Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study.

Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents' access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents' SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents' access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty.

Phenomenography: An emerging qualitative research design for nursing.

BACKGROUND: Phenomenography emerged from pedagogy to examine the qualitatively different ways that individuals experience and perceive the same phenomenon. Despite its uniqueness, the uptake of phenomenography in nursing research is still limited. Potentially, this may be related to confusion regarding what the design is about, its philosophical underpinnings and how distinct it is from other qualitative designs. OBJECTIVES: To offer a better understanding of phenomenography by comparing it with other established qualitative research designs, examining its theoretical foundations, highlighting some studies that have employed the approach in nursing and offering methodological guidance to improve its uptake in nursing. DESIGN: Discussion paper. FINDINGS: Compared to the traditional qualitative designs employed in nursing, phenomenography has been utilized in fewer studies. The ontological, epistemological and methodological basis of phenomenography highlights it as a distinct design. The strength of phenomenography lies in its emphasis on understanding the collective variations between participants and presenting these holistically as an 'outcome space'. DISCUSSION: Phenomenography is a distinct qualitative research approach that presents a unique opportunity for nursing to further its use. Issues regarding bracketing, the inclusion of phenomenography studies in qualitative meta-synthesis and employing a hermeneutic approach to phenomenography are avenues for further work in nursing. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Sharps Injuries Among Healthcare Workers in Liberia and Ghana: A Cross-Sectional Survey.

Objective: There is little data on sharps injuries among healthcare workers in West Africa, despite the region's high rate of Hepatitis B and HIV. The purpose of this study is to investigate healthcare workers' history of sharps injury in Liberia and Ghana. Design: An electronic cross-sectional survey disseminated by local nursing, midwifery, physician assistant, and physician associations. Setting: Healthcare workers in Liberia and Ghana from February to June 2022. Participants: Participant were registered nurses, physician assistants, physicians, or midwives, and had been working in a patient care role for at least nine of the previous twelve months. Methods: A link to the survey was texted to participants through their professional association membership lists, including nursing, midwifery, and physician assistant organizations in both Liberia and Ghana and a physician organization in Ghana only. Results: 509 participants reported an average of 1.8 injuries per year in Liberia and 1.1 in Ghana (p=<0.01). 15.1% of healthcare workers reported three or more injuries in the past year. Liberia had a higher proportion of frequently injured workers (p=<0.01). Frequently injured workers were evenly distributed across worker types. Conclusions: Workers in this region are vulnerable to sharps injuries. A frequently injured subset of workers likely has distinctive risk factors and would benefit from further investigation and intervention.

Technology: A metaparadigm concept of nursing.

Undoubtedly, technology continues to permeate the world at an unprecedented pace. The discipline of nursing is not alien to this phenomenon as nurses continue to employ various technological objects and applications in clinical practice, education, administration and research. Despite the centrality of technology in nursing, it has not been recognised as a metaparadigm domain of interest in the discipline of nursing. Thus, this paper sought to examine if technology truly reflected a metaparadigm domain using the four requirements posited by Fawcett. Using these requirements, we examined the onto-epistemology of technology in relation to nursing and conclude that technology potentially represents a distinct domain that intersects with nursing (particularly, from the humanities perspective). Also, technology encompasses some phenomena of interest to the discipline of nursing, demonstrates perspective-neutrality, and is international in scope and substance albeit with some nuances which do not fit well with nursing onto-epistemology. Put together, it is highlighted that technology intersects with the existing metaparadigm domains (person, health, environment and nursing) which positions it as a potential phenomenon of interest to the discipline of nursing requiring further work to articulate its position and role.

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study.

AIM: The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0-14 years living with tuberculosis. DESIGN: Exploratory descriptive qualitative design. METHODS: Semi-structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer-enhanced thematic analysis. RESULTS: Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. CONCLUSION: Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad-based emotional and other support for these women.

Ghanaian nurses' and midwives' perspectives on technology adoption in nursing and midwifery education.

