Dartey1 AF and Phetlhu2 DR
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Citation:
Dartey AF and Phetlhu DR. Employee Assistance Programme for Midwives: A resource to mitigate the effects of Maternal deaths in Ghana. Special Journal of Banking, Finance and Management 2021, 2 (1): 1-18
Highpoints
- Employee Assistance Programme (EAP) is an Occupational Health Programme.
- EAP helps identify performance and behavioural challenges affecting workers.
- EAP was developed for midwives dealing with maternal death at the hospitals.
Abstracts
Introduction:
Employee Assistance Programme (EAP) is one of the most effective workplace programmes for the identification and resolution of performance and behavioural related challenges. Examples of these challenges are discrimination, tight work schedules, and the death of patients which could lead to anxiety and stress. Long-term maternal death distress has been shown to have significant effects on midwives’ health and the quality of care provided to clients under their care.
Objective:
The objective of this paper was to develop An Employee Assistance Programme: a tool to assist midwives to alleviate maternal death-related pain and anxiety.
Materials and Methods:
The development of the EAP followed the occupational health programmes and services at workplace guidelines (involving situation analysis/data collection, data analysis, planning, implementation, and evaluation).
The results:
Two steam services of the Employee Assistance Programme were developed: Direct and Indirect Services. The direct services include Assessment, Trauma debriefing, Crisis intervention, Counselling services, Referral services, Monitoring, and Follow-up. While the indirect services were Training and Workshops.
Conclusion and recommendations:
A robust implementation of the EAP will help to improve the wellbeing and performance of midwives that translates to improved quality of work-life for midwives in the Ashanti Region of Ghana and the country at large.
Keywords:
Employee Assistance Programme, Occupational health, Midwives, maternal death and Quality of work-life
Addresses:
School of Nursing and Midwifery, The University of Health and Allied Sciences, Ho, Ghana, PMB 31, Ho, Volta Region-Ghana. E-mail : fadartey@uhas.edu.gh/aniadfafa@gmail.com. 2. School of Nursing, University of the Western Cape, South Africa. Email: dphetlhu@uwc.ac.za
Correspondence:
Dr Dartey Anita Fafa, Senior Lecturer, School of Nursing and Midwifery, The University of Health and Allied Sciences, Ho, Ghana, PMB 31, Ho, Volta Region-Ghana, Ph.D. Nursing, MNurs, BTech OHN, RN, Email: fadartey@uhas.edu.gh/aniadfafa@gmail.com
Article history:
Received:Â October 26, 2021: Accepted: December 7, 2021:Â Published:Â December 12, 2021
 Distribution and usage license:
This open-access article is distributed by the terms and conditions of the Creative Commons Attribution 4.0 International License seen in this link (http://creativecommons.org/licenses/by/4.0/). You are free to use, distribute, and reproduce this article in any medium, provided you give correct credit to the original author(s) and the source, including the provision of a link to the Creative Commons license website. Pls show any modification’s
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Introduction
Employee Assistance Programmes (EAP) started as far back as in the early 1940s in the United States of America (USA) as a support programme to assist employees with alcohol and drug problems (1)(1-3). Also, the programme was intended to improve employer-employee communiqué and create a positive atmosphere within the working environment(1, 2). As the years went by, the programme became more comprehensive with more services introduced to assist employees in areas such as work-related stress, family problems, bereavement, financial and legal problems(Dickman & Challenger, 2009).
Given its successes in addressing employee-related problems, the programme was also extended to include other areas of concern in the workplace, such as boredom, anxiety, and other interpersonal problems that impact health and wellness leading to stress and subsequent decreased work performance(1). Since the time EAP was introduced, many organizations have used it as a means to enhance the performance and well-being of their employees(1, 2).
It is evident in the literature that the workplace is a crucial setting for health protection, promotion, and disease prevention programmes, especially in cases where employees spend more time at work than at home (2-4). Thus, the importance of a programme such as Employee Assistance Programme, which provides intervention in the alleviation of challenges employees are faced with at workplaces is crucially significant.
Furthermore, Employee Assistance Programme,s are designed to address occupational health and safety issues in the workplace and are also important for any profession or organization which seeks to comply with the standard requirements set by the International Labour Organization (ILO) and the World Health Organization (WHO). Employee Assistance Programme, can bring positive attitudinal change to individual employees within the organization that they work for (3), by establishing a wellness culture, thereby promoting healthy behaviour for the entire workforce (5).
This is partly because EAPs lessen health risks and improve the quality of life for all employees (3). Owing to marked differences among workplaces, each may have different work-related problems which in effect necessitate the need to provide services that directly respond to the needs of employees in these work environments. Some of the services Employee Assistance Programme, may provide are short-term counselling, referral treatment, and other support services (6), which may vary from one organization to another. Prominent among organizations that employ such programmes include the police service, different business institutions, and the health sector itself.
