Compliance of state registered nurses to nursing standards during practice in tertiary facilities in Malawi

The aim of this study was to describe the quality of practice offered by nurses to patients who underwent surgical incision into the abdomen (post-laparotomy) at tertiary hospitals (Kamuzu, Mzuzu, Queen Elizabeth and Zomba) in Malawi. The study design was descriptively cross sectional and utilized a quantitative data collection and analysis method. All available 48 registered nurses in the surgical ward of four central hospitals and 100 patients that were admitted in the ward during the time of study were recruited. A 3-point scale rating consisting of compliance (C = 1), partial compliance (C 1.0-0.5) and non compliance (C 0.5-0.0) was used to describe the nurse midwives compliance with the process standards of care. Results show that nurses in all the 4 central hospitals partially complied with assessment and planning standards. During assessment, the nurses assessed the physical aspects of care but did not assess the psychological, spiritual and cultural aspects of care. At planning the nurses assigned and delegated tasks based on the knowledge and skills of the provider selected but did not comply with factors related to safety, effectiveness and cost of care. All the facilities fully complied with implementation standard because they implemented care in a safe and appropriate manner and communicated with patients/ significant others and other health care providers. However, regarding systematic and ongoing evaluation of patients’ condition only Mzuzu Central hospital partially complied while the rest of the facilities were not compliant. All the facilities did not comply with documentation standard of care because the patient records were not legible and did not precisely depict comprehensiveness of care nor bore signatures of the implementers of the care. Results are discussed by relating the level of compliance to standards and the quality of patient care.

Exploring the meaning of care among lived experiences of patients with blindness:an interpretive phenomenological study

Objective:To explore the meaning of care experienced by people with blindness in hospitals.Methods:Interpretive phenomenology along with the 6-step method of van Manen was used to conduct the study.Using purposeful sampling,15 people with legal blindness were interviewed.Thematic analysis was used to isolate the meaning of care.Results:Five themes emerged:(a)nurses in the eyes of patients with blindness;(b)negligence in the caring moments;(c)being cared for in ambiguity;(d)Uncoordinated care;and(e)Psychological discomfor t.These sub-themes were condensed into an overarching theme titled as“marginalized patients inside the stereotypical healthcare system.”Conclusions:Lived experiences of patients with blindness revealed that hospitals provide stereotypic or inappropriate care for this minority group in society.Health professionals par ticularly nurses should be skilled to provide person-centered and coordinated care for patients with blindness.

A Review of the Clinical Interdisciplinary Collaboration among Nurses and Physicians

Background: Care is a team effort that its continuity is not possible by a person alone. Nurses and physicians should have collaboration with other professions to solve care complex problems. Aim: We conducted a review of the literature to evaluate clinical nurses collaboration with other disciplines examined by qualitative approach. Method: We searched all articles that published from 1995 to 2014 in both English and Persian which had been performed interdisciplinary collaboration processes in the clinical nursing. These articles were done with qualitative approach for nurse’s collaboration with other disciplines. We searched using databases of Proquest, Scopus, pub Med, Science Direct, and Iranian databases of Sid, Magiran, Iran Medex. This review was performed using keywords matching with MESH terms such as interdisciplinary relations, nurse-physician relations, care team, collaboration, and their Persian equivalents at the first separately and then with AND/OR as combination. In most studies, the main structure was three components of collaboration process, context of collaboration and consequences that they were emphasized. Results & Conclusions: However context and processes were different but most studies reported outcomes similarity of interdisciplinary collaboration. Thus to achieve common goals between different disciplines working together is essential for effective care in clinical settings.

