CULTURAL COMPETENCE AMONG MIDWIVES AND NURSES PROVIDING MIDWIFERY CARE IN MPIKA DISTRICT, ZAMBIA

Abstract

Background: Cultural competence is an essential component of quality midwifery care that enhances respectful and individualized care regardless of the woman’s cultural background (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). Consequently, it assists midwives and nurses to know their clients’ needs, beliefs, and values, and to establish an appropriate relationship with them. This enhances accessibility and utilization of midwifery care provided by skilled personnel (Bastami et al., 2016). In the Mpika district, most women are reported to respect their cultural practices during antenatal, labour and postnatal. The district in 2020 recorded 218 home deliveries with 11 (20%) maternal deaths, which were increasing and maintaining consistent from 2018. According to the Mpika Health Information Management System report, the deaths related to home deliveries were a result of cultural beliefs. The indicator was recorded despite measures to train and recruit adequate midwives and nurses to provide midwifery care, especially in the most rural areas of the district (Mpika HMIS, 2020). Main objective: To determine cultural competence among nurses and midwives providing midwifery care in the Mpika district. Methods and Materials: A descriptive cross-sectional study involving 58 conveniently selected midwives and nurses was conducted in the Mpika district. Data was collected using a self-administered questionnaire and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 23.0. Chi-square test was used to test associations between dependent and independent variables, while linear regression was used to determine the degree to which the independent variables influenced the dependent variable. The level of significance was a p-value of <0.05. Results: Study results revealed that of the 58 participants (36), 62% were not culturally competent. The attitudes of the nurses and midwives towards the provision of culturally competent midwifery care were negative, with a p-value of <0.008. The nurses and midwives were offended and denied care to clients who insisted on upholding their cultural beliefs during antenatal, labour and postnatal. Further outcome indicated that the younger nurses and midwives (19 to 25 years) were providing culturally competent care with a p-value of 0.023. This can be attributed to the society's culture of respecting elderly women. All 5 of the 58 participants respected women’s culture during midwifery care. Professional qualifications showed that Registered Nurses (13 of 22) provided culturally competent care, with a p-value of 0.007. The cultural beliefs of the nurse and midwife had a positive influence on the provision of culturally competent care, with a p-value of 0.008. The nurses’ and midwives' cultural differences with the women under their care led to demeaning and rejecting women’s needs during antenatal, labour and postnatal. Despite the nursing and midwifery curriculum's inclusion of cultural competence, there was no statistical significance between having knowledge on cultural competence and respecting women’s culture when providing midwifery care p-value 0.603. The professional duration of providing midwifery care did not show a strong influence on the provision of culturally competent midwifery care, with a p-value of 0.05. Participants with ten years or more (12 of 16) providing midwifery care were not respecting women’s culture. Conclusion: Cultural competence among midwives and nurses providing midwifery care is vital because it enables them to provide acceptable and valued midwifery care, which is effective for clients of diverse cultural backgrounds. This can contribute to the reduction of morbidity and mortality among women during antenatal, labour and postnatal. The findings signify the need for more rigorous mentorship, supervision and regular in-service training on cultural competence. Recommendation: To enhance the program on induction, in-service training and technical support on cultural competence for nurses and midwives providing midwifery care to mothers during the antenatal, labour and postnatal periods.

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