Objectives
The purpose of this paper was to develop an Employee Assistance Programme for midwives who are challenged by maternal deaths (MDs) at the workplace in the Ashanti Region of Ghana. This tool is to help them mitigate the effects of maternal deaths they experience in the workplace.
Materials and Methods
Population
In all, five different populations were involved in the study: The basis for populations one and two was to establish the need for the development of the EAP. Population three, four and five, help in the development of the Employee Assistance Programme,
Population one: Made up of eight focus group discussions with membership ranging between four to seven participants, a total number of fifty-seven people took part in the study. They were all ward midwives.
Population two:Â Made up of 18 supervisors, who were taken through individual semi-structured interviews. Population one and two were drawn from nine health care facilities of four-level hospitals: a teaching hospital, a regional hospital, 4 district hospitals (2 with high maternal death cases and 2 with lower maternal death cases since 2015), and 3 health centres.
With purposive sampling, these participants took part in the first stage of the study where primary data were collected through semi-structured interviews and focus group interviews to find out the midwives’ experiences with maternal death. The criteria for selection were any midwife with at least one year of practice and who had experienced maternal death during work.
Population three: Members of two health institutions were gathered for information dissemination purposes. These stakeholders were recruited from two workshops organised by researchers to disseminate the results of the primary data of the study. After the presentations, discussions were held and members’ views were solicited to contribute to the development of Employee Assistance Programme. The stakeholders were recruited by use of invitation letters to their various departments. In all, one hundred people participated in the two workshops.
Population four: This was a multi-disciplinary team of experts made up of (Psychologist, Physiotherapist, Public Health specialist etc) in the health sector with knowledge and background, expertise needed to contribute by reviewing the drafted Employee Assistance Programme. A total of twenty experts was recruited by letters and verbal invitations.
Population five: Two specialists in the field of Employee Assistance Programme, were recruited through referrals from Occupational Health Nurse colleagues. These specialists are providers of Employee Assistance Programme, services in South Africa. One had earlier seen the summary of findings situation analysis while the other was recruited after the development of the programme. They were particularly concerned about the context of Employee Assistance Programme, development. A report of specialist comments was sent via emails.
Methods of development
The development of an Employee Assistance Programme, as a workplace programme adopted Acutt, Hattingh and Bergh’s (2): steps of providing occupational health programmes and services at the workplace. The following are the steps: situation analysis/data collection, data analysis, planning, implementation and evaluation. A review of the processes in developing employee assistance programmes and how they are managed in other countries were also examined (7) and a more contextual one was developed to suit the health system in Ghana.
Acutt, Hattingh, and Bergh (2) contend that the establishment of occupational health programmes and services should be done following organizational philosophy, vision, and mission as well as the legal requirements of the country in which the programme will be implemented. Since workplace hazards vary from one organization to another, Acutt, Hattingh, and Bergh (2) argue for the need for the content of the programme to meet the needs of the workers. The methods of development are presented in figure 1 as follows:
 Step 1: Situation analysis and needs assessment
A detailed assessment of the current situation of the need to develop an Employee Assistance Programme, was conducted. Data were collected from midwives to explore the need for the programme development. It included individual worker demographics, the organization’s environmental assessment, health needs, risks involved in the midwives’ work, support services available, resources available, the services required to fill the needs, and addressing risks.
The comprehensive situation analysis conducted, provided a rich source of information as the participants gave their experience dealing with maternal death (MD) and how they coped with the situation. This brought to bear the considerate content of the programme to be developed. Data were collected through focus group discussions and individual semi-structured interviews.
Step 2; Data analysis
The data were analysed to help determine the contents of the Employee Assistance Programme, and prioritize the most important needs. Therefore, the researchers produced an integrated workplace needs assessment report from analysed data. The findings were then presented to two groups of stakeholders: management of teaching hospital and regional health directorate of the GHS in the Ashanti Region.
The idea was to make them understand what the midwives go through with regards to maternal death; seek their views and contributions to help in the development of the Employee Assistance Programme. Additionally, the researcher wanted to create awareness and support of the programme when it is developed. After the two discussions, it was evident that stakeholders in the health sectors saw the need for the programme development and thus pledged their support for its development.
The data were analysed by using the Thematic Content Analysis and conclusion statements of the research findings, proposing the need for the establishment of EAP for the midwives. A summary of the analysed data is presented in the table below:
 Summary of analyzed data
- Participants experienced grief: the grief is unique and felt disenfranchised. This impacted negatively on most of them.
- Emotional, psychosocial, and physical effects of maternal death were prominent. Examples are fear, distress, trauma, depression, sleep difficulty, inability to eat, and more.
- The effects of maternal death also affected the family of the midwives, their output at work, and the hospitals they work for.
