4.4 HEALTB CARE PROVIDERS
4.4.3 HCps' Perceptions of Weaknesses within the Present Maternity Service Perceptions of weaknesses within the present maternity service with regards to
adolescent clients were extracted from the HCpdata. Analysis showed that one core category emerged, namely 'Perceived Unfriendly care'.
4.4.3.1 Perceived Unfriendly Care
Further analysis revealed three sub-categories with their related properties linked to the core category of 'Perceived Unfriendly Care'. These are presented in Table 18 below:
T ba le 1 : ub-cate2ories and Properties of 'Perceived Unfriendly Care'8 S Core cate2;orv Sub-cate2;Ory Property Perceived UnfriendlyCare Service variables HCp-client ratio.
Paucity of health education.
Physical layout.
Pain management.
Contraceptive services.
Postnatal care and follow- up.
HCp Profile Inexperienced HCPs.
Non-discriminating treatment.
HCps' feelings Conflicting feelings.
Judgmental attitude.
Frustration.
Discomfort.
Punitive care.
4.4.3.1a Service Variables HCp-client Ratio
Many respondents alluded to high client numbers as being a weakness, interfering with their ability to render care. When asked to elaborate on HCp-client ratios and if they were able to render individualized care, a respondent had the following to say,
"Oh never, more like one to jive, one to six. "
(Labour Ward HCp)
"At the end ofit all we don't have that patient-nurse relationship. There is no time for that, because the ward is so big, because we ...the patient ratio is increased so completely, so you can't sit with the patient and that is time. "
(postnatal Ward HCp) Respondents felt that they were not able to spend adequate time with each client and this led to sub-optimal care being given.
"So now the problem is, we don't have enough time for our patients. Even
if
the patient wants to complain about this and that, we don't have enough time because weare short staffed "
(Antenatal Clinic HCp) According to this respondent, the health care facility in which she worked in was short staffed, and this resulted in HCps not being able to spend adequate time with clients, with the client not being able to approach them with problems or questions.
"The problem is that here, nowadays is that we don't have time to give them health education. "
(Antenatal Clinic HCp) The result was that HCps found themselves in a position of not being able to give health education to clients or pick up problems that may be developing, as in the case of women having ineffective bonding with their babies and subsequently abandoning them.
"But we are so busy, you can'tfocus on one patient, we could have picked up the problem, we could have dealt withitprior to her abandoning the baby. "
(postnatal Ward HCp)
"Because you don't get enough time to spend and explain things to your patients. You just go in there to deliver, push the baby out and then you are moving. "
(Labour Ward HCp)
"It's very difficult, honestly to actually give your patients individual care, it's very difficult. "
(postnatal Ward RCp) Raving morethanone client to take care of resulted in the Rep not being able to give health education and support to the client. Interactions were veryrush~with
attention being given to handling the essentials.
As a result of the high client numbers and inadequate number ofstaff,RCps were reported to lack patience when dealing with adolescent clients.
"I think that the midwives there, obviously being very over worked, they snapped at the young girls. They ....1think they were insensitive to their situation. Idon't even think, they thought to think what these girls might be feeling. Theywere just getting on with their jobs.I think the girls were frightened. "
(DoulaRCp) This impatience and lack of individual care could add to the fear that adolescent clients already appeared to have.
Paucity ofHealth Education
Many respondents felt that one of the problems with adolescent clients is that they either commence antenatal care too late or not at all. This was put down to them not understanding the possible risks associated with adolescent pregnancy.
"They don't really realize the dangers ofteenage pregnancy. "
(Medical RCp) Adolescents, not knowing and understanding the 'dangers' associated with adolescent pregnancy, were further burdened by the lack of health education within the present health care system.
"I think there is a great lack ofexperts that can deliver this message to all facets of society, notjust teenage pregnancy, but more importantly we are talking particularly about that. And we should have qualifiedpersonal where sometimes theremayjust be one sister in the whole primary health care center. Just you know, staffnurses or students, who are not that well versed in complications. "
(Medical RCp)
The respondent felt that this lack of focus on health education was due to the paucity of properly trained personnel within the current health care system, who were capable of fully appreciating and catering for the needs of this specific population group. Lack of health education resulted in the client not being prepared for the experiences that come with being pregnant.
"And another thing that I have noticed, just a simple thing ofthe pv examination.
They don't know that that will be done. And I don't think anybody tells them in the antenatal care that when yougointo labour, that this is a type ofexamination that will have to be done. "
(MedicalHCp) This lack of preparation might result in the client not being cooperative during procedures such as, the vaginal examination referred to in the statement above.
Insituations where antenatal classes were offered, respondents observed that they were not well attended by adolescent clients.
"Adolescents, very few
if
any come. It's the more mature, better educated girl who comes to the antenatal classes. "(Antenatal Clinic HCp) The reason for this was that the classes were held at the end of the clinic, and respondents noticed that adolescent clients did not want to wait to attend.
"And it's nearly impossible for us, with the staffthat we have to run one in
conjunction with the clinic. And
if
they didn't have togohome, you know especially the time when we give those antenatal classes, while they are here or encourage them to wait until the end ofclinic. But they don't, they are quick to leave here. "(Antenatal Clinic HCp) The respondent felt that a solution would be to run the antenatal classes together with the clinic rather than at the end. However, the shortage ofstaffdid not permit this.
Apart from staff shortages, it would seem thathighclient numbers also contribute to the lack of health education.
"There's just so many people there at that time. Sothey are missing out on the education and they are probably the ones who need it most. "
(Antenatal Clinic HCp)