RESUMO
BACKGROUND: Turnover intention is a probability of an employee to leave the current institution within a certain period due to various factors. It is the strongest predictor of actual turnover expected to increase as the intention increases. Emergency Department (ED) nurses are especially vulnerable to high turnover because of their increased risk of developing burnout and compassion fatigue associated with the work environment. This study is aimed to assess nurses' intention to leave emergency departments and associated factors at selected governmental hospitals in Addis Ababa, Ethiopia. METHODS: Institutional based cross-sectional study was conducted on 102 nurses in three selected governmental hospitals, Addis Ababa from February 19 to March 31, 2018, using a structured pre-tested self-administered questionnaire. The logistic regression model was used and an adjusted odds ratio with a 95% confidence interval was calculated to identify associated factors. RESULT: A total of 102 respondents were involved with a response rate of 91.1%. Among them, 79 (77.5%) respondents had the intention to leave the current working unit of the emergency department or hospital. Significant predictive factors of nurses' intention to leave their institutions are educational status (adjusted odds ratio (OR) =4.700, 95% confidence interval (CI) = 1.033-50.772; p < 0.048), monthly income of less than 3145 Birr (adjusted OR = 6.05, 95% CI = 1.056-34.641; p < 0.043) and professional autonomy (adjusted OR = 0.191, 95% CI = 0.040-0.908; p < 0.037). CONCLUSION: More than 77% of the respondents have the intention to leave their current working place of the emergency unit. Educational status, monthly income, and autonomy were significantly associated with emergency nurses' turnover intention in three governmental hospitals. Emergency leaders and hospital managers should have made efforts to enhance nurses' decision making for patient care activities and shared decision overwork or unit related activities.
RESUMO
BACKGROUND: Despite improvement, sepsis mortality rates remain high, with an estimated 11 million sepsis-related deaths globally in 2017 (Rudd et. al, Lancet 395:200-211, 2020). Low- and middle-income countries (LMICs) are estimated to account for 85% of global sepsis mortality; however, evidence for improved sepsis mortality in LMICs is lacking. We aimed to improve sepsis care and outcomes through development and evaluation of a sepsis treatment protocol tailored to the Tikur Anbessa Specialized Hospital Emergency Department, Ethiopia, context. METHODS: We employed a mixed methods design, including an interrupted times series study, pre-post knowledge testing, and process evaluation. The primary outcome was the proportion of patients receiving appropriate sepsis care (blood culture collection before antibiotics and initiation of appropriate antibiotics within 1 h of assessment). Secondary outcomes included time to antibiotic administration, 72-h sepsis mortality, and 90-day all-cause mortality. Due to poor documentation, we were unable to assess our primary outcome and time to antibiotic administration. We used segmented regression with outcomes as binomial proportions to assess the impact of the intervention on mortality. Pre-post knowledge test scores were analyzed using the Student's t-test to compare group means for percentage of scenarios with correct diagnosis. RESULTS: A total of 113 and 300 patients were enrolled in the pre-implementation and post-implementation phases respectively. While age and gender were similar across the phases, a higher proportion (31 vs. 57%) of patients had malignancies in the post-implementation phase. We found a significant change in trend between the phases, with a trend for increasing odds of survival in the pre-implementation phase (OR 1.24, 95% CI 0.98-1.56), and a shift down, with odds of survival virtually flat (OR 0.95, 95% CI. 0.88-1.03) in the post-implementation phases for 72-h mortality, and trends for survival pre- and post-implementation are virtually flat for 90-day mortality. We found no significant difference in pre-post knowledge test scores, with interpretation limited by response rate. Implementation quality was negatively impacted by resource challenges. CONCLUSION: We found no improvement in sepsis outcomes, with a trend for increasing odds of survival lost post-implementation and no significant change in knowledge pre- and post-implementation. Variable availability of resources was the principal barrier to implementation. TRIAL REGISTRATION: Open Science Framework osf.io/ju4ga . Registered June 28, 2017.