- Midwives employed depended on family members, colleagues, and other individuals around to help them cope since there are no organised counselling services for the workers at the healthcare facilities.
- The maternal death review is seen as a good tool in the review of maternal death and it is seen as an unofficial means of coping since until the review is done, the case is not closed.
- Participants were not happy because maternal death reviews do not consider spiritual and cultural issues that surround the death of some mothers.
 Step 3: Planning
A draft of the Employee Assistance Programme was done after gathering and incorporating the views of stakeholders from the MOH/GHS as well as staff from the teaching hospital. In addition, ideas were gathered from reviewing literature from other countries that are employing the Employee Assistance Programme, as well as results of a needs assessment from midwives at the various hospitals.
The draft of the EAP involved formulating the objectives, vision, and mission of the Employee Assistance Programme. It provided advice to the hiring of professionals to the Employee Assistance Programme, and advertising the programme. Planning of the programme evaluation was instituted. After the draft, the researcher assembled a multi-disciplinary team of experts. The team to review the draft was made up of experts in the field of occupational health, public health, psychology, ward management, gynaecologist, health service administration, and social work.
The draft document once completed was revised accordingly. The document was then sent to two specialists in the field of Employee Assistance Programme, service providers outside Ghana for their final inputs.
The details of step three (planning) follow the five stages as indicated below:
Stage 1: The domain of EAP
The domain of the Employee Assistance Programme, states and defines what it is as well as establishes boundaries of operation. EAP per the current study is “A wellness programme” developed for midwives dealing with maternal death cases in the Ashanti Region of Ghana. The programme is meant for the early identification and diffusion of maternal death-related problems at the workplace. From the perspective of this study, Employee Assistance Programme, is NOT:
- a social welfare programme;
- a prescriptive programme;
- a long-term programme; or
- The only programme that can solve all problems workers faces in the health sector.
Therefore, an Employee Assistance Programme (EAP) is a work-based, voluntary programme for midwives dealing with maternal death cases that provide free and short-term counselling, confidential assessments, referrals, and follow-up services to employees who have personal and/or work-related problems. EAP speaks to many issues affecting the psychological, physical and social well-being of employees and works stress, as well as burnout (3, 7, 8, 9, 10).
Stage 2: Characteristics of EAP
The following section presents the characteristics of the Employee Assistance Programme,, which are: vision, mission, core values, the purpose of the programme, and the objective.
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The vision statement of EAP
The vision of Employee Assistance Programme, is “to provide a programme of choice that aims at the organization of self-worth even after experiencing maternal death and to develop the culture of well-being to take away all the emotional, physical and social effects that maternal death brings among midwives”.
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The mission statement of EAP
According to (11), every organization has a mission for its existence and this mission must be unique to differentiate that organization from all others. In this study, the mission of the Employee Assistance Programme, is “to provide counselling, debriefing services, and training related services to individual midwives as well as group therapy”.
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Core Values:Â
The core values of EAP are: Compassion; Excellence Veracity
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Purpose of the program
The purpose of this EAP is to assist midwives to mitigate the effects of maternal death and improve the quality of work-life among them.
Objectives of the Programme
The objectives of the programme include the following:
- To promote health and wellbeing of midwives in the Ashanti Region of Ghana;
- To ensure job security among midwives in the Ashanti Region of Ghana;
- To enrich job satisfaction and job performance through improved well-being; and
- To promote a balance between work and non-work life of the midwives in the Ashanti Region of Ghana.
 Stage 3: Principles of EAP
The principles are important for the success of any programme, and therefore, EAP would operate without compromising on the principles. The Employee Assistance Programme, would function under the following four principles namely: 1. Confidentiality; 2. Voluntary participation; 3. Equal treatment. 4. Proper recordkeeping
Stage 4: Models and Drive of EAP
(i) On-site or internal model
On-site or internal model: This is the model that is based in the workplace and run by the organization. All workers of EAP are part of the organization and work within the organizational policy. These models are short time and no fee is paid by users of the programme.
(ii) Off-site or external model
Off-site or external models: These are models that provide services from outside the organization. The company in which the employees work is responsible for the payment of the service employees receive.
(iii) Combine model (on-site and off-site)
Combine model: (on-site and off-site): this is the combination of on-site and off-site models. The employees enjoy some services on-site and are referred for other services off-site.
For Employee Assistance Programme, to function well in any organization, it is important to identify what can drive and keep it running. In the current study, Employee Assistance Programme, is driven by midwives’ wellness or wellbeing as well as management involvement or support for the programme.
It focuses on midwives’ wellness because the Employee Assistance Programme, is designed to help them deal with the effects of maternal deaths at their workplaces and therefore improves the quality of work life. Management involvement or support for Employee Assistance Programme, is important because the programme would need to be supported financially. Workers referred for treatment or counselling may need to take some time out as well as the need for training.
