Barriers and outcomes of therapeutic communication between nurses and patients in Africa: a scoping review.

BACKGROUND: Therapeutic communication (TC) promotes effective patient care, emotional wellbeing, and improves patient outcomes. The purpose of this review was to synthesise evidence on barriers and outcomes of TC between nurses and patients in Africa and to inform future studies and systematic reviews. METHODS: Search for the records was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Results and findings from published studies and grey literature were included. A total of 16 articles met the eligibility criteria and were included in the review. This scoping review followed the guidelines by Askey and O'Malley. RESULTS: Barriers associated with TC were grouped under five main themes: sociodemographic factors, patient-related factors, nurse-related factors, environmental and health service-related. Age, and religious beliefs were the main sociodemographic factors that hindered TC while stress and inadequate knowledge and skills were identified among the nurse-related barriers to TC. Extreme weather conditions and mosquito infestation were environmental factors while lack of access to TC educational programmes on TC was a health service-related factor that interfered with TC. Both positive and negative outcomes of TC were also identified. CONCLUSION: Continuous professional development on TC is necessary to improve nurses' attitudes and update their skills to enable them to render culturally competent nursing care to patients.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana.

BACKGROUND: Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers. METHODS: An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach. RESULTS: Three themes emerged from the data; "… And the pandemic struck", "Impact of the pandemic on ART service delivery"; "Effecting the needed change". The healthcare workers' initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients' clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals' work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management. CONCLUSIONS: Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Self-management needs, strategies and support for sickle cell disease in developing countries: a scoping review protocol.

INTRODUCTION: Sickle cell disease (SCD) poses a significant global health burden, particularly affecting individuals in developing countries with constrained healthcare resources. While research on self-management in the context of SCD is emerging, it has predominantly focused on primary studies, and there is a notable dearth of evidence synthesis on SCD self-management in developing countries. This scoping review aims to identify and map self-management needs of individuals living with SCD, the strategies they employed to meet those needs, and the support systems available to them. METHODS AND ANALYSIS: The review will be conducted following the Arksey and O'Malley's (2005) 29 framework to comprehensively examine the landscape of SCD self-management research. Searches will be performed in PubMed, Scopus, Embase and Dimensions AI, with additional searches in other databases and grey literature. Indexed literature published in English from inception to January 2024 will be included. Reference list from included studies will also be searched manually. Two teams will be constituted to independently screen titles, abstracts and full text against the eligible criteria. Data will be extracted from included studies onto a customised data extraction form. ETHICS AND DISSEMINATION: Ethical approval is not required for this review due to the fact that it synthesises information from available publications. The findings will be disseminated through publication in a peer-reviewed journal. Also, the findings will possibly be presented at relevant international and national conferences. This protocol has already been registered with the Open Science Framework. The study characteristics such as design and setting will be descriptively analysed and presented as graphs, tables and figures. Thematic analysis will also be conducted based on the study objectives and presented as a narrative summary.

Integrating Preconception Health into Routine Reproductive Health Services of Ghana: A Qualitative Study Among University Students.

Objective: The preconception health (PCH) strategy provides a unique opportunity to reduce risk factors for adverse reproductive outcomes before pregnancy. However, many reproductive-aged individuals continue to miss opportunities to improve their health before pregnancy occurs. This study, qualitatively explored strategies required for integrating PCH promotion interventions into routine reproductive health services from university students' perspectives. Materials and methods: We conducted eight mixed-gender focus group discussions (FGDs) with students in eight schools and faculties in the University from March 2019 to June 2019. Audio-taped data were transcribed verbatim and analyzed manually using inductive content analysis. Results: Three major themes emerged from the analysis of transcripts: interpersonal behavior change strategies, institutional policy directives, public policy interventions, and three main categories with eight sub-categories. The study showed that PCH promotion awareness campaigns, context-relevant service delivery initiatives, institutional and public policy directives are critical approaches for the delivery and uptake of PCH interventions. Participants also recommended prepayment schemes, walk-in services, mobile PCH clinics, and PCH incorporation into university curricula as context-specific strategies for PCH promotion among university students. Conclusion: PCH promotion could be feasible as an integral component of routine reproductive health services for university students. However, multi-level interventions at the student, health service, and institutional levels are necessary to increase awareness and facilitate the request and delivery of PCH services.

Explorative-descriptive study on the effects of COVID-19 on access to antiretroviral therapy services: the case of a teaching hospital in Ghana.

