Enhancing Evidence-Based Practice and Critical Thinking Skills of Nursing Students: Lessons from the Review of the Bachelor of Science in Nursing Curriculum of the University of Zambia

Background: Making changes in the existing curriculum aims, objectives, course contents learning outcomes and assessment strategies have become a fact of life for nurse educators. Purpose: To enhance the existing Bachelor of Science (BSc) in nursing curriculum through integration of evidence-based practice (EBP) and teaching of critical thinking skills. Materials and Methods: A needs analysis was conducted using a five-phased approach to review the BSc in nursing Curriculum. Kern’s six-step model was adapted and introduced through a series of workshop exercises that highlighted the application of each step: 1) Desk review of the BSc curriculum offered globally;2) Administration of the needs assessment questionnaire to key informants;3) Strengths, weakness, opportunities and threat analysis;4) Consultative meeting with major stakeholders;5) Curriculum review. Results: The five-phased approach established some gaps in existing curricula, and identified critical core competences and best practices in integrating EPB and critical thinking in the BSc undergraduate curriculum and some “A” level content that was not in tandem with the practice of nurses. New courses were developed to support students in academic writing and enhance professionalism and duration of training was reduced from 5 to 4 years. Conclusion: The process demonstrated that BSc curriculum review, in fact, should be thoroughly scrutinized to encourage positive changes to the curriculum, provide opportunities for team building and the development of leadership skills and a whole-of course perspective on the curriculum.

Contextualisation of Early and Enhanced Clinical Exposure Model through Development of Curricula for Advanced Practice Nursing and Midwifery

Background: An Advanced Practice Nurse is a generalist or specialized nurse who has acquired thorough graduate education a minimum of a master’s degree. The need for Advanced Practice Nurses is increasingly recognized globally. This paper describes the process, which was undertaken by School of Nursing Sciences, University of Zambia in reviewing and developing advanced practice nursing and midwifery curricula which will be implemented using the Early and Enhanced Clinical Exposure model (EECE). Materials and Methods: The curricula development/review process utilized a modified Taba’s Model which followed a step-by-step approach including: 1) desk review, 2) diagnosis of needs (needs assessment), 3) stakeholder consultations, 4) content development, 5) validations and approval from which several lessons were learnt and recommendations made. Findings and recommendations from different stages were used as a basis for reviewing and developing advanced practice nursing and midwifery curricula. Results: Desk review needs assessment and stakeholder consultations identified both strengths and weaknesses in the existing curricula. Major strengths were duration and core courses which met the minimum requirement for postgraduate nursing and midwifery training. Major weaknesses/gaps included some content that was too basic for the master’s level and the delayed exposure to practicum sites which limited the development of advanced practice skills. Others were inadequate competence for advanced practice, inadequate research methodology course, lack of content to foster development of personal soft skills and predominant use of traditional teaching methods. Stakeholders recommended implementing advanced, clinical and hands-on Masters of Nursing and Midwifery programmes which resulted in the review of four existing and development of five demand-driven curricula. Conclusion: The reviewed and developed curricula were strengthened to close the identified gaps. Both the reviewed and developed curricula have been implemented using the Early and Enhanced Clinical Exposure Model with a view to producing Advanced Practice Nurses and Midwives who are competent to meet diverse health care needs and contribute to improving patient outcomes.

Adherence to Radiation Therapy among Cervical Cancer Patients at Cancer Diseases Hospital in Lusaka, Zambia

Background: Radiation therapy has the potential to improve cure rates and provide palliative relief for cervical cancer patients. Despite adherence to radiation therapy being a key treatment modality, patients rarely follow prescriptions. Poor adherence to radiation therapy is associated with low survival and high mortality rates. This study therefore sought to investigate the levels of adherence and factors influencing adherence to radiation therapy among cervical cancer patients being treated at Cancer Diseases Hospital. Methods: A cross-sectional analytical study design was used, 142 patients were selected from the outpatient department using a fishbowl sampling method. A structured interview schedule was used to collect data. Data was entered and analyzed using SPSS, the binary logistic regression analysis was used to predict levels of adherence to treatment and to identify factors associated with adherence to RT among cervical cancer patients. Results: The findings showed that 93% of the participants adhered to radiation therapy while 7% did not adhere to treatment. Majority of the patients 77.1% had experienced side effects of radiation therapy. About 28% of patients had severe psychological distress. By using binary logistic regression, there was a statistically significant association between adherence and perceived quality of health care services (p = 0.001). The analysis showed that patients who perceived poor quality of health care services were 0.005 (99.5%) times less likely to adhere to radiation therapy. The other independent variables were not statistically significant despite being associated with adherence among cervical cancer patients. Conclusions and Recommendations: The findings showed that patients who perceived good quality of health care services had higher chances of adherence compared to those who perceived poor quality of health care services. There is therefore a need for quality service provision which could include good maintenance of radiation machines. Furthermore, there is a need to develop guidelines for follow-up in case of any disease outbreak to avoid interference with patients’ treatment schedules and appointments for reviews.

Postnatal Care within Six Hours Following Delivery at Two Selected General Hospitals of Zambia—Mothers’ Experiences

Background: The days and weeks following childbirth (the postnatal period or puerperium), are a critical phase in the lives of mothers and new-born babies. The most vulnerable time for both is during the few hours and days after birth. The period places major demands on the physiological processes of mother and new-born as they adapt the changes of pregnancy and intrauterine life respectively. However, this is the most neglected time for the provision of quality services. Postnatal care is an integral part of the midwife’s role in providing care and support to the individual mother and her baby. Postnatal care encompasses aspects of observing and monitoring the health of the mother and her baby, as well as offering support and guidance in breastfeeding and parenting skills. Aim of the study: The aim of the study was to explore the experiences and expectations of mothers concerning care during the immediate postnatal period. Methods and materials: A qualitative approach was utilised to collect data from mothers in their immediate postnatal period using recorded in-depth interviews. A total of thirty (30) mothers were interviewed from two general hospitals. Thematic content analysis was used to analyse the data. Findings: From the study, three main themes emerged;inadequate physical examination, information needs and professional support, and varied staff attitude. The findings of the study have highlighted the inadequacies that are still there regarding immediate postnatal care. Conclusion and recommendations: It can be concluded that mothers have a lot of needs and expectation during this period which are usually not met. One most important conclusion is the lack or poor information given to the women regarding the care of the new-born and subsequent care. This could be one of the reasons mothers do not come back for the subsequent postnatal visit. There is an evidence of poor quality of postnatal care being offered to women during the immediate postnatal period. There are also some negative experiences that postnatal mothers have had and these have led them to being unsatisfied with the care they receive during the immediate postnatal period. However, despite all the above, there is still room for improving the care given during this time. This can help reduce maternal and neonatal morbidity and mortality.