An Employee Assistance Programme (EAP) to support midwives affected by maternal deaths and stillbirths in Khomas region, Namibia
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Date
2022
Authors
Endjala, Tuwilika
Journal Title
Journal ISSN
Volume Title
Publisher
University of Namibia
Abstract
Globally, Employee Assistance Programme (EAP) has become a vital workplace programme that assists employees in managing personal and work-related problems. EAP aims to provide midwives with the ability to cope with the demands of their professional and private lives through various mechanisms. EAPs can play an essential role in helping midwives and their family members balance work and personal life demands whilst supporting employers' goals towards improved and continuing levels of workplace productivity. Since midwives work autonomously,
they are inherently exposed to traumatic situations, such as Maternal Deaths (MD) and Fresh Still Births (FSB), which may occur daily due to the nature of their work. However, this programme is considered a neglected component in attempts to uphold and improve midwives' wellbeing in the midwifery profession as there is limited literature for Namibia. Therefore, this study targeted the Khomas Region because it has the highest MD and Stillbirths (SBs) in Namibia. The study aimed to develop an EAP that supports midwives affected by maternal deaths and
stillbirths in the Khomas Region. The study was conducted with a pragmatic worldview at two public referral hospitals in the Khomas Region. The study was based on a mixed method approach that includes a convergent parallel design in which the qualitative part used a descriptive, exploratory and contextual design. In addition, the quantitative part used cross sectional design. The study was conducted in three phases: Phase 1 comprised of situational analysis based on the
four objectives that correspond with the study population: midwives. Qualitative data was collected to explore and describe midwives' experiences affected by MD and FSB using Focus Group Discussions (FGDs) and individual interviews. Four FGDs and four individual interviews were conducted with midwives from two state hospitals. Midwives were purposively sampled, and a total of 29 midwives participated in the qualitative part of the study. FGDs and individual interviews were audiotaped and transcribed verbatim. Qualitative data was analysed using content
analysis and coded using Tech's steps of open-coding. Five themes and 21 sub-themes were identified. In addition, quantitative data was collected using a questionnaire to determine the occupational exposure of midwives to MD and FSB, evaluate the self-reported level of stress among midwives due to exposure to MD and FSB, and to determine the coping mechanism used by midwives to cope with MD and FSB in the absence of EAP. Since the population was small, a total population sampling was used (n=140). Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 27 and SPSS AMOS version 23. The study showed that the midwives experienced varied challenges such as MD and FSB effects on midwives, high exposure to MD and FSB with inadequate professional and environmental support, death distress among midwives, and difficulties related to the emotional versus problem focused coping mechanism.
The study’s phase 2 conceptualised the findings from phase 1 and led to the development of the study's conceptual framework based on the Practice Theory by Dickoff, James and Wiedenbach (1968) survey list components such as agent (the researcher, counsellor and management), recipient (midwives), context (health facilities), dynamics (challenges hampering the successful development of an EAP), procedure (EAP and implementation strategies developed) and terminus (the ability of midwives to cope with MDs and FSBs). In addition, Phase 3 of the study developed an EAP to support midwives affected by MDs and SBs in the Khomas Region. The EAP was developed according to Lokanadha and Mohan (2010) Quality of Work Life Model. The programme description includes a philosophical basis, aim, principles, objectives, approach, the content of EAP/activities, expected outcome and evaluation of the process. The implementation strategies for the programme were also developed according to Howe's (2011) Compass Aligned Performance System (C@PS) model which is a strategic management tool simplify the strategies and plan to implement designed strategies. Four strategies were developed, and these are the provision of support services to midwives through EAP at the workplace, training of midwives on how to deal with MD and FSB, motivation of midwives through a visible support system from management and training of supervisors on the EAP, and how to make referrals. A team of experts verified the EAP and implementation strategies after development. Based on the findings, it is concluded that MD and FSB affect midwives, high exposure, high death distress, and midwives use various coping mechanisms, hence the need to address these challenges. The study made recommendations based on the study findings for practice, education and future research. It is further recommended that hospitals in the Khomas Region implement the EAP to support midwives on how to cope with MD and FSB.
Description
A dissertation submitted in fulfillment of the requirements for the Degree of Doctor of Philosophy in Public Health