Development of an Employee Assistance Programme (EAP) for midwives dealing with maternal death cases in the Ashanti Region, Ghana
Globally, Employee Assistance Programme (EAP) has become the most effective workplace programme used to assist employees in the identification and resolution of performance and behavioural related problems. Employees, irrespective of the sector of employment are seen as the most valuable assets of any organization and therefore their wellness is as important as the organization itself. Employees' personal or work related problems may adversely affect their health as well as their productivity, thereby impeding the growth of an organization. It is for this reason that the EAP has increasingly become an important tool in addressing employees’ personal and work related challenges. Midwives as employees are prone to challenges such as maternal deaths at the workplace. They are more likely to undergo stressful situations for failing to meet the general goal of their profession, which, among others, include provision of adequate care for pregnant women until they safely deliver. These stressful conditions have negative effects on midwives' health, behaviour and productivity. However, there is no literature that has looked at how midwives in the Ashanti Region of Ghana are affected by maternal deaths and their coping mechanisms employed to address the effects of maternal deaths. Literature revealed that there is hardly any known work-related assistance programme designed to support Ghanaian midwives when faced with work-related challenges likely to affect their work-output. Hence, this study developed an appropriate EAP for midwives dealing with maternal deaths in Ghana based on the exploration and description of the effects of maternal death, coping mechanisms used and their experiences with the facility-based maternal death review (MDR). In order to meet the general aim of the study, a qualitative research approach, with a combination of exploratory, descriptive and contextual designs was used. Purposive sampling was employed to select participants; ward and unit managers (supervisors) (18) and midwives who met the inclusion criteria (39). A total of 57 participants were used in the study. Data were collected through semi-structured individual interviews and focus group discussions, as well as field notes. Thematic Content Analysis was used to manage data through transcribing, organizing, development of category and coding of data. Final data management was done with qualitative computer data analysis package (Atlas ti version 7.1.7). The full understanding of the effects of maternal deaths on midwives and the mechanisms of coping employed to address effects afforded the development of an EAP to support midwives dealing with maternal deaths. Five main themes emerged from the analysis of collected data, namely effect of death as a unique experience, multi-dimensional effects of MD on Midwives' personal life, effects of MD on the midwives’ associated environment, mechanisms of coping employed by Midwives and Perceived MDR process (Phase 1). Phase 2 considered the development of Employee Assistance Programme (EAP) for midwives dealing with maternal deaths in Ashanti Region of Ghana. The steps of developing occupational health service at the workplace by Acutt Hattingh and Bergh (2011) were applied to develop the EAP. Ethical practices pertaining to the study of human subjects as specified by the Research Ethics Committee of the University of the Western Cape and research guidelines of Ministry of Health- Ghana Health Service were observed. It is recommended that, all hospitals in Ashanti Region institute the EAP programme to assist midwives cope with challenges associated with maternal death.