The psychosocial experiences of pregnant women in the early stages of the COVID-19 pandemic: A retrospective qualitative study.

BACKGROUND: Pregnant women are among the most vulnerable and suffer the most during pandemics, according to earlier studies. Pregnant women had to seek healthcare for both themselves and their unborn child(ren) in the wake of the COVID-19 pandemic, which was unprecedented. Pregnant women's psychosocial experiences during pandemics are crucial since they both directly and indirectly affect the course of pregnancy and childbirth. The study therefore sought to explore the psychosocial experiences of pregnant women during the COVID-19 pandemic. METHODS: In this retrospective qualitative study, 15 nursing mothers who were attending a postnatal clinic at the Kwame Nkrumah University of Science and Technology (KNUST) hospital in Ghana were recruited. Individual interviews were conducted with mothers who were pregnant between March and December 2020. The audio-recorded interviews were transcribed verbatim and inductively analysed into themes. RESULTS: Nursing mothers were aged 25-30 years and had infants ranging from 5 months to 15 months. Thirteen (13) were married and two were single. Two (2) major themes and five (5) subthemes emerged from the study. The unpleasant feelings connected to the potential for contracting COVID-19 and experiencing stress were described by the theme, "Fear and Stress". Participants' social experiences (support from significant others), alterations in daily routine and the economic impact because of the pandemic were presented as the "Socioeconomic impact". CONCLUSION: Pregnant women go through several challenges during pregnancy such as perceived stress and anxiety. These are likely to heighten during a pandemic, as presented in the study. They therefore need emotional and psychosocial support in such uncertain times to improve outcomes of pregnancy.

Caregivers' perception and acceptance of malaria vaccine for Children.

BACKGROUND: Malaria is a disease of public health concern and in endemic areas, pregnant women and children under-five years are vulnerable to the disease. The introduction of the pilot program of a malaria vaccine for children under-five years in Ghana is an intervention to further reduce the burden of the disease. However, the availability of the vaccine does not necessarily mean it will be accepted by the public. This is why the perceptions and acceptance of the vaccine among mothers of these children are worth exploring. METHOD: A descriptive qualitative study, with the aid of a semi-structured interview guide, was utilized in collecting data from ten (10) purposively sampled mothers whose children were taking the malaria vaccine in a municipality in Ghana. Written informed consent was obtained from all participants. The audiotaped interviews were transcribed verbatim and inductively analyzed into themes describing their perceptions and acceptance. RESULTS: Participants were aged between 22 and 40 years with eight (8) of them married. Three themes emerged from the study. "Awareness of malaria and the malaria vaccine" (1), "Insight into the malaria vaccine" (2), where participants communicated the beliefs and judgments formed on the vaccine, its benefits, and the need for vaccinating their children. With the third theme "Reaction to vaccine" (3), participants communicated their motivation to vaccinate their children and their concerns about the administration of the vaccine. CONCLUSION: The caregivers had positive perceptions about the malaria vaccine for children, with fewer hospital admissions and saving money as some benefits. Healthworkers played a significant role in influencing the acceptance of the vaccine. However, the fear of the unknown concerning the side effects of the vaccine serve as a possible barrier to recommending the vaccine to other caregivers. Health education must also address the fears of caregivers in order to enhance recommending the malaria vaccine to other caregivers and promote uptake of the vaccination.

Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals.

BACKGROUND: As part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children's pain management in order to improve the practice in pediatric care settings. METHODS: Guided by Bourdieu's theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records. RESULTS: Analysis of the field data resulted in four themes. "Children's pain expression and response of caregivers" described the disposition (habitus) of both children and caregivers to act in particular ways due to children's incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. "Pharmacological pain management practices and attitudes" elucidated the use of analgesics as the mainstay disposition (habitus) in children's pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). "Managing pain without drugs" illustrated healthcare providers and family caregivers' disposition (habitus) of using diverse nonpharmacological methods in managing children's pain. "Communication and interaction between pain actors" depicted how children's access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field). CONCLUSIONS: The habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.

Evaluating the content validity of two versions of an instrument used in measuring pediatric pain knowledge and attitudes in the Ghanaian context.