AIM: The purpose of this study was to explore the perceived benefits and challenges of online distance education and computer-based testing (CBT) among registered nurses and midwives in a sample of government-owned health facilities and health training institutions in Ghana. DESIGN: Exploratory descriptive qualitative design. METHODS: Individual semi-structured interviews were conducted with 45 participants (i.e. 25 nurses and 20 midwives). The data were manually processed and analysed using Braun and Clarke's thematic analysis approach (November 2019-February 2020). RESULTS: Nurses and midwives prefer online distance education for three reasons: convenience, cost-effectiveness and learning centre proximity to the workplace. The course schedule's flexibility allowed participants to work and study simultaneously. Others acknowledged online distance education as a viable option for overcoming the challenges of obtaining study leave. However, the lack of recognition of certificates by some employers, poor Internet connectivity and perceived excessive course load were noted as deterrents. Regarding the CBT, many of the participants said that it was useful. Among the advantages of CBT are: (1) a decrease in examination malpractices, (2) a decrease in examination costs and (3) a rise in students' interest in information, communication and technology (ICT). This finding emphasizes the necessity of integrating ICT into nursing and midwifery education and examinations, as well as maximizing its benefits.

Physical and socioeconomic burden of caregiving on family caregivers of children with cancer at a tertiary Hospital in Ghana.

BACKGROUND: Childhood cancer is proportionately higher in Africa and these result in increased demands on caregivers. The inability of affected children to take care of themselves; coupled with prescribed medical interventions presents physical and social burdens on family caregivers. AIMS AND METHODS: This study used a qualitative exploratory design to explore the physical and socioeconomic challenges for family caregivers of children diagnosed with cancer and receiving care at one of the biggest tertiary hospitals in Ghana. A total of thirteen family caregivers of children with cancer were interviewed. FINDINGS: Two major themes were identified: Burden of care on Physical Health and Socioeconomic burdens of caregiving on the family caregiver. It was reported that family caregivers encounter physical challenges such as Aches and Pains when performing caregiving activities, Loss of Appetite, Fatigue, Compromised Functional State and Sleep Disruption. The second theme, Socioeconomic burdens of caregiving on family caregivers account for the consequences of caregiving on social lives, family relationships, finance and employment. CONCLUSIONS AND RECOMMENDATIONS: The study recommends that measures that provided relief for the caregivers such as teaching them to adopt local measures of pain relief such as massage should be encouraged. Policies should adopt measures that encourage caregivers to have some days of rest whiles providing care to their children with cancer. Also, health insurance packages that provide relief for the cost of accessing healthcare, should be extended to children with cancers to support their caregivers.

Experiencing motherhood as a blind mother in the Greater Accra Region of Ghana; a qualitative study.

BACKGROUND: Females in developing countries are likely to suffer from visual impairment more than their male counterparts. People living with blindness or any other form of disability also have the right to reproduce and care for their children like all other humans. There is paucity of literature in the experiences of blind mothers in Ghana. Therefore, this study explored the experiences of blind mothers as they navigated the process of motherhood. METHODS: Qualitative exploratory descriptive design was used to conduct the study. Nineteen blind mothers were interviewed individually. Permission was sought for data to be audiotaped, transcribed and content analyzed inductively. RESULTS: Three main themes emerged from the data: mothering role and difficulties (sub-themes; feeding, disciplining and protection), mothering challenges (sub-themes; discrimination and prejudice, financial distress and psychological distress) and coping strategies (prayer, children and self-motivation). Most of the mothers reported difficulties in playing their roles in the areas of feeding, disciplining and protection. Challenges were poverty, discrimination, prejudices on their ability to be mothers and psychological distresses such as depression. They coped with their challenges with prayers, self motivation and the hope they had in their children. CONCLUSION: A lot of public education is needed to make the lives of people living with disability better. Health professionals must be trained to treat blind mothers with dignity and respect.

The Image of Nurses and Midwives in Ghana: Patient and Family Perspectives.

This study aims to explore the perceptions of patients and family caregivers on the image of nurses and midwives in Ghana. The study adopted a qualitative exploratory descriptive approach. A total of 25 participants were interviewed during data collection. Content and thematic analysis were applied in the data analysis to develop themes. The findings are captured under two major themes that describe the primary influences on participant images of nurses: Thus, (1) nurses' and midwives' attributes with four subthemes; staff appearance, communication strategies and behaviors, work attitudes, and professional competence and (2) patients' status and subthemes were; uneducated poor and educated rich. We conclude that patients and families in Ghana recognize the professional attributes of the nurse and midwife, which reflect in their personality, grooming, communication, competencies, and attitudes. However, low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image. A policy to perform a regular public audit on the image of the Nurse/Midwife is important for professional advancement.

Qualitative exploration of perceived barriers of exclusive breastfeeding among pregnant teenagers in the Greater Accra Region of Ghana.

BACKGROUND: The World Health Organization endorses exclusive breastfeeding for the first six months of every child's life since exclusive breastfeeding has the potential of saving thousands of infants' lives. The global exclusive breastfeeding rate among mothers is sub-optimal. This predisposes infants born to teenage mothers to all types of ailments. Therefore, this study explored the factors that inhibit the practice of exclusive breastfeeding as perceived by pregnant teenagers in the Greater Accra Region of Ghana which is an urban area. METHODS: The study used techniques in qualitative descriptive exploration to collect data from 30 pregnant teenagers through focus group discussions. Six focus group discussions were conducted and each group was made up of five participants. Informed consent was obtained from participants who were 18 years and above as well as parents of participants below 18 years while informed assent was obtained from participants below 18 years after purposive sampling. Interviews were audiotaped, transcribed and data were analysed through content analysis. RESULTS: Two major themes and eight sub themes emerged from the data after analysis. Personal related barriers (negative emotional feelings, irrational thinking, perceived health risks to the baby and perceived self-inefficacy) and social related barriers (provider-client interaction, disapproval of exclusive breastfeeding by close relatives, unfriendly workplace policies and social myths) were the perceived factors that discouraged exclusive breastfeeding among teenage mothers. CONCLUSION: Health professionals should be trained to provide culturally sensitive care to teenage mothers in order to promote exclusive breastfeeding. The media, religious leaders and politicians should help debunk misconceptions about breastfeeding expressed by participants in the study.

Exploring Ghanaian nurses knowledge and application of bio-ethical principles in postoperative pain management.

Managing postoperative pain require good understanding of the bio-ethical principles in order to preserve patients' rights. Bio-ethical principles in health care include autonomy, beneficence, justice and nonmaleficence. It is important that health care professionals understand that patients in pain have the right to satisfactory management. Good insight on ethical principles and how they relate to pain management places the nurse on a better pedestal to manage postoperative pain effectively. However, there is scanty literature on the level of Ghanaian nurses' knowledge and application of bio-ethical principles in postoperative pain management. Therefore, the study objectives were to: explore nurses' understanding of the bio-ethical principles in postoperative pain management; explore how nurses apply bioethical principles in postoperative pain management. The study employed qualitative exploratory descriptive design. Purposive sampling technique was used to recruit participants from the surgical wards. Semi-structured interview guide was designed for data collection. Data saturation was reached at the fourteenth participant. Thematic analysis method was used and themes emerged inductively. Three main themes identified through inductive content analysis of data were: beneficence, autonomy and justice. Findings showed that nurses had some appreciable level of knowledge of the fundamental principles related to ethics and applied them in postoperative pain management. Nurses knew their duties in advocating for patients. Patients rights to refuse treatment was also appreciated by some nurses. Nurses also demonstrated humanity by helping patients financially to settle hospital debts which explicitly shows the empathetic characteristics of nurses. The study concluded that nurses are knowledgeable in bioethical principles underpinning post operative pain management and also applied these principles when caring for surgical patients.

Experiences and contextual practices of family-centered care in Ghanaian nicus: a qualitative study of families and clinicians.

BACKGROUND: Families, whether at home or at the hospital, should be a vital part of newborn care. However, most families are excluded from hospital care, particularly in neonatal intensive care units (NICUs). This is incompatible with the concepts of Family-Centered Care (FCC) and may compromise care continuity and family satisfaction following discharge from neonatal intensive care facilities. The purpose of this study was to examine FCC practices in Ghanaian neonatal intensive care units and provide the experiences and contextual practices of FCC from the perspectives of families and clinicians. METHODS: The study qualitatively examined the contextual practices of FCC from the perspectives of families and clinicians in neonatal intensive care units using an exploratory descriptive design. With the help of MAXQDA software, 36 transcripts were generated and their contents were analyzed. RESULTS: Contextual practices of FCC, family experiences of FCC and clinician experiences of FCC emerged as three main categories from the data. Respect and dignity, culture and religion and a multidisciplinary approach were the contextual practices. Emotional stress, lack of information and coping strategies were all common family experiences. Support, counseling, education and financial problems have all been experienced by clinicians. CONCLUSIONS: Shared decision-making, counseling and education, