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The purpose of this qualitative study was to examine the facilitators for and barriers to neonatal resuscitation from the contexts of nurses working in a rural clinic in Zimbabwe to identify potential areas for improvement that may be similar across low, moderate and high resource settings, and to identify areas for improvement for potential collaborative global partnership.
The rationale underlying this study was the need to develop an understanding of factors that affect neonatal resuscitation from the standpoints of healthcare providers from their specific cultural contexts for the discovery of significant issues at multiple levels of care delivery that may remain undiscovered in strictly quantitative research. Additionally, this preliminary study provided useful information regarding constructivist grounded theory (CGT) as an appropriate means of qualitative inquiry in this cultural context.
Specific Aims:
Aim 1: Using semi-structured in-depth qualitative interviews with three health care providers at a rural delivery setting in Zimbabwe, identify facilitators and barriers to effective neonatal resuscitation upon delivery, and categorize themes that may be consistent with those in a different setting.
Aim 2: Using a constructivist grounded theory approach, perform initial, focused open coding with constant comparative analysis, and then theoretical coding of data employing categorizing and memo writing to identify intermediate categories from coded data and final theoretical concepts.
Aim 3: Generate theory from the perspectives of participants from their Zimbabwean contexts regarding neonatal resuscitation and collect preliminary data to determine the utility of constructivist grounded theory as a means to explore more extensive observational comparisons, and testable hypotheses for future research.
Methods:
Three nurses were interviewed from a rural clinic setting in Zimbabwe.
Purposive sampling was used and participants recalled incidents in neonatal resuscitations by describing events from their perspectives.
They also shared their views about what works well in NR and areas for improvement. Participant responses were analyzed using the constant comparison method. A social ecological model was used to guide the description of the study findings.
Results:
Interpersonal level factors identified were triage and decision-making skills, a sense of urgency, knowledge, practice, and organization of responsibilities.
Interpersonal factors identified were teamwork and collaboration, communication, and facilitation of the bonding process
Organizational factors included competency, levels of care, continuing education, and equipment.
Societal level factors included cultural family practices, HIV cases, and poverty.
Conclusion: The findings from this preliminary study support the use of low-moderate fidelity simulation and interactive learning methodologies as an ongoing form of education and skills maintenance. While multiple level factors affect neonatal resuscitation, maintenance of competency via regularly scheduled education and mock drills can enhance provider comfort level with infrequently encountered situations. Information gained from this study addresses a critical element of the neonatal resuscitation process, the multiple level factors affecting neonatal resuscitation as experienced by neonatal resuscitation providers from their situational and cultural contexts, while addressing the Millennium Development Goal 4 which called for a two-thirds reduction in under five mortality by the year 2015. Additionally, constructivist grounded theory was supported as an appropriate method of qualitative inquiry when adapted to suit the cultural contexts of the setting and the participants.