Abstract
Since the introduction of the midwifery specialist (MS) training programme in 1980,
South African MSs have faced limitations that hinder their full professional potential.
The existing scope of practice (SOP) and other related regulations seem not to permit
trained MSs to apply their advanced knowledge and skills in clinical facilities, posing
barriers to their professional autonomy. Amid these challenges, it is unclear what MSs’
lived experiences are, as well as that of the multidisciplinary team members they
engage with during interpersonal collaboration within the public and private sectors in
South Africa.
The purpose of the study was to develop strategies to facilitate an enabling
professional practice environment for MSs to optimally utilise their knowledge and
skills in the public and private health sectors in South Africa. The design used to
explore and describe the MSs’ practice in South Africa was qualitative, exploratory,
descriptive and contextual, with a phenomenological approach.
Guided by the Theory of Health Promotion in Nursing (THPN) and Patricia Benner’s
novice-to-expert model, this study was conducted over four phases. Phase one
explored lived experiences related to the optimal utilisation of MSs’ specialised skills
and knowledge to gather empirical data from a purposively sampled diverse group of
participants, including MSs, midwifery managers, obstetricians, and medico-legal
experts (MLEs) from both public and private health sectors in South Africa. Data
collection involved individual interviews and focus group discussions, and the following
questions were posed to the various groups of participants: What is your experience
as an MS in the optimal utilisation of your knowledge and skills in either the private
and/or public health sector in South Africa?; What is your experience as a midwifery
manager regarding MSs optimally utilising their knowledge and skills in the private
and/or public health sectors in South Africa?; What is your experience as an
obstetrician of MSs optimally utilising their knowledge and skills in the private and/or
public health sectors in South Africa?; What is your experience as a medico-legal
expert dealing with medico-legal litigations involving MSs from both the private and
public health sectors in South Africa? Based on Collaizi’s seven steps of
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phenomenological data analysis, data revealed that, despite 44 years and several
curriculum revisions, MSs’ practice remains constrained by legal and ethical
frameworks, SOP regulations, and job descriptions. These limitations render MSs
vulnerable to litigation and impede their ability to practice autonomously and
independently. Consequently, MSs experience a diminished professional identity and
an overreliance on managers and obstetricians, leading to a loss of their specialised
knowledge and skills. The central concept that emerged was a disenabling
professional practice environment for MSs, limiting them from optimally utilising their
knowledge and skills in the public and private health sectors in South Africa. Phase
two focused on developing a conceptual framework in response to the empirical data
and central concept. A conceptual framework was developed using Dickoff, James,
and Wiedenbach’s survey list. The conceptual framework guided the development of
strategies aimed at optimising the use of MSs’ expertise in clinical settings by creating
an enabling professional practice environment for MSs to optimally utilise their
knowledge and skills in the public and private health sectors in South Africa. Phase
three entailed strategy development; the study’s original contribution to midwifery and
neonatal nursing science lies in the development of several key strategies: The
empowerment of MSs, which enables MSs to assume their specialist roles confidently,
and the adaptation of clinical practice environments, which may enable MSs to modify
their clinical settings to support MSs’ autonomous and independent practice. Revision
of the SoP, which includes updating the SoP to legally recognise MSs’ specialised
practice. Alignment of job descriptions to correspond with MSs’ training and the revised
SOP. Elimination of unauthorised practices that enables MS to align the revised SOP
with their job descriptions, knowledge, and skills to prevent unauthorised practices.
Phase four was an expert evaluation; the proposed strategies were presented to a
panel of experts and evaluated for their relevance to midwifery and neonatal nursing
education, practice, and research. Experts were selected based on their various
expertise in midwifery and neonatology, obstetrics, legislation, academia, research
and strategy development and evaluation. The experts were presented with the
strategies, and discussion groups were conducted with them to gain their expert
evaluation on the strategies. The evaluation affirmed the strategies’ potential to
enhance MSs’ roles and contributions to maternal and neonatal health in South Africa,
creating an enabling professional practice environment for MSs.
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The ethical principles of justice, beneficence and non-maleficence were applied to
protect the participants throughout the study. Trustworthiness was also promoted
through Lincoln and Guba’s principles of credibility, transferability, dependability,
confirmability, and authenticity.
This study has resulted in three published articles and numerous presentations at
national and international conferences, contributing to the ongoing discourse on
optimising the role of MSs in South Africa’s healthcare system.