Transition Support Programme for Newly Graduated Midwives in Limpopo Province, South Africa

Abstract

Introduction: For newly graduated midwives to function effectively with regard to provision of quality midwifery services, successful transition from student status to professional status should be enhanced. It is therefore important that transition support programmes be put in place in order to provide a baseline for guidance and support of newly graduated midwives. Purpose: The purpose of this study was to develop a transition support programme to enhance effective support of newly graduated midwives during their transition period in Limpopo Province, South Africa. Setting: The study was conducted in maternity units of selected regional hospitals and a tertiary hospital in all the districts of Limpopo Province, South Africa. Methods: Phase 1: A qualitative, exploratory and descriptive design was used for the study. The population comprised of all newly graduated midwives who have undergone a comprehensive nursing programme (R425 of 19 February 1985, as amended) and qualified as nurses (General, Psychiatric and Community) and Midwifery from the universities and nursing colleges; as well as all professional nurses working at selected hospitals. A non-probability, purposive sampling method was used to select five newly graduated midwives who have been working for a period less or equals to one year following their successful completion of training, and were working in maternity units of the selected hospitals. Five professional nurses qualified as midwives and have been working in maternity units of the selected hospitals for at least five years, were also sampled through a non-probability, purposive sampling method. Data were collected through in-depth individual face-to-face interviews; a ABSTRACT vii voice recorder was used to capture information shared by participants, and field notes were also taken. An open-coding method was used to analyze data. Ethical principles and measures to ensure trustworthiness were considered. Major themes, themes and sub-themes were identified from the analyzed data. The following major themes emerged from data analysis: Experiences of being a newly graduated midwife in labour ward, Support provided by experienced midwives, Relationship between experienced and newly graduated midwives in labour ward, Expectations of experienced midwives from newly graduated midwives as well as Newly graduated midwives’ views related to placement in the labour ward. Empirical findings revealed that newly graduated midwives viewed labour ward as a traumatic environment as it is very busy with serious shortage of staff. Graduates also expressed a professional nurse’s role as stressful as it demands high level of responsibility and accountability which they did not have, resulting in frustration and anger. Newly graduated midwives felt that the support they received from the experienced midwives was ineffective, as they were neither mentored nor properly supervised and the environment was not conducive for learning. The relationship between graduates and experienced midwives was poor and some experienced midwives displayed negative attitudes towards the graduates. Results showed that graduates failed to meet experienced midwives’ expectations as they were unable to function independently, resulting in failure to reduce the workload. Newly graduated midwives recommended that their placement in maternity ward be extended from a period of six months to a year in order for them to build confidence in midwifery practice. Phase 2: Results of phase 1 of the study revealed transition support gaps which led the researcher to analyze ‘effective transition support’ as a core concept. Concept analysis was done in accordance with Walker and Avant’s method; in order to clarify its meaning. The findings of both phase 1 and concept analysis guided the ABSTRACT viii development of a transition support programme aimed to enhance effective support of newly graduated midwives during their transition period. Development of a transition support programme was based on Duchscher’s transition theory as well as ADDIE’s model for training and instructional design, the steps of which were: analysis, design, development, implementation and evaluation. A developed transition support programme was validated using a quantitative approach, whereby exploratory and descriptive designs were employed. The main aim was to validate for effectiveness and applicability of a developed transition support programme. Validation was conducted in a similar setting as in phase 1, with the same population. Puposive sampling method was used to select participants who met inclusion criteria. A sample consisted of twelve (12) newly graduated midwives, thirty eight (38) experienced midwives of which thirteen (13) were operational managers. A self developed questionnaire was used for data collection. The validation process was based on a framework for programme evaluation in public health by the Centers for Disease Control and Prevention. According to the validation results, the developed transition support programme met the standard as it can be easily implemented, it is practical, utilizable, appropriate and will benefit patients, family members, health care facilities and the community at large. Recommendations: The developed transition support programme addressed the major challenges identified in the findings of the main study. Only aspects of the results which were not addressed by the developed transition support programme were covered in the recommendations. Recommendations were directed to the nursing education, nursing practice as well as future research.