THE FACTORS INFLUENCING WORK ATTITUDES OF MIDWIVES IN THE MATERNITY UNIT, GENERAL HOSPITAL CALABAR, CROSS RIVER STATE, NIGERIA: BSC NUR001

                                      CHAPTER ONE
                                                                 INTRODUCTION

1.1     Background of the Study        

The midwife may practice in any setting including the home, the community, and hospital or in any other maternity service. In all settings, the midwife remains responsible and accountable for the care she provides. The midwife works in partnership with women on her own professional responsibility, to give women the necessary support, care and advice during pregnancy, labour and the postpartum period up to six weeks, to facilitate births and to provide care for the newborns. The midwife understands, promotes and facilitates the physiological processes of pregnancy and childbirth, identifies complications that may arise in mother and baby, accesses appropriate medical assistance and implements emergency measures as necessary. When women require referral, midwives provide midwifery care in collaboration with other health professionals. Midwives have an important role in health and wellness promotion and education for the woman, her family and the community. Midwifery practice involves informing and preparing the woman and her family for pregnancy, birth, breastfeeding and parenthood and includes certain aspect of women’s health, family planning and infant’s well-being (Health Practitioners Competence Assurance Act, HPCAA 2003, America).    

The attitude of midwives and the work environment are known to affect each other mutually. Positive interaction contributes to both the individual’s health and the success of the institution (Tekarslan, Sencan, Kilinc & Bayal 2004). These midwives demonstrate common or personal attitudes towards their profession, managers and institutions which varies according to the interaction experienced in the work place (Bayal, 2005). Attitude is the predisposition or potential behavioural interaction to respond in a favourable or unfavourable way to any concrete – abstract, animate – inanimate objects in the environment, which shaped over time in relation to the upbringing of the individual and lifelong experiences (Erem, 2004; Tekarslam et al., 2004). In addition, it could prompt the individuals to distinguish themselves from others; however, it might change or gain strength or completely disappear in time, while it cannot be observed directly, it can be interpreted from the individuals statements and behaviours (Schermerhorn, Hunt & Osborn, 2005; Simsek, Akgemci & Celik, 2004). The attitude of employees towards a profession manifest itself in the way they respond to work related factors. Given the relationship between the individual’s attitude and behaviours towards an object, many authors have expressed that identifying the attitudes of employees towards their profession would provide significant data for managers in predicting employees job satisfaction, performances and productivity (Hulm & Judge, 2003).

Negative attitude have been found in a significance number of midwifery populations since the 1960s and 1970s and although the proportion of midwives with pessimistic attitudes appeared to lessen throughout later decades, negative attitudes still exist today (Waston & Devellis, 2005). Although researchers such as Howard and Chung claim that the attitude appeared to have improved since the 1970s, negative attitude identified in numerous studies throughout the 1980s and 1990s suggest that attitude may not have actually changed all that much from those found decades ago. In institutions providing human services in healthcare industry, characterization of midwives and nurses’ attitudes towards their profession is essential for both other individuals employed towards their profession is essential for both other individuals employed in the same organization and patients receiving healthcare from these institutions as midwives and nurses are the members of the healthcare team who spend the most time and thereafter, the most familiar with patients.

However, studies have so far demonstrated that midwives exhibit negative attitude towards their profession such as frequently complaining about the difficulties of the professionals and working conditions, finding the profession very stressful, practicing unwilling, seriously considering to leave the profession, and showing a tendency to absenteeism and job dissatisfaction (Konver, Brewer, Wu, Cheng & Suzuki, 2006). Most of the midwives in Nigeria are employed in public hospital, which account for the majority of the hospital in Nigeria healthcare system. In these hospitals, midwives have to work in settings where the number of personnel is often inadequate, while the number of patients in their responsibility is extremely high; in addition, working hours are long, vacation times are not always granted appointment style to the position, job satisfaction, work environment and personal factors such as age, educational level, years of professional experience, family issues, marital status, rank, which are the factors that could lead to midwives to perceive less job satisfaction and develop negative attitudes towards their profession (Baykal, Sezgin & Seren, 2005). The public hospital have begun to occupy increasingly more of the healthcare industry in recent years, which has also increased the need for midwives and resulted in initiatives to improve their working conditions (better salary, improved benefits, etc.). However, despite the better physical environment, technology and equipment offered, midwives employed in these hospitals have been reported to continue experiencing undesired perceptions including high stress and dissatisfaction due to such condition as long working hours, lack of job security and the obligation to meet high customers expectations (Baykal, Altumtas, Sokmen & Akgen, 2005). Midwives unsatisfied with their jobs experience emotional problems, including high stress, tension and anxiety, which could result in a failure to concentrate on their tasks, which in turn leads them to demonstrate behaviours that disrupt the quality and the continuity of nursing/midwifery services such as complaining about their work, the facility and their coworkers, neglecting duties etc. Therefore, research on attitude would be of great importance to improve employees’ job satisfaction and to enhance their quality of professional life, and consequently to achieve organizational goals, then, the essence of this study was to determine factors influencing work attitude of midwives in the maternity unit of General Hospital, Calabar.