Stage 5: Services to be offered under the Employee Assistance Programme
- There are two main types of services to be offered under the Employee Assistance Programme, These are direct and indirect services. Figure 4 presents the services to be offered under the Employee Assistance Programme.
- Direct services:
Direct services are services that deal with the individual workers either identified and referred or self-referred. These services are provided to the workers who need them. The type of services to be provided under direct services may include, but are not restricted to, the following;
- Assessment
- Trauma debriefing
- Crisis intervention
- Counselling services
- Referral services
- Monitoring
- Follow-up
 Indirect services:
Indirect services are services that are provided to a supervisor and all midwives to help them identify colleagues with problems; behaviour change, low outputs, and so on for early referral and treatment. The services are as follows:
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Training
- Assertiveness training;
- Induction training; and
- In-service training of unit, ward managers, and all ward midwives.
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Workshops
The indirect service of EAP is the training (assertive, induction and in-service) of the unit, ward managers as well as all ward midwives to identify any colleagues who have problems after experiencing maternal death for behaviour change and refer and workshops for all. These also serve as a means of preparing midwives on what to do when they experience maternal death on the wards.
Type of services to be provided under indirect services may include, but are not restricted to, the following:
  Table 2a: Direct Services
Table 2b: Direct Services
Table 3: Indirect Services
EAP services should help all midwives become more positive even after experiencing maternal death at the hospitals and be more productive, giving the best nursing care needed by their clients. When these are achieved, it would be justifiable the midwives have attained the needed quality of work life.
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How to access the EAP?
Accessibility of Employee Assistance Programme, services shall be based on the following conditions:
- There shall be a 24-hour service available either by face to face or by telephone;
- Seven (7) days a week service for all who need it.
- The services shall be in any language of clients’ choice, especially the major languages that are spoken in Ghana, for example, in English, Twi, Ewe, Ga, Hausa, and Dagbani.
- The services could be provided at different locations as per the agreement between the EAP service providers and the client midwives. This location, however, will be within the Ashanti Region of Ghana.
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Participation in the programme:
Participation in the Employee Assistance Programme may follow:
- Voluntary participation/Self-referred by individuals who seek the services on their own;
- Informal referral where ward managers or colleagues recommend the programme; and
- A formal referral based on job performance and a supervisor’s recommendation with a referral note or telephone call to the Employee Assistance Programme providers.
A piece of advice was given as to the type of professionals to hire for the provision of EAP of the health facilities, according to the chosen model and provide the necessary resources to be used.
Step 4: Implementation
The programme should be advertised in meetings, posters on notice boards, and hospital intercom. Names and contact numbers of midwives who had experienced maternal death in hospitals should be sent to the EAP counsellors. Calls should be made to these individuals to voluntarily seek Employee Assistance Programme counsel. The advertisement could also follow orientation programmes at the hospitals and introductory letters could be given to the staff while brochures could also be used. Details of appointment times should be given. A list of available services should be provided and confidentiality should be assured.
Step 5 Evaluation
Evaluation refers to the act of assessing the outcome of the plan. It is defined as attributing value to an intervention by gathering reliable and valid information about it systematically, and by making comparisons, to make more informed decisions or understand the causal mechanism or general principle (12). The evaluation forms should be designed and made available to midwives who benefited from the Employee Assistance Programme. Participants should be asked to complete the evaluation form.
The following should be considered for evaluation: confidentiality; the services provided; the counselling section; and how the programme could be improved. Remedial actions should be taken to address any established gaps. Quarterly and annual reports must be submitted to the hospital management for quality assurance purposes. The names and staff identities should not be part of the report. A summary of all actions taken in developing the Employee Assistance Programme is presented in figure 8. The figure presents the problems identified, inputs made in terms of direct and indirect services and the output (outcomes).
Conclusion
An Employee Assistance Programme, for midwives dealing with maternal death, has been developed. The programme is simple to understand, easy to use in mitigating the effects of maternal death on the midwives, and also would help in improving their quality of work life. The researchers believe this will go a long way in improving maternal health care and the wellness of midwives in their various workplaces.
Data availability statement
Data is available upon request from the School of Nursing, University of Western Cape, South Africa, who issued ethical clearance for the data collected on PhD research titled “The development of an employee assistance program for midwives dealing with maternal deaths”.
Conflict of interest
The authors wish to declare therein, that there is no conflict of interest concerning this manuscript.
 Ethical considerations
The researcher got ethical clearance from the Senate Research Committee of the University of Western Cape and the Ministry of Health/Ghana Health Service. Additional permission was obtained from the Ethical Clearance Committee of the Ghana Health Service, Accra and Ashanti Region where the study took place
 Source of funding
The study was self-funded by the authors. No financial support was received for the study.
Acknowledgment:
Acknowledge goes to all participants and all those who contributed to the success of the study.
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