In this article, we compared the content validity of two instruments used in measuring pediatric pain knowledge and attitudes. This was considered necessary due to the universal differences in culture, semantics and healthcare resources in different parts of the globe. Thirteen (13) pediatric experts in Ghana assessed the content validity of two instruments: the 42-item Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS) and the 41-item Pediatric Healthcare Providers' Knowledge and Attitudes Survey Regarding Pain (PHPKASRP). The relevance and clarity of each item on these instruments were rated on a four-point likert scaled options from 1 (not relevant/ not clear) to 4 (very relevant/ very clear). The item-level content validity index (I-CVI) was calculated by dividing the number of experts who rated an item with 3 or 4 by the total number of experts. The average scale-level content validity index (S-CVI/Ave) was also estimated by summing up the I-CVIs of all items and dividing them by the total number of items. The I-CVIs on the PNKAS ranged from 0.62 to 1.00 for the relevance component and 0.69 to 1.00 for the clarity component. The I-CVIs on the PHPKASRP ranged from 0.62 to 1.00 for both the relevance and clarity components. The S-CVI/Ave were 0.87 and 0.89 for the relevance and clarity aspects on the PNKAS respectively. The S-CVI/Ave for the PHPKASRP instrument were 0.86 and 0.89 for the relevance and clarity aspects correspondingly. At the end of the validation process, 5 items were revised on both instruments whilst 37 and 36 items were maintained on the PNKAS and PHPKASRP instruments respectively. The PNKAS and PHPKASRP have an acceptable level of content validity in the Ghanaian context and recommended for educational and research purposes. Other forms of validity and reliability of these instruments should also be examined in future studies.

Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana.

BACKGROUND: Diabetes often coexists with other medical conditions and is a contributing cause of death in 88% of people who have it. The study aimed at evaluating medication adherence, self-care behaviours and diabetes knowledge among patients with type 2 diabetes mellitus in Ghana. METHODS: A total of 330 participants were recruited into the study from three public hospitals in the Tamale metropolis. A validated medication adherence questionnaire and the Summary of Diabetes Self-care Activities tool were used to assess medication adherence and self-care activities respectively. Logistic and linear regressions were used to determine factors positively associated with non-adherence to medication and self-care behaviours respectively. RESULTS: Of the 330 participants whose data were analysed, the mean (SD) age was 57.5 (11.8) years. The majority (84.5%) were adherent to anti-diabetes medication. Participant's age, educational level, and practice of self-care behaviours influenced adherence to anti-diabetes medication. Participants aged 70 years and above were 79% less likely to be non-adherent to medication as compared to those below 50 years [OR = 0.21 (95%CI: 0.06-0.74), p = 0.016]. Participants with senior high school education were 3.7 times more likely to be non-adherent to medication than those with tertiary education [OR = 3.68 (95%CI: 1.01-13.44), p = 0.049]. Participants with tertiary education had an increase in the level of practice of self-management by 1.14 (p = 0.041). A unit increase in knowledge score also increased the level of practice of self-management by 3.02 (p<0.001). CONCLUSION: The majority of participants were adherent to anti-diabetes medication. Non-adherence to medication was associated with younger age and low level of education. Interventions to improve adherence should target younger and newly diagnosed patients through aggressive counselling to address healthy self-management behaviours.

Exploring the educational needs of nurses on children's pain management: A descriptive qualitative study.

Aim: To explore the educational needs of nurses on children's pain management. Design: A descriptive qualitative study. Methods: Individual and group interviews were conducted among 28 nurses and four nurse managers at four hospitals in the Ashanti region of Ghana. The recorded interviews were later transcribed verbatim and thematically analysed based on a conceptual interest in the educational needs on paediatric pain management. Results: Nurses were acquainted with pain assessment of children who can verbally communicate. They mainly used drugs in treating pain and were familiar with the use of some non-pharmacological interventions. Notwithstanding, they desired to know more about pain assessment for children with non-functional speech. Additionally, they were interested in learning more about both drug and nondrug pain relief methods for children. The sampled nurses and nurse managers indicated diverse preferences on the nature of the paediatric pain educational programme based on their personal choices and working dynamics.

Final Year Nursing Students' Knowledge and Attitudes regarding Children's Pain.

Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively affect their physical, psychological, and social well-being; it also places financial burden on families of affected children and healthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students are insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing student's knowledge and attitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate nursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the 42 individual items on the Pediatric Nurses' Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive statistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the final year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an average (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that were related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of pre-emptive analgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items that focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological pain management interventions. Final year nursing students have insufficient knowledge and attitudes toward children's pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered when designing and implementing educational interventions on this subject. Curricular revisions should be made on existing nursing curriculum to lay more emphasis on children's pain management and use educational interventions that support knowledge translation for improved care.