Comparison of Nurses’ and Families’ Perception of Family Needs in Critical Care Unit at Referral Hospitals in Malawi

This study compared needs of family members as perceived by nurses and the family members themselves. The study design was descriptive and utilized quantitative data collection and analysis method. Nurses (n = 62) working in the Intensive Care Units (ICU) and High Dependency Units (HDU) of three tertiary health facilities in Malawi at the time of the study consented to participate in the study. In addition, family members (n = 62) who were looking after a critically sick relative in the ICU and HDU in the same tertiary facilities consented and participated in the study. Data were collected using a questionnaire developed from the Critical Care Family Needs Inventory for a period of 7 days. STATA version 10 was used to analyze data. The rank correlation between the mean scores of perceived needs across major need categories of support, comfort, information, proximity and assurance between the nurses and family members was significantly different from zero (r = 0.97, p = 0.005). Nurses and family members, respectively ranked assurance (90% and 92%) as the highest priority need, followed by information (78% and 85%) and comfort (78% and 84%) and then support (70% and 73%) and proximity (66% and 69%). The ranking however between the 2 groups on 16 out of 45 individual needs were significantly different (p < 0.05). Among the nurses, the rankings by registered nurses were significantly higher (p < 0.05) from those of nurse midwife technicians. There were also significant differences (p < 0.05) in the mean scores between the gender of family members with men demanding more “comfort” than females. Results show a need for facility authorities to formulate ICU policies and strategies that ensure provision of friendly services to family members of critically ill patients.

Explaining the dimensions of specific competence in training specialist nurses in multiple sclerosis:a qualitative study

Background:The complexity of multiple sclerosis(MS)due to psychological,emotional,physical,family,and social dimensions complicates the care of these patients.MS patients need hospitalizations and long-term care to treat and control the progression of the disease.Therefore,the competence of caring for MS patients is one of the important issues in clinical nursing.Objective:To explain the dimensions of competence in caring for MS patients.Methods:This study is a qualitative descriptive study using conventional content analysis method.Field notes and semi-structured face-to-face interviews were conducted on 12 specialist nurses of MS and 3 MS patients from the neurology ward.Participants were selected through purposeful sampling.Data analysis was performed using the approach of Zhang and Wildemuth by continuous comparison simultaneously with data collections.Results:Data analysis led to the extraction of 2 categories with 5 subcategories.The first category is“unlearned care competence,”with the subcategories as psychological-emotional resilience,psychological skills,and excellent communication skills.The second category is“specialized technical competence,”with the subcategories as up-to-date pathological knowledge and expertise in clinical procedures.Conclusions:Identifying the competencies of nurses of MS patients is important for educating nurses to provide qualified care and improve MS patient satisfaction.Nursing managers can empower nurses in non-technical areas such as in-service psychology courses and improve professionalism in caring for MS patients by promoting communication and specific clinical skills.

肯尼亚西阿亚医院护士对患者家属在场时实施复苏的自信心与实践的关联性研究

目的本研究旨在确定护士对家属在场时实施复苏的自信心与实践之间的关系,并描述护士对相关情形的偏好。方法采用横断面调查方法,研究对象来自肯尼亚西阿亚县转诊医院内外科不同单元。采用匿名自填问卷进行调查,主要测量工具为Twibel等设计的家属在场自信量表(Family Presence Self-confi-dence Scale)。采用χ^(2)检验和二元回归分析进行统计学分析。结果护士对家属在场时实施复苏操作的自信心与实践存在关联(χ^(2)=8.060,P=0.01)。非常自信的护士在临床实践中实施家属在场情况下复苏操作的可能性是有点自信的护士的4.9倍(OR=4.94,95%CI 1.07~22.71)。结论护士对实施家属在场复苏操作的自信心差异较大。为成功实施家属在场复苏实践,护士还需通过更多专门培训和实践获得更高水平的自信心。

Comparison between Emergency Severity Index and Heart Failure Triage Scale in heart failure patients: A randomized clinical trial

