This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients' and providers' understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers' possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals' and patients' perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients’ needs, preferences and experiences.

本文探讨了加纳一家三级医院如何对患有妊娠期高血压疾病 (HDP) 的妇女进行护理。部分是为了应对中低收入国家孕产妇和新生儿死亡率居高不下的情况，提高产妇保健质量的努力有所增加。质量改进计划由护理质量的基本概念形成，通常由全球 (WHO) 标准和协议驱动。然而，全球护理标准与当地客户和提供者对护理实践和护理质量的理解之间存在紧张关系。标准的实施因影响供应商可能性和优先级的结构和组织限制而进一步复杂化。根据民族志田野调查，我们探索临床指南和专业人士和患者的观点如何融合，更重要的是，如何分歧。我们阐明了当地的、情境化的护理实践，并展示了专业人士如何创造性地应对实地出现的紧张局势。在这种中等收入环境中，照顾患有 HDP 的女性需要在不确定、稀缺、责任不同和利益冲突的背景下进行修补和导航。我们解开了一个复杂的网络，有时，相互矛盾的逻辑，从中产生了各种形式的护理，并且其中并存了不同的良好护理概念。当从业者通过这些不同的护理逻辑进行导航时，生存的逻辑渗透到所有的实践中。