Nursing-Related Barriers to Children's Pain Management at Selected Hospitals in Ghana: A Descriptive Qualitative Study.

Staff shortages, deficient knowledge, inappropriate attitudes, demanding workloads, analgesic shortages, and low prioritization of pain management have been identified in earlier studies as the nursing-related barriers to optimal children's pain management. These studies have mainly been undertaken in developed countries, which have different healthcare dynamics than those in developing countries. The current study, therefore, sought to identify and understand the nursing-related barriers to children's pain management in the Ghanaian context. A descriptive qualitative study was conducted among 28 purposively sampled nurses working in the pediatric units of five hospitals in the Ashanti region of Ghana. Over the course of three months, participants were interviewed on the barriers which prevented them from optimally managing children's pain in practice. Recorded interviews were transcribed verbatim and deductively analysed based on a conceptual interest in pain assessment and management-related barriers. NVivo 12 plus software guided data management and analyses. The mean age of participating nurses was 30 years, with majority being females (n = 24). Participants had worked in the nursing profession for an average of five years and in the pediatric care settings for an average of two years. The nursing-related barriers identified in the present study included communication difficulties in assessing and evaluating pain management interventions with children who have nonfunctional speech, insufficient training, misconceptions on the experience of pain in children, lack of assessment tools, and insufficient number of nurses to manage the workload and nurses' inability to prescribe analgesics. The present study revealed some barriers which prevented Ghanaian nurses from optimally managing children's pain. Nurses should be educated, empowered, and supported with the requisite material resources to effectively manage children's pain and improve outcomes for families, healthcare systems, and the nation. Future studies should explore the facilitators and barriers from other stakeholders involved in pediatric pain management.

Nursing students and nurses' knowledge and attitudes regarding children's pain: A comparative cross-sectional study.

INTRODUCTION: Nurses encounter children who report of pain of diverse and unknown causes in their professional work. The current study therefore assessed and compared nursing students and nurses' knowledge and attitudes pertaining to children's pain in the Ghanaian context. The goal of this was to have a baseline information to guide the development and implementation of the content for a sustainable educational programme (short-course) for nursing students and nurses in Ghana. METHODS: Between October and December 2018, a cross-sectional study was carried out among 554 final year nursing students and 65 nurses in Ghana. The Pediatric Nurses Knowledge and Attitudes Survey Regarding Pain (PNKAS) was used to collect data from participants who were affiliated to four educational institutions and eight hospitals. Data were descriptively and inferentially analyzed using chi-square test of independence, independent samples t-test and one-way analysis of variance (ANOVA). RESULTS: Our findings revealed that nursing students and nurses generally had unsatisfactory knowledge and attitudes towards pain management in children. Nursing students however, had significantly higher scores than nurses in the total PNKAS score and in 10 out of the 13 identified item-areas. Greater scores were obtained by nursing students in areas which were related to pain physiology, pharmacokinetics, pharmacology of analgesics and pain perceptions (p < .05). All the participating nurses could not accurately determine: the onset of action of orally administered analgesics, equianalgesia of orally administered morphine, and the right dosage of prescribed morphine for a child who consistently reported of moderate to severe pain. CONCLUSION: Final year nursing students and nurses have unsatisfactory knowledge and attitudes regarding children's pain; which reiterates the need for urgent and effective educational efforts in this area. Regular in-service training should be offered to post-registration nurses to enhance their pediatric pain knowledge and attitudes for improved pain care in children.

The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children: An Integrative Review.

BACKGROUND: Nurses play an important role in children's pain assessment and management because they spend the majority of the time with them and provide care on a 24-hour basis. However, research studies continue to report on nurses' inadequate assessment and management of children's pain, which may be partly attributed to their insufficient education in this area. OBJECTIVES: This integrative review sought to examine the effect of strategies used in educating nurses on pediatric pain assessment and management. DESIGN: An integrative review. DATA SOURCES: Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed/ Medline and Scopus. REVIEW/ANALYSIS METHODS: Four databases were searched up to February 2018 based on a prescribed eligibility criteria. The review included 37 studies with varied methodologic quality. RESULTS: Our findings revealed that various types of educational strategies improve nurses' knowledge, attitudes, and practice of pain assessment, management, and/or documentation. CONCLUSIONS: Developing a responsive program that includes expectations of beneficiaries, integrating it into existing facility training systems and delivering it through multidisciplinary collaboration, offers the benefit of securing sustainability of the educational gains.