Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study

OBJECTIVES

Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH).

METHODS

The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis.

RESULTS

Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team.

CONCLUSION

The participants' experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.

A Descriptive, Cross-sectional Study to Assess Pressure Ulcer Knowledge and Pressure Ulcer Prevention Attitudes of Nurses in a Tertiary Health Institution in Nigeria

Globally, higher-than-expected pressure ulcer rates generally are considered a quality-of-care indicator. Nigeria currently has no national guidelines for pressure ulcer risk assessment, prevention, and treatment. A descriptive cross-sectional study was conducted to assess the pressure ulcer knowledge and the attitude of nurses regarding pressure ulcer prevention in a tertiary health institution in Nigeria. During a period of 2 months, nurses were recruited to complete a 25-item paper/pencil survey that included participant demographic information (6 items), pressure ulcer knowledge questions (11 items), and statements on participants' attitude toward pressure ulcer prevention (8 items). Data were entered manually into statistical analysis software, analyzed, and presented using descriptive statistics (frequencies and percentages). The majority of the 90 nurse participants were female (60, 66.7%), 45 (50%) were married, and 75 (83.3%) had 1 to 10 years' experience in nursing practice; 69 (76.7%) had received special training on pressure ulcer prevention. Overall, 58 (64.4%) nurses had correct pressure ulcer knowledge and 67 (74.4%) had a positive attitude toward preventing pressure ulcers. However, 56 nurses (62.2%) disagreed with regular rescreening of patients whom they deemed not at risk of developing pressure ulcer, and 70 (77.8%) believed pressure ulcer prevention should be the joint responsibility of both nurses and relatives of the patients. Thus, the majority of the 90 nurses knew the factors responsible for pressure ulcers and how to prevent them, but nurses need to be orientated to the fact that pressure ulcer risk screening of all patients with limited mobility is an integral part of their job and that it is important that nurses enlighten patients and their relatives on how to prevent pressure ulcers.