoughtful strategies matching the supply to demand as well as the different efforts to support the health workers are essential in mitigation of the effects of working in this context and improvement in the quality of obstetric care for women in Malawi.

On the other note, the critical appraisal of this research paper reaches a conclusion that the author defined the problem, mentioned the research purpose, reviewed literature as part of the research background and used a qualitative research design.

References

Bowser, D., & Hill, K. (2010). Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-TRAction Project, Harvard School of Public Health.

Bradley, S., Kamwendo, F., Chipeta, E., Chimwaza, W., de Pinho, H., & McAuliffe, E. (2015). Too few staff, too many patients: a qualitative study of the impact on obstetric care providers and on quality of care in Malawi. BMC pregnancy and childbirth, 15(1), 65.

Burns, N., & Grove, S. (2014). Understanding nursing research (6th ed.). St. Louis:Elsevier.

Carlson, C., Boivin, M., Chirwa, A., Chirwa, S., Chitalu, F., Hoare, G., ... & Martineau, T. (2008). Malawi health SWAp mid-term review: summary report. Norad collected reviews, 22.

Chilopora, G., Pereira, C., Kamwendo, F., Chimbiri, A., Malunga, E., & Bergström, S. (2007). Postoperative outcome of caesarean sections and other major emergency obstetric surgery by clinical officers and medical officers in Malawi. Human resources for health, 5(1), 17.

Rawlins, B. J., Kim, Y. M., Rozario, A. M., Bazant, E., Rashidi, T., Bandazi, S. N., ... & Noh, J. W. (2013). Reproductive health services in Malawi: an evaluation of a quality improvement intervention. Midwifery, 29(1), 53-59.