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Learning Objective 1: The learner will be able to describe the unique antenatal care processes within the rural context in Nyanza province in Kenya.
Learning Objective 2: The learner will be able to identify the area of need for a focused framework in approach to antenatal care in their diverse care contexts
Maternal mortality ratio in Kenya is 414/100,000 live births, despite 92% antenatal coverage. This is due to low use of skilled attendants at delivery. In Suba District, Nyanza Province, skilled attendant delivery is 6.8%. The national average is 43% (KDHS, 2008).
Theory based practice can improve quality of antenatal care. The concern in Sub-Saharan Africa is that nursing theories taught are inappropriate for practice in Africa (Munjanja et al., 2005). Current maternal mortality figures are therefore possibly the result of an inappropriate theory base for practice. By offering a client-centered antenatal care model, the study enables nurses to contribute towards the national target for maternal health, in keeping with the 5th Millennium Development Goal, by helping the client rise above challenges of the rural context in order to access a skilled attendant.
The purpose of the study was therefore to analyze antenatal nurse – client interaction processes in rural health facilities, in order to generate a substantive theory of the processes involved in influencing the decision of mothers for skilled attendant delivery.
Methods:
This was an inductive qualitative study, using grounded theory methodology (Glaser & Strauss 1967). A practice theory for antenatal nursing was generated using constant comparative analysis of the substantive concepts and emergent theoretical statements.
Results:
Six main concepts emerged: Willingness of mother to attend antenatal clinic, reciprocal exchange of information, nursing care and treatment, focused preparation of the mother, evaluating readiness for delivery within the rural context, and referral of the client.
Conclusion:
The resultant substantive “theory of nurse-client interactions for childbirth preparedness” proposes that the nurse-client interaction processes in preparation for delivery by a skilled attendant are mainly influenced by the complex challenges of the rural context. The quality of the interaction process therefore helps the nurse and mother rise above the prohibitive context.