1.2     Statement of Problem

The attitude of many midwives towards pregnant women and those in labour is poor by study report. In the course of their professional duty as midwives, they act inappropriately to the women in labour. Such attitude raises the question of what the duties of the midwives are to a woman in labour. Sometimes, one wonders if they have any knowledge of the literal meaning of their profession or even what their profession entails. The situation becomes worse if the woman in labour is an HIV – positive patients. Their attitudes range from that of neglect to abandonment such that one questions the professional training they had and knowledge about the mode of transmission of HIV and the skill to prevent it. The Nigerian health system as a whole has been plagued by problems of service quality, including unfriendly staff attitudes to patients, inadequate skills, decaying infrastructures, chronic shortages of essential drugs and the well – known “out - of – stock syndrome”. It was observed in the course of clinical experience that midwives spend less than one minute to interact and answer questions from the patients. Interaction with patients also revealed lack of satisfaction with the care they received because they were not involved in the decisions concerning their care. The patients complained of the midwives becoming too busy to attend to them even when they were in pain, anxious or fretful. In view of all these, does it imply that the midwives have negative attitude towards their patient or are there certain factors that influence the practice of midwifery. These questions can only be answered at the end of this study.

1.3 Purpose/Aim of the Study

The purpose/aim of this study was to determine factors influencing work attitude of midwives in the maternity unit, General Hospital Calabar, Cross River State, Nigeria.

1.4     Specific Objectives of the Study

The specific objectives of this study were to:

(i)         Determine the influence of educational level on midwives attitude and practice in the maternity unit.

(ii)       Ascertain whether professional experience influence the attitude and practice of midwives in maternity unit, General Hospital Calabar. 

(iii)     Determine the relationship between age of midwives and attitude and practice in maternity section, General Hospital Calabar.

(iv)     Ascertain the influence of marital status on attitude and practice of midwives attending to women in the maternity unit.  

1.5     Research Questions

(i)         What is the influence of educational level on attitude and practice of midwives in the maternity unit?

(ii)       What is the relationship between level of professional experience and attitude and practice of midwives in the maternity unit, General Hospital, Calabar?

(iii)     What is the relationship between age and attitude and practice of midwives in the maternity section, General Hospital, Calabar?

(iv)     What is the influence of professional ranks on attitude and practice of midwives attending to women in the maternity?

 Research Hypothesis

H₁: There is no significant relationship between the educational level on attitude and practice of midwives in maternity unit.

H₂: There is no significant relationship between the ages and attitude of midwives in maternity unit.

1.6      Scope of the Study

This study was limited to the midwives working in the maternity unit of General Hospital, Calabar.

 

1.7     Significance of the Study

The Profession: If factors responsible for midwives negative attitudes and practice are discovered, necessary intervention will be planned to address these problems and it may enhance professional practice related to midwifery. If such factors are addressed, the image of this profession may be enhanced.

The Patients: This study may also facilitate recovery of the patients because of interpersonal relationship between the midwives and the women. It would encourage the women to freely communicate their feelings and problems without hesitation thereby meeting their psychological needs. It would also strengthen the relationship between midwives and the women which can lead to the provision of holistic care. This study may bring about valuing and respecting the women as a unique individual who possess their own meanings, experience and attitude. If intervention is implemented the patient will benefit in terms of satisfaction with the care provided.

The Midwives: It may help in identification of factors respectively needed in areas of attitude so that if necessary intervention could be planned and implemented to address negative attitude.

The Hospital Management: This study may enhance the image of the hospital and the organizational goals of the hospital will be achieved. It would encourage more women to seek for their health care services.

The Researchers: Finally, the outcome of this study may also serves as a source of information for future researchers and equips the researcher with additional knowledge about the attitude and practice of midwives in the maternity unit.

1.8     Limitations of the Study

The main problem encountered in this study was difficulty in getting all the accessible used for the study due to their tight duty schedule shift.

Operational Definition of Terms

Attitude: Refers to the ways midwives react to a situation emotionally, express themselves physically or verbally to the patients that may be positive or negative.

Midwives: Persons who have been admitted to a midwifery educational programme, who has successfully completed the prescribed course of studies and has acquired the required qualification to be registered and/or legally licensed to practice midwifery.

Work: Refers to providing advice, care and support for women, their partners and families before, during and after childbirth including counselling, health promotion and education.

Factors: Age, marital status, professional experience and educational level.

Age: Refers to the number of years that the midwives has lived or existed.

Marital status: Refers to whether midwives are married or not married.   

Professional Experience: Refers to duration/years of midwives have been working in the maternity section.

Educational Level: Refers to the level and type of training the midwives have undergone.

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