A framework for effective communication of information was further developed: the FAAS framework for effective intrapartum management. I urge the framework to provide a basis for evaluating the effectiveness of the ICP included in the effective management of the intrapartum period.
Introduction
Several published systematic reviews of cohort studies (Hodnett et al., 2010; Walsh and Downe 2004; Overgaard et al., 2011) have found that women who deliver in midwife-led units are less likely to had interventions during labor, and are more likely to have spontaneous labor. vaginal delivery. Page | 3 Inaccurate communication and lack of information during a woman's transfer to a referral hospital could lead to delays in emergency procedures such as caesarean section (Overgaard et al., 2011).
Motivation for choosing this topic
Research Problem in context
Therefore, this issue highlights the need to understand information communication (IC) processes between skilled birth attendants. At the same time, it is important to determine ways to effectively optimize information communication to enable rapid and efficient service delivery during the critical intrapartum period.
Basic Assumptions
In addition, the poor transfer of information between different health care institutions further exacerbates the problem with referrals. 2011), further states that in South Africa, delays in (or lack of) information transfer and insufficient collection of information are one of the main factors responsible for delays in providing adequate basic and comprehensive emergency obstetric services. The author further claims that understanding the context or participants in their environment enabled the development of an information communication framework relevant to the users as it was based on the findings from this context, although the interpretation was based on one's own experience and background of the researchers ( Creswell 2009:8-9).
Aim of the Study
Furthermore, information is readily available for communication, but ICP is socially constructed as the skilled midwives interact daily according to Spangler (2012); Krotty (1998). On a more practical level, the skilled midwives interact with their environment and make sense of it based on the historical-social perspectives bestowed on them by their own culture.
Research Question (RQ)
Page | 7 On a philosophical level, the study assumed that if maternal mortality and morbidity is lower in developed countries, then this means that it is preventable with appropriate measures. This would be reasonable with appropriate strategies that are context specific due to the dynamic nature of health care contexts that are influenced by social cultural and political mandates.
Research Objectives
The Significance of the Study
Operational Definitions of Key Concepts
Page | 11 Gravidogram: defined as a chart used to record the progress of pregnancy during the antenatal/antepartum period (Frasier et. al., 2010) the same definition applies to the study. Fetus: A fetus is a period of development from conception to birth of a mammal in the womb (Frasier et al., 2010).
Structure of the Dissertation
- Chapter one
- Chapter two
- Chapter three
- Chapter Four
- Chapter Five
- Chapter Six
- Chapter Seven
- Chapter Eight
- Chapter Nine
The chapter examines the concept of Activity Driven (AD) approach, Activity Driven Information System Development Model (ADISD), Activity Analysis and Development (Act AD) framework and Activity Theory which was the basis of the theoretical framework used in the study. Discuss the development of the IC framework and the description used in the development of the framework.
Introduction
Maternal Health care
- Attainment of (MDGS)
- Health care
- Healthcare in the Developed Countries
- Healthcare in the Developing Countries
- Healthcare in the Context of South Africa
- Maternal Healthcare Perspective
- Referral chains in maternal health care
- Management of pregnancy and birth
- The partogram
Communication of these factors becomes essential in the management of the mother postpartum (Frasier et al., 2010). This will be the information that is expected to be included in the documentation and communication during the management of the intrapartum period.
Chapter Summary
The data collection process should be appropriate for effective communication during the management of the intrapartum period. Further data interpretation on a partogram determines the decision made for patient management or appropriate referral.
Introduction
Health Information
- Data
- Knowledge
- Information
- Information behaviour
The knowledge base of the clinician according to Coiera (2013) on acid-base balance will influence the interpretation of pH and the management required. Characteristics of information sources such as the usefulness and reliability of information, which affects the choice of sources by the user and the judgment of the information received.
Information skills
- Communication
- Structuring information
- Questioning
- Searching
- Making decisions
Make your contribution as informative as is required for the current purposes of the exchange. Effective communication according to Gephart et al., (2012) is conversations that achieve a goal that both the sender and receiver of the message understand.
Means of coordination
The study attempts to review the expected ICP according to the guidelines' protocols and policies. The review of expectations in this study is based on domestic policies, protocols, and guidelines that guide day-to-day practices.
Paper based versus electronic medical record
As these challenges associated with paper records are identified, there is a growing push to replace them with electronic records (Hawley, et al., 2014; Underwood et al., 2012; Shortliffe and Barnett 2006: Coiera 2003). The review confirmed that paper records were an important tool in maternal care (Hawley et al., 2014; Fawdry et al., 2011).
Information communication in maternal health
Team behavior was found to influence communication according to the results of a multicenter study by Simpson et al., (2006) which showed that many nurses'. Some of the desirable traits that emerged from the study by Simpson et al., (2006) showed that nurses (midwives) and physicians desired respectful interdisciplinary interactions.
Chapter Summary
Information communication within and between health care settings relies heavily on data collection and information communication processes that are influenced by team collaboration and communication. This study investigates the communication of processed information and the complexity experienced by skilled obstetricians with ICPs.