BACKGROUND:It is not clear whether Emergency Severity Index(ESI)is valid to triage heart failure(HF)patients and if HF patients benefi t more from a customized triage scale or not.The aim of study is to compare the effect of Heart Failure Triage Scale(HFTS)and ESI on mistriage among patients with HF who present to the emergency department(ED).METHODS:A randomized clinical trial was conducted from April to June 2017.HF patients with dyspnea were randomly assigned to HFTS or ESI groups.Triage level,used resources and time to electrocardiogram(ECG)were compared between both groups among HF patients who were admitted to coronary care unit(CCU),cardiac unit(CU)and discharged patients from the ED.Content validity was examined using Kappa designating agreement on relevance(K*).Reliability of both scale was evaluated using inter-observer agreement(Kappa).RESULTS:Seventy-three and 74 HF patients were assigned to HFTS and ESI groups respectively.Time to ECG in HFTS group was signifi cantly shorter than that of ESI group(2.05 vs.16.82 minutes).Triage level between HFTS and ESI groups was signifi cantly different among patients admitted to CCU(1.0 vs.2.8),cardiac unit(2.26 vs.3.06)and discharged patients from the ED(3.53 vs.2.86).Used resources in HFTS group was significantly different among triage levels(H=25.89;df=3;P<0.001).CONCLUSION:HFTS is associated with less mistriage than ESI for triaging HF patients.It is recommended to make use of HFTS to triage HF patients in the ED.

The reliability of the Australasian Triage Scale:a meta-analysis

BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies(GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator.RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428(95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version.CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.

The effect of hot intermittent cupping on pain,stiffness and disability of patients with knee osteoarthritis

Objective:The aim of this study was to investigate the effect of hot intermittent cupping on pain,stiffness and inability of patients with knee osteoarthritis(KO).Methods:The present study was a clinical trial,which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic.Based on permutation block method,the research units were divided into cupping therapy and control groups.For the cupping therapy group,four sessions of cupping therapy were performed every four days.To collect data,the form of demographic information,Visual Analogue Scale(VAS)and the Western Ontario and McMaster(WOMAC)osteoarthritis scale were used,and the data were analyzed by SPSS software v.16 using descriptive statistics and independent t-test,paired t-test,Chi-square test and Fishers exact test with a significance level of P<0.05.Results:Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous.Findings indicated that,based on VAS,the mean pain intensity in the left(P<0.001)and the right knees(P<0.001),as well as based on WOMAC,stiffness(P=0.006),pain intensity(P<0.001)and disability(P<0.001)in the cupping therapy group significantly decreased compared to the control group.Conclusion:Findings showed that hot intermittent cupping therapy reduced the pain intensity,stiffness and disability in patients with KO.

Coping mechanism against high levels of daily stress by working breastfeeding mothers in Iran

Objectives:Breastfeeding mothers returning to work undertake multiple conflicting roles at home and work that can result in high levels of stress.Exploring coping skills amongst these mothers can help in planning useful programmes to promote family wellbeing.This study aims to explore the experiences of working breastfeeding mothers and their coping mechanism against high levels of daily stress.Methods:In this qualitative study,we described the experiences of 20 Iranian breastfeeding mothers through in-depth and semi-structured interviews.All interviews were recorded,transcribed and analysed using thematic analysis.Results:Two main themes emerged as follows:1) self-management with subthemes of a) attitude reconstruction,b) order and planning,c) creating a boundary between work and family and d) reprioritising life affairs;and 2) seeking help with subthemes of a) family member support,b) childcare facilities and c) spirituality.Conclusions:Findings suggest that women need support from family members and family-friendly policies at the workplace.Breastfeeding mothers may benefit from educational programmes that focus on effective coping strategies.

The effectiveness of dalethyne dressings for reducing bacteria in diabetic foot ulcers

Objective:This study evaluates the effectiveness of a dalethyne dressing for decreasing bacteria in diabetic patients with infected foot ulcers.Methods:This study was conducted from March to September 2018 with a sample of 30 participants from the outpatient Kitamura Wound Clinic in Pontianak City,Indonesia.A quasi-experimental non-equivalent pretest-posttest control group design was used for the study.Participants were divided into two groups:an intervention group(treated with a dalethyne dressing)and a control group(treated with a standard dressing).Two trained research assistants collected the data using the Wagner wound classification system and a bacteria counter.The assistants swabbed each wound surface with sterile cotton,and the swabs were used to conduct a bacteria culture and count.Results:The study population was 50%female and 50%male with no significant differences between each other in age,HbA1c,blood pressure,or ankle-brachial index(ABI;P>0.05).Both groups had a significant reduction in the number of bacteria from the pretest to posttest(P<0.05).Mann-Whitney analysis of posttest data indicated a significant difference in bacteria reduction between the control group(median=2.25)and the intervention group(median=7.6;P=0.018).It was noted that Staphylococcus aureus was found in the control group at posttest,but not in the intervention group.Conclusions:This study provides evidence that a dalethyne dressing is effective for killing S.aureus in the infected foot ulcers of diabetic patients.

