Nurse-midwife provided postnatal newborn care recommendations in Eldoret, Kenya : a rapid focused ethnographic assessment

The purpose of this study was to describe the newborn care recommendations that nurse-midwives provide to mothers and other caretakers before discharge in Western Kenya, and explore the factors that may influence the content and provision of the care recommendations. This rapid, focused, ethnographic assessment was guided by Leininger's culture care theory as an orienting framework. The study was conducted on the postnatal ward at a publicly-funded, tertiary-level referral hospital and university-level nursing school from November to December 2018. Data were collected via participant observation; 24 semi-structured interviews in English, with purposive sampling of nursing and medical staff, hospital administrators, and maternal-child nursing faculty directly involved in newborn care; collection of relevant documents; and researcher-generated fieldnotes. Data were analyzed using qualitative thematic analysis to identify key themes. The study found that nurse-midwives counseled on exclusive breastfeeding for six months, umbilical cord care, follow-up examinations and immunizations, and select danger signs and care-seeking. Most recommendations were provided orally, however some were written in English with some use of medical terminology by the nurse-midwife or medical personnel before being reviewed with the caretakers by the nurse-midwives. The content and provision of recommendations were influenced by six themes: prioritization of maternal health, the baby is not sick, ward congestion, staff shortage, heavy workload, and other approved providers. The findings support evidence that broad national- and ward-level policies influenced the staff of the postnatal ward to focus on maternal and sick newborn health while also managing ward congestion, staff shortages, and heavy workloads. To address neonatal mortality in the community via comprehensive provision of evidence-based guidelines, the content and consistency regarding the recommendations that are provided prior to discharge should be improved. Study findings can be used to inform policy changes to address clinical, administrative, educational, and regulatory interventions such as appropriate postnatal staffing ratios and newborn practice competency to improve the quality of nursing care for well-newborns. This study reveals issues to be explored in larger studies of nurse-midwives’ roles and the sociocultural and economic influences that affect provision of well-newborn care recommendations.