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African Journal of Primary Health Care & Family Medicine

On-line version ISSN 2071-2936
Print version ISSN 2071-2928

Afr. j. prim. health care fam. med. (Online) vol.11 n.1 Cape Town  2019

http://dx.doi.org/10.4102/phcfm.v11i1.1936 

ORIGINAL RESEARCH

 

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal

 

 

Desiree GovenderI, II; Saloshni NaidooII; Myra TaylorII

IKwaZulu-Natal Department of Health, Ugu District, South Africa
IISchool of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

Correspondence

 

 


ABSTRACT

BACKGROUND: Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.
AIM: The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.
SETTING: The study was conducted in a local district hospital in Ugu, KwaZulu-Natal.
METHODS: An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.
RESULTS: Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.
CONCLUSION: In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Keywords: adolescent pregnancy; multidisciplinary care; healthcare providers; teamwork; knowledge exchange.


 

 

Introduction

Adolescent pregnancy is a complex and multifaceted public health issue.1 Early childbearing poses a challenge to the eradication of poverty, universal primary education, gender equality and women's empowerment, reduction of child mortality, improvements in maternal health, and the struggle with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS).2,3

A retrospective cohort study carried out in Manitoba, Canada, identified that children of adolescent mothers had a higher risk of hospitalisation, high hospital use, academic failure and poor social skills.4 Furthermore, evidence concluded that the children of the adolescent mothers accounted for 27% of hospitalisation cases in the first year, while 34% had experienced early mortality (birth to 17 years). The study further emphasised the vulnerability of adolescent parents and their children to social problems, with 51% of children in foster care, while 44% were dependent on welfare and 36% became adolescent mothers. It is therefore evident that adolescent motherhood drives the social problems from one generation to another.

The children of adolescent mothers are also prone to neglect, accidental injuries and speech and language delays. The research conducted by Keown et al.5 in New Zealand found that maternal intrusiveness and maternal involvement with the child accounts for the relationship between adolescent motherhood and poor language development. Maternal intrusiveness is defined as 'frequent, non-contingent physical behaviour or verbal directives that limit the child's activities' (p. 195).6 Therefore, speech language screening is recommended on a regular basis so that early intervention can be implemented.

Thompson7 asserts that an adolescent mother and her child are considered as two individual paediatric patients, with each requiring specialised health care. Because of the high-risk nature of adolescent pregnancy, the multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.8 Multidisciplinary care is defined as 'care that occurs when professionals from a range of disciplines work together to deliver comprehensive care that addresses as many of the patient's health and other needs as possible' (p. S61).9

Pinzon and Jones10 have also emphasised the usefulness of multidisciplinary collaboration in the care of parenting adolescent mothers and their children. Quinlivan and Evans11 conducted a study in three Australian hospitals that investigated the impact of a multidisciplinary antenatal clinic for pregnant adolescents on birth outcomes, breastfeeding postpartum and contraception uptake. The various healthcare providers at the multidisciplinary antenatal clinic included psychologists, social workers, dieticians, psychiatrists, doctors and clinical midwives. Adolescent mothers (attendees of the multidisciplinary clinic) in the study had a significantly lower risk of threatened premature labour (OR: 0.45; 95% CI: 0.29-0.68, p < 0.0001), premature rupture of membranes (OR 0.34; 95% CI 0.18-0.6, p = 0.0002) or premature delivery (OR: 0.40; 95% CI: 0.25-0.62, p < 0.0001) compared with adolescent mothers from general clinics.11 Postpartum uptake of contraception was higher among the adolescent mothers attending the clinic (OR: 1.58; 95% CI: 1.07-2.25, p < 0.01).

