The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia.

BACKGROUND: In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City. METHOD: A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05. RESULTS: Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7). CONCLUSION: Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.

Working environment of nurses in public referral hospitals of West Amhara, Ethiopia, 2021.

BACKGROUND: Healthy working environment for nurses is a foundation for promoting patients' and nurses' safety in hospitals. However, in Ethiopia, there is scarcity of data on this issue. Therefore, the objective of this study was to assess the working environment of nurses in Public Referral Hospitals in Public Referral Hospitals of West Amhara Regional State, Ethiopia, 2021. METHODS: An institution based cross-sectional study was conducted among 423 nurses from January to February 2021. Systematic random sampling was used to select nurses from each hospital. Structured, self-administered questionnaires were used to collect the data. EPI- DATA and SPSS were used for data entry and analysis respectively. Frequency, percentages, and means were calculated. Practice Environment Scale of the Nursing Work Index tool was used to measure the outcome variable. Binary and multivariable logistic regression analyses were computed to identify associated factors. Finally, texts, tables and graphs were used to report findings. RESULTS: The response rate for the study was 96.2%. Around 210 (51.6%) of the study participants were male. One hundred eighty eight (46.2%) nurses reported that their working environment was healthy, while 219 (53.8%,) reported it as not healthy. Nurses who were working in pediatrics wards (AOR = 0.13, 0.02, 0.1) and nurses who gave care for 7-12 patients per day (AOR = 0.21, 0.05, 0.98) were less likely to have a healthy working environment, respectively. Nurses who reported the Ministry of Health to give focus to the nursing profession were 73% more likely to have a healthy work environment (AOR = 0.27; 0.09, .82). CONCLUSION: and recommendations. More than half of nurses reported that their working environment was not healthy to appropriate practice. Hence, introducing systems to improve participation of nurses in hospital affairs and patient care is essential. It is also important to give attention to nurses who are working at pediatrics wards, and for nurses who give care more than the standards.

Incidence and Associated Factors of Failed First Peripheral Intravenous Catheters among Adult Patients at Medical Surgical Wards in Public Referral Hospitals of West Amhara, Ethiopia, 2021.

BACKGROUND: Complications of peripheral intravenous catheters cause problems in clinical practice and bring high costs in terms of morbidity and mortality of patients. Therefore, this study aimed to assess the incidence and associated factors of failed first peripheral intravenous catheters among adult patients in selected Public Referral Hospitals of West Amhara Regional State, Ethiopia, 2021. MATERIALS AND METHODS: An institution-based prospective observational study was conducted among 423 adult patients from January to February 2021. Patients were selected using systematic random sampling techniques. The data were collected using interviewer-based, structured questionnaires and observational checklists. EPI-DATA 3.1 and SPSS version-23 were used for data entry and analysis, respectively. Frequency, percentages, and means were calculated. The outcome variable was determined and graded based on phlebitis and infiltration scales. Binary and multivariable logistics regressions were computed. RESULTS: Four hundred and seventeen first peripheral cannula sites from 418 patients were followed for 2,565 peripheral catheter hours. A failed first peripheral intravenous catheter was observed in 124 (29.7%, CI: 25.6-34) adult patients. Patients who were female (AOR = 0.4, 95% CI: 0.22-0.74) had cannula duration of 49-72 hours (AOR = 0.31, 95% CI: 0.14-0.7) and 73-96 hours (AOR = 0.39, 95% CI: 0.17-0.9), and patients who had been given electrolytes (AOR = 0.31, 95% CI: 0.11-0.86) were more likely to have failed first peripheral intravenous cannula. CONCLUSIONS: Failed first peripheral intravenous cannula is much higher as compared to the acceptable rate of ≤5% by the Infusion Nurses Society. Hence, all patients with peripheral intravenous catheters are screened for catheter failure at least once a day. Providing appropriate nursing care and patient education is also required to reduce the risks.

Moral Distress and Its Associated Factors Among Nurses in Northwest Amhara Regional State Referral Hospitals, Northwest Ethiopia.

BACKGROUND: Moral distress is the cognitive-emotional dissonance that arises when one feels compelled to act against one's moral requirements. The study aimed to assess the proportion of moral distress and associated factors among nurses working in Northwest Amhara Regional State referral hospitals in 2018. METHODS: A cross-sectional study was conducted among nurses working at Northwest Amhara regional state referral hospitals from April 1-30/2018. A total of 423 study participants were enrolled in the study. A systematic random sampling technique was used to select the study participants. A pretested self-administered structured questionnaire was used to collect data. Moral Distress Scale-Revised (MDS-R) was used to assess the proportion of moral distress. Epi info version 7 for data entry and SPSS version 22 for data analysis were used. A binary logistic model was computed. Variables having p-value < 0.5 with 95% CI were used to declare the presence of significant associations. RESULTS: A total of 423 study participants were enrolled in the study with a response rate of 97.4%. The mean (SD) age of the respondents was 30.62 ± 5.7 years. The majority of nurses 350 (85%) were degree and above holders in nursing. The proportion of moral distress among nurses was found to be 83.7%. Work experience 11-20 years [adjusted odds ratio (AOR)=2, 95% CI: 1.01, 3.34], perceived poor team communication [AOR=4.5, 95% CI: 1.78, 11.62], perceived powerlessness in decision making [AOR=3.3, 95% CI: 1.38, 7.87], inadequate staffing [AOR=2.96, 95% CI: 1.26, 6.97], and inappropriate provision of care [AOR=4.12, 95% CI: 1.55, 10.9] were significantly associated with moral distress. CONCLUSION: Nurses frequently experienced moral distress in clinical settings. Perceived poor communication, perceived powerlessness in decision making, inadequate staffing, and inappropriate provision care were the factors associated with moral distress.