Introduction
Page | 48 theoretical structure of work activity, established by Engeström in his PHD dissertation in 1987, will be discussed further on the activity-driven framework. The existing information systems that facilitate and assist work activities will be used to describe the human activity system.
Activity - Driven Approach to ISD
These definitions will be taken into consideration when applying the Activity Driven (AD) approach to the study. Due to the nature of the research, participatory and cooperative methods were used during the interviews to obtain the desired ICP.
Activity Driven ISD model
Levels of activity
The work activities were modelled, and the information tools and information used in the work processes were mapped to the workflows. A detailed analysis of individual actions, including the information tools used and data elements necessary for the central action, was examined.
Phases of activity
During this process, the challenges identified were seen as development points and would be used in the next phase to design for common understanding of the target state. During the research process, identification of the current state enabled the researcher to evaluate the desired state.
Activity Analysis and Development Framework
Work tools Internal or external mediating tools that help achieve the results of the activity. The working means of information communication processes during the management of the birth period.
Activity Theory (AT)
- Hierarchical structure of activity
- Object-orientedness (purposefulness)
- Internalization/Externalization
- Mediation
- Development
We identified the object, goal and result of managing the intrapartum period from both collective and individual actions. This communicative act affects the activities involving subjects during the management of the period during childbirth.
Introduction
Contextualising Research Perspectives
As an interpretive study, the researcher understands/interprets the work processes and artifacts used during the intrapartum period for the information communication processes. These differences were between the expected information communication processes and the actual communication processes which are both socially constructed.
Introduction to interpretivism
Page | 64 The fact that information-communication processes are described through interpretability was the assumption that language is socially constructed and the case study would achieve different socio-cultural interpretations of information-communication processes (Walsham 2006). Interpretative studies are appropriate for the health care context because the researcher can interpret the construction of information communication processes in an actual health services research environment (Dixon-Woods et al., 2006; Henderson 2005).
Methodological choice
The selection of case study strategy
The case study approach offered a multi-perspective analysis of the views of different actors and their interaction through the ICP in the management of the intrapartum period within and between healthcare providers. This approach helped the researcher gain a deeper understanding of the dynamics involved in ICP among skilled birth attendants during the management of the intrapartum period.
Case study Design
In addition, a multiple case study approach allowed for more detailed analysis within each setting and between settings (Baxter and Jack 2008). This requires an in-depth understanding and interpretation of rival explanations that empower the case study findings (Yin 2014).
Challenges of case study methodology
In summary, Yin indicates that while these five concerns can be mitigated, a good case study is still difficult to do. The issue of credibility in case study research seems to be a high point raised by authors as discussed above.
Types of case study
The design of the data collection protocol was done simultaneously with the careful selection of cases. Each of the cases has been comprehensively investigated at different stages, while a report has been written for each individual case.
Defining the case
Page | 76 Each of the case studies was carefully selected to produce a literal replication or similar result as the ICP may be similar in the northern and southern suburbs. Page | 77 Although the management of the intrapartum period involves the staff nurses, doctors, laboratory technician's ambulance staff and other community workers, the delimitation enables the researcher for the purpose of this study to exclude them and only the skilled birth attendants (midwives and obstetricians) to include. ) in the management of the intrapartum period.
Theoretical framework and the place of theory in case study design . 77
The issue the researcher identified about the impact of ICP on intrapartum management was more prevalent in MOUs where midwives independently managed women. This means that issues such as proximity of access and hospitality influence case selection.
Ethical Considerations
Ethical Issues Relating to Informants
This was done before the study, giving the informants enough time to decide whether they wanted to participate in the study or not. During the interview, additional information was offered and signed consent was obtained (Appendix C) as a prerequisite for the study.
Data sources
These schedules were adjusted as necessary due to the fact that maternity wards were very busy on some days and quiet on others. However, observation was limited to informal observation in order to enhance the information obtained from documents and interviews due to time and resource constraints.
Data collection methods
- In-depth interview
- Field notes/ prolonged engagement
- Document Review
- Observations: Observer- as –participant
- Reflective diaries
I could also ask about ICP and their challenges during intrapartum management. The researcher was the observer, therefore the transcription and interpretation of the data remained consistent (Baker 2006).
Data analysis
Process of analysis
Understanding the theoretical framework prior to data collection allowed data collected to emerge and answer the questions appropriately by being purposefully sought. Triangulation of the data from other sources allowed similar categories to be merged and to look for meaning in the emerging categories.
Coding Framework
Being able to read and listen to audio tapes while confirming observations with the participants enabled a thorough data analysis process. Confirmation with participants and filling of gaps in the interviews also enabled a rigorous process in data collection and analysis.
Conclusion
Introduction
Case description
As shown in the referral chain in Table 6.2, MOUs are categorized as the primary level of care and always treat low-risk women in the perinatal period. Kraaifontuin MOU Bishop Lavis MOU Elsies River MOU Khayelitsha Hospital (New District. Hospital) bed capacity 372.
Motivation of Cases
Page | 98 MOU B refers all moderate-risk patients to RH B and high-risk patients to GSH (which was not part of the study) while MOU A refers moderate clients to RH A and high-risk patients to TBH (which was not part of the study). Data analysis was done using thematic analysis and the activity-driven approach as theoretical lenses.