South African adolescent females are not immune to the negative consequences of early childbearing. Pregnant adolescents attending a district hospital in northern KwaZulu-Natal underutilised antenatal services (< 4 visits).12 The underutilisation of antenatal services by pregnant adolescents was significantly associated with lower gestational age (< 37 weeks) (OR: 2.64; 95% CI: 1.04-6.74, p < 0.05). Adolescent mothers in this study also reported emotional vulnerability and the burden of stigma related to adolescent pregnancy in society.12 Similarly, Sodi and Sod,13 gathered from their study, conducted in Limpopo, South Africa, that adolescent mothers experience elevated emotional problems, negative social relationships, disruption in schooling and intense lifestyle changes. Drawing from the South African context, nurses are the first-line of practitioners who have been tasked with the provision of sexual and reproductive health services to adolescents, but multifaceted problems, such as adolescent pregnancy, are not limited to nursing care.

According to Thompson7, the basic needs of the adolescent mother and her child include growth and development screening, immunisation, nutrition screening, acute illness management, lactation support, psychosocial assessment, provision of birth control, sexual health education, infant mental health screening, early childhood interventions, child safety and behaviour support, parenting support and maternal mental health screening.

Understanding the perceptions of the multidisciplinary care approach for adolescent mothers and their children in the South African context is a vital step in supporting clinical practice. This study explored nurses' perceptions of the MDT approach of care for adolescent mothers and their children.

 

Research methods

Study design

This research was part of the first phase of a larger PhD study titled 'A community of practice model for a multidisciplinary and comprehensive approach towards caring for the parenting adolescent mother'. The larger PhD study encompassed a mixed-methods action research study (MMAR). For the purpose of this research, a descriptive qualitative study was used to explore nurses' opinions and perceptions of the MDT approach of care to possibly introduce an intervention. The descriptive qualitative study also prepared for the action research process as an environmental scan. It is widely acknowledged that action research is a method that can improve practice and the working environment.14 Reason and Bradbury15 define action research as 'a participatory process with developing practical knowing in the pursuit of worthwhile human purposes' (p. 8). In the healthcare setting, action research has the ability to positively impact healthcare clinical practice and health outcomes for users. Focus group discussions (FGDs) were conducted for data collection.

Context of the study

The principal researcher of this study (D.G.) has worked as a physiotherapist for 10 years at a 300 bedded local district hospital in Ugu, KwaZulu-Natal. The services offered by the hospital include obstetrics and gynaecology, surgery, orthopaedics, paediatrics, mental health, dietetics, rehabilitation, radiology and social work services. The hospital provides healthcare services to the residents of Umdoni. Umzumbe and Vulamehlo. The principal researcher had the opportunity of interacting with adolescent mothers while rendering physiotherapeutic services to them in the postnatal ward and to their infants in the nursery. She has also observed the increase in the adolescent delivery rate (females 19 years and younger) at the hospital. The adolescent delivery rate in Ugu district is currently 23%. Adolescent females attending the antenatal clinic and labour ward do not always present for a first pregnancy but for repeat pregnancies.16

The principal researcher's engagement with adolescent mothers and her growing awareness of the multitude of problems (medical, psychological, socio-economic) experienced by adolescent mothers and their children motivated her to probe into the nature of their current care at her institution. After informal discussions with the medical doctors, clinical midwives, nursing managers, a clinical psychologist and social workers, it was apparent that there were no specific services in the hospital tailored for adolescent pregnancy, adolescent mothers or their children. Nurses were the first-line of contact for pregnant and parenting adolescents.

Study population

The population of interest were all professional nurses, enrolled nurses and auxiliary nurses caring for the health of pregnant adolescents, adolescent mothers and their children, in the health facility. Three wards that were identified included the antenatal clinic, the postnatal ward and the nursery with a total of 24 nursing staff.

Sampling method

The antenatal, the postnatal and nursery units were purposefully identified because the research interest was the care of pregnant adolescents, parenting adolescents and their children. The principal researcher contacted all operational managers of the antenatal, postnatal and nursery units to obtain permission to inform staff about the research study. This study included a sample of volunteer nurses from these identified units to participate in the study. Therefore, all professional nurses, enrolled nurses and auxiliary nurses who were willing to voluntarily participate in this study were included in the FGDs.