OBJECTIVE: To explore how the COVID-19 pandemic affected access to antiretroviral therapy (ART) services from the perspective of the persons living with HIV (PLWH). DESIGN: The study adopted an exploratory-descriptive qualitative design that used in-depth interviews as the technique for the data collection. Data analysis was done using conceptual content analysis, following the traditions of Elo and Kyngäs on deductive and Hsieh on inductive content analysis. SETTING: ART clinic, Cape Coast Teaching Hospital, Ghana. PARTICIPANTS: Twelve participants who had at least 1 year history of accessing ART care before the COVID-19 pandemic and at least one clinic visit during the pandemic were purposively sampled from the ART clinic. RESULTS: Five concepts of accessing healthcare proposed by Penchansky and Thomas were explored: accessibility, availability, affordability, accommodation and acceptability. The ART unit in the study setting remained open for service delivery throughout the pandemic. However, fear of contracting the virus while patronising services affected the participants' decision to use the facility. Although all the participants in this study reportedly honoured their refill appointments, they indicated knowledge of other PLWH defaulting. With reference to the availability of resources, a shortage of antiretrovirals was reported, affecting the refill appointment intervals. In spite of the challenges, several strategies were implemented to accommodate the patients' needs while protecting them from contracting the virus by instituting the stipulated COVID-19 protocols. The study found that some of the strategies impacted the acceptability and affordability of the services as transportation costs increased. Varying levels of accessibility to health workers providing ART services in the study setting was also recorded. CONCLUSION: Strategies were implemented to accommodate the effects of the pandemic on ART provision. However, these had deficiencies that must be addressed using appropriate Differentiated Service Delivery (DSD) interventions that will ensure continuous access to service delivery in the ongoing and any similar future occurrences.

Nursing Students' Perception of Clinical Teaching and Learning in Ghana: A Descriptive Qualitative Study.

Background: Clinical teaching and learning are critical in bridging the theory-practice gap in nursing education. This study aimed at exploring nursing students' perception of clinical teaching and learning in Ghana. In particular, this study sought to (1) describe the factors that promote clinical teaching, (2) examine students' perception of clinical teaching, (3) describe the impact of clinical learning on students, and (4) explore ways of improving clinical teaching and learning. Methods: A descriptive qualitative study was conducted with 16 final-year nursing students using telephone-based interviews. Individual in-depth interviews were conducted with a semistructured interview guide, and data were analysed by the qualitative thematic analysis. Results: The findings indicate that being taught new things, being supervised, and having autonomy were the most significant factors that promoted clinical learning. Participants also reported that clinical experience created learning opportunities that helped develop clinical competence. They described learning experiences in the clinical setting as good, albeit gaps in practice. Poor staff attitude, lack of equipment, poor student attitude, inadequate learning opportunities, and lack of clinical supervisors were perceived as challenges in the clinical environment. Conclusions: Efforts to consciously teach, supervise, and challenge students to have independence in the clinical area will promote clinical teaching and learning. Therefore, nursing educational institutions and all other stakeholders need to collaborate in eliminating the numerous challenges students encounter in the clinical environment.

A Multisite Study on Knowledge, Perceived Motivators, and Perceived Inhibitors to Precepting Nursing Students within the Clinical Environment in Ghana.

BACKGROUND: Preceptorship constitutes an important component of the educational process of training nursing students. The purpose of this study was to assess the knowledge, perceived motivators, and perceived inhibitors to precepting nursing students at the clinical placement sites in the Cape Coast Metropolis of the Central Region of Ghana. METHODS: A descriptive cross-sectional study was conducted among 442 nurses and midwives aged 27-56 years with at least three years of work experience. Data were collected with a questionnaire and analyzed using frequency counts, percentages, exploratory factor analysis, and point biserial correlation. RESULTS: The results indicate that the participants had a high knowledge of preceptorship of up to 91.2% (n = 404). A significant proportion of up to 88.2% (n = 390) had an intention to precept nursing students in the near future. The three important perceived motivational factors to precepting nursing students were the learning and professional needs of students, helping students to develop skills, and experience and formal recognition of the role of preceptorship. The main perceived inhibitors to engage in a preceptorship role were lack of preparation for the role, lack of support from faculty and nurse managers, and additional work burden. The results further indicate a significant strong positive correlation between experience and professional recognition of preceptorship and the intention to precept nursing students in the near future (r = 0.99, p=0.037). CONCLUSIONS: The nurses and midwives who participated in the study are knowledgeable about preceptorship and have the intention to precept nursing students. Having enough experience on the job and being formally recognized as a preceptor may motivate these professionals to precept nursing students. However, there are critical perceived barriers that need to be addressed, to enable more nurses and midwives with the desire to precept students to engage in the preceptorship role.