Lavender aromatherapy on anxiety and depression in patients with Acute Coronary Syndrome: a single-blind randomized clinical trial

Objective:In cardiovascular disease,a patient’s anxiety and depression can increase cardiac rehabilitation duration and recovery.Lavender aromatherapy as a non-pharmacological intervention effective in other contexts may be an efficient intervention to alleviating anxiety and depression in patients with Acute Coronary Syndrome(ACS).Methods:In this study,110 ACS patients were randomly assigned to two intervention and control groups.Inhalation of the lavender fragrance was prescribed for the intervention group and the drop of aromatic almond for the control group for 3 days.Results:The first-day anxiety and depression were significantly different in the two groups at 1 h and 9 h after the intervention.The’morning’s difference before the intervention was not significant,but it was substantial 1 h after the intervention.On the third morning of the intervention,this difference was confirmed.Conclusions:This study confirmed the effectiveness of lavender aromatherapy in reducing anxiety and depression in ACS patients.This’study’s results enable intensive care nurses to use aromatherapy with lavender oil as a non-pharmacological and cost-effective intervention to reduce their psychological tensions and increase patient satisfaction during hospitalization in the cardiac care units(CCU).

Influential factors of healthcare provider resilience in disasters:A thematic analysis

Objective:To identify the influential factors of healthcare staff resilience in disasters.Methods:In this qualitative study,the influential factors of healthcare staff resilience in disasters were investigated through interviewing 20 experts.The interviews were conducted face-to-face,and MAXQDA software version 10 was used to organize the data and thematic analysis.Results:The participants included 5 medical emergency technicians,5 physicians,2 Red Crescent technicians,and 8 nurses.The main influential factors of healthcare providers’resilience were limited relief infrastructure,supportive empowerment,organizational capitals,and contradictory consequences.Other important factors were resource limitation,confusion and uncertainty,empowerment training,comprehensive support,human and value capital,social capital,physical capital,suffering,disability,calm,and excellence.Conclusion:Improving healthcare providers’resilience can be achieved by reducing uncertainty,providing the physical,economic,and human resources,strengthening motivation and comprehensive supports.It is suggested that disaster managers consider all identified dimensions to improve the resilience of healthcare providers to serve better in disasters.Moreover,researchers should study each dimension to provide profound knowledge regarding resilience in disasters.

Operations of school health program assessment at selected secondary schools in Egor Local Government Area,Benin City,Nigeria

Background:School health program(SHP)is the most cost-effective investment a nation can make to simultaneously improve education and health conditions of her citizen.In spite of this,the adoption of SHP in developing countries is still below set standard.Therefore,this study assesses the operations of SHP in secondary schools in Egor Local Government Area(LGA),Benin City,Nigeria.Materials and Methods:A descriptive cross-sectional survey was conducted with accidental sampling method to select 56 school health teachers from secondary schools in Egor LGA.A self-structured instrument was used to collect data based on the research objectives.Data collected were analyzed using percentages,means,and standard deviation.Results:This study showed that despite high level of the program awareness,the actualization of its objective was found to be poor,and this was found to be related with the lack of government support,lack of needed personnel and materials,lack of effective supervision of the program and inappropriate funding.Conclusion:In-service training on SHP should be provided to enhance the skills needed for implementation of SHP.The government should provide needed materials and equipment and employ competent health personnel to take charge of the school health services,and other policymakers should mobilize and strengthen SHP and education activities at the state.