Thematic Overview
Principle theme; understanding of the present state
Subtheme: Expected ICP
The policy requirements identified several tools recommended for use during intrapartum management. The effectiveness of the tools used in communication should be a consideration to improve communication.
Subtheme: Actual ICP
Effective communication processes with appropriate communication tools are also recommended for efficient management of the woman during the intrapartum period. However, in accessing the services, the use of telephone connections for communication is recommended even though the actual communication process is not described.
Subtheme: Actual ICP MOU A
The information provided during submissions is derived from information collected from the woman during her pregnancy. Feedback provided by clinicians includes referral to the woman or follow-up information on the woman's management.
Subtheme: Actual ICP MOU B
The division of tasks required the midwives to inform each other of the findings and this is data entered into the maternal case record. The history of the woman in previous pregnancies, including reproductive history, was included in the maternal case record and the continuation of the assessment of labor was entered in the same document.
Subtheme: Actual ICP in RH A
Page | 119 begin to say what they are concerned about, including women's history. So that's the way we can talk to them but obviously it's just logistically impossible that we can sit down and answer the phone because there's just too much to do and it's just the two of us , but if it were ideal that would be nice – a hotline would be nice.” (P10:67).
Subtheme: Actual ICP in RH B
Anyone in the RH A hospital gown can answer the call when the phone rings. A triage criterion is used in the admission suite to triage the women according to the information on the acuity of the woman in labor.
Subtheme: Challenges of ICP
The category frustration with the telephone calls emerged strongly in all four units of analysis located within two different referral drains (MOU A and RH A and MOU B and RH B). This was linked to the category of frustration with the information given, which also emerged in this referral drain.
Subtheme: Challenges of ICP MOU A
The midwives acknowledge mistakes made during the information communication that had consequences for the care of the pregnant woman as below where the doctor did not make an informed decision and the woman ended up dead. So most of the doctors are good and start by saying why you want to refer the woman and then give all the other information.
Subtheme: Challenges of ICP MOU B
Disappointment with feedback given by doctors, or the lack of it, affected relationships with midwives. In summary, some challenges were expressed as solutions to existing problems, which the midwives envisioned as desired solutions.
Subtheme: Challenges to ICP in RH A
Frustration over calls from the doctors was also a big problem, as the doctors recognized that the MOU midwives found it difficult to reach them in an emergency. The doctors found it frustrating because they gave the midwives the impression that they didn't want to help.
Subtheme: Challenges to ICP in RH B
Sometimes they are so anxious that I think of getting rid of the woman and they leave out very important information. The attitude and experience of the sender or the receiver of information also influenced the information communication processes.
Principle theme: The desired goal state
- Subtheme: Desired ICP
- Subtheme: Desired ICP MOU A
- Subtheme: Desired ICP MOU B
- Subtheme: desired ICP RH A
- Subtheme: desired ICP RH B
Telephones were mostly used when the referral hospital A was called for consultation or referral of the woman. I think if the response would come directly to the maternity ward, not via, because sometimes it is via reception, then it is the reception that has to transfer that call to you." (P2:18).
Findings
Document completion was an action that complied with the rules such as auditing, but was not considered useful for use by the skilled birth attendants. This was seen as the completeness of the message if the receiver provided accurate feedback to the sender.
Introduction
In this way, the analysis of data was consistent with the focus of the case study. The description of the case as below is described to illuminate the context within which the case was described.
Activity analysis: IC within MOU A
- Antepartum care
- Intrapartum
- Individual work activity
- Actors activities within MOU A labour ward
- Group activities within MOU A
- ELEMENTS OF WORK ACTIVITIES MOU A
The information collected and documented in the mother's file (Gravidogram) is very important in the management of the woman during the intrapartum period. The information collected during the prenatal period also influences the management of the intrapartum period.
Activity analysis: IC between the MOU A and the RH A
- Actors in the RH A
- Group activities within the RH A
- Network of activities between the referral drainage A
- ELEMENTS OF WORK ACTIVITY RH A
- Information flows in case study A with challenges identified
The referring hospital included the doctors on call in the maternity ward and the telephone operators. Midwives in RH A: advocate for better women's care, care of women in labor in RH A.
Activity analysis: IC within MOU B
Antepartum care MOU B
Intrapartum care MOU B
Individual Action of a midwife
Group Activities in MOU B
Activity analysis MOU B labour ward milieu
Elements of work activity of MOU B with development spots
Activity analysis: IC between the MOU B and the RH B
Flow of information in RH B
Elements of work activity RH B development spots
Elements of work activity with development spots MOU B and RH B
Introduction
Suggested developments
Improving ICP
The FAAS Framework
Explanation of the framework
Effective communication
Adequate information
Evaluation USING FAAS framework
Summary
Introduction
Revisiting research questions
Conclusions and recommendations
Conclusions
Recommendations
Quality of the research
Credibility
Transferability
Reflexivity
Contributions
Contribution to knowledge
Theoretical contribution
Practical contribution
Methodological contribution
Limitations and implications for further research
Conclusion
