Nurses' perception of epidural services in a Johannesburg academic setting.

Nomalungelo C Mbokazi, Janine Wagner
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Abstract

Background:  Labour pain is associated with detrimental maternal and foetal physical and psychological effects. Labour analgesia is a basic right for all women and labour epidural analgesia has been accepted as the gold standard for providing such, with reported improvement in patient satisfaction. In South Africa, studies have shown that labour epidural rates are low. At an academic hospital in Johannesburg, a 24-h labour epidural service combined with an awareness campaign and educational programme (LEAP) was initiated with the aim of improving labour epidural rates. Results showed a short-lived uptake with a subsequent decline.

Objectives:  This study explored the experiences of labour ward nursing staff regarding the labour epidural service at this academic hospital including perceived limitations and possible recommendations regarding improving service provision.

Method:  A qualitative, descriptive and exploratory study was conducted. Purposive sampling was used with semistructured, audio-recorded individual interviews, thematic analysis was performed using Braun and Clarke's six-phase approach.

Results:  The key theme is required education and supervision of epidural insertion (see page 3), management of childbirth and challenges related to epidural service provision.

Conclusion:  A positive sentiment was expressed by the participants; however, deficiencies in the service such as shortages of experienced personnel, work constraints and insufficient training may be affecting service sustainability. Further studies are recommended to form guidance towards the development and implementation of interventions to improve service delivery.Contribution: Provision of continual training and increased staffing of healthcare personnel will help improve the sustainability of the labour epidural service.

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约翰内斯堡学术机构护士对硬膜外麻醉服务的看法。
背景: 分娩疼痛会对产妇和胎儿的身心造成不利影响。分娩镇痛是所有妇女的一项基本权利,而分娩硬膜外镇痛已被公认为是提供分娩镇痛的黄金标准,据报道患者的满意度也有所提高。在南非,研究表明分娩硬膜外镇痛率很低。约翰内斯堡的一家学术医院启动了 24 小时分娩硬膜外镇痛服务,并结合宣传活动和教育计划 (LEAP),旨在提高分娩硬膜外镇痛率。结果显示,该服务的使用率在短时间内有所上升,随后又有所下降: 本研究探讨了该学术医院产房护理人员对产科硬膜外麻醉服务的体验,包括感知到的局限性以及改善服务的可能建议: 方法:进行了一项定性、描述性和探索性研究。采用了有目的的抽样方法,进行了半结构化的个人录音访谈,并使用布劳恩和克拉克的六阶段方法进行了主题分析: 关键主题是硬膜外麻醉插入所需的教育和监督(见第 3 页)、分娩管理以及与硬膜外麻醉服务相关的挑战: 结论:参与者表达了积极的看法,但服务中存在的不足,如缺乏有经验的人员、工作限制和培训不足,可能会影响服务的可持续性。建议开展进一步研究,为制定和实施干预措施提供指导,以改善服务的提供:贡献:提供持续培训和增加医护人员编制将有助于改善分娩硬膜外麻醉服务的可持续性。
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