Sample size

A total of three FGDs were conducted. Focus group 1 consisted of eight participants, while focus groups 2 and 3 consisted of six participants each, making a total of 20 participants. The number of participants was limited and therefore the focus groups were few. However, data saturation was reached by the third focus group.

Data collection

To ensure the trustworthiness of the data, the focus group discussion guide (FGDG) was developed with the clinical manager (obstetrics and gynaecology) and three clinical midwives during research meetings (see Box 1). The FGDG was also checked by the research supervisors. Prior to data collection, the principal researcher became familiar with the units within the organisation who participated in the FGDs. Initially, the research idea was introduced to nursing staff during ward meetings to give them the opportunity to decide if they wanted to participate in the FGDs. This ensured that individuals who participated in this study were sincerely interested in sharing their perspectives.

 

 

With regard to dependability, a detailed methodological description of this study was provided by the researchers.17 Each FGD was conducted in a private room of the unit at a convenient time agreed upon by the principal researcher and the operational manager, thus allowing for confidentiality. Before conducting the FGDs, the principal researcher and a secondary facilitator (clinical midwife) informed the participants about the purpose of the research, informed consent and the tape recording of the discussions. Participants were assured that all tape recordings would be kept confidential. The facilitators also encouraged participants to be honest, and they were assured that there were no right or wrong answers to the questions that were probed. The FGD was facilitated by the principal researcher and the secondary facilitator. All FGDs were conducted in English and within an average time of 70 minutes.

Data analysis

Following data collection, the audiotapes were transcribed verbatim. Codes were assigned to each of the participants using the focus group number and an individual number (FGD1, P1). Braun and Clark's18 approach to thematic analysis was used to analyse the transcribed data. Guest et al.19 describe thematic analysis as a 'focus on identifying and describing both implicit and explicit ideas within the data, that is, themes'. Codes are then typically developed to represent the identified themes and are then applied or linked to raw data as summary markers for later analysis. The steps that were followed in the thematic analysis included (1) reading and familiarisation with the transcribed data; (2) coding; (3) searching for themes; (4) reviewing themes; (5) defining and naming themes and (6) writing up the report. Confirmability was achieved through member checking. The transcribed data were taken back to participants to review. The authors provided a 'thick description' of the participants and the research process.17 The information provided on the participants and research process would enable the reader to decide if the findings of this study could be transferable to their own setting.

Ethical considerations

The University of KwaZulu-Natal Bioethics Research Committee (ref. no.: BFC553/16) and the KwaZulu-Natal Department of Health (ref. no.: KZ_2016RP26_545) approved this study. Permission was also granted by the Chief Executive Officer to conduct the study at the hospital facility. Written consent was obtained from all the participants.

 

Results

The demographic characteristics of the participants are shown in Table 1. There were 19 female participants and one male participant, aged 25-54 years. Six overarching themes emerged from the data analysis which included perceived professional benefits of adopting the MDT care approach for adolescent mothers and their children, perceived barriers to multidisciplinary collaboration, perceived clinical benefits of adopting the multidisciplinary care approach for parenting adolescent mothers, perceived problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.

 

 

Theme 1: Perceived professional benefits of adopting the multidisciplinary team care approach for the adolescent mothers and their children

Nurses identified the professional benefits of collaborating in an MDT to offer care to adolescent mothers and their children. These professional benefits are discussed under the following subthemes: clinical networking, improvement in communication and teamwork.

Clinical networking

The participants stated that clinical networking is important to allow for improved communication between healthcare providers regarding the care of the adolescent mother and her child. The absence of a clinical network to address adolescent-specific issues was clearly mentioned by participants. The quotes below reflect participant's views on clinical networking as a benefit of adopting the MDT care approach for adolescent mother