IMPROVING ACCESS TO SKILLED ATTENDANT ASSISTED CHILD BIRTH: A FRAMEWORK FOR ANTENATAL CARE NURSING IN RURAL KENYA

Abstract

The purpose of this paper is to propose a framework for improving access to skilled attendant assisted childbirth in rural, Kenya. A review article on maternal health established the need to re-visit current approaches to maternal health care in Kenya. Subsequently, an analysis of nurse–client interaction processes in rural health facilities in Nyanza Province, within the context of antenatal nursing care was carried out, in order to generate a substantive theory and framework from the processes involved in influencing the decision of antenatal mothers for skilled attendant delivery. A grounded theory study was conducted through observations and interviews of nurses, antenatal and postnatal mothers. The study elicited rich experiences concerning skilled attendant assisted deliveries.  A theory was generated and an initial analysis and evaluation of the theory was done. Six main concepts emerged from constant comparison of data, and were key elements in the resultant “Owino’s theory of nurse-client interactions for childbirth preparedness”. The concepts include Reciprocal exchange of information; Nursing care and treatment; Focused preparation of mother; and Evaluating readiness for delivery within the rural context. The theory posits that Nurse-client interaction processes geared towards child birth assisted by a skilled attendant are influenced by the complex rural context, and that high quality interaction should help the nurse and mother rise above contextual challenges. After a baseline analysis and evaluation of the theory, a framework for antenatal nursing care that would ensure skilled attendant assisted childbirth is proposed.  The application of the framework will be guided by the professional organizing framework of the nursing process. Additionally, guiding principles for this framework include respect of client’s beliefs, recognition of own Christian values, autonomy, beneficence, non-maleficence and veracity among others. It is necessary to train nurses to effectively apply the framework to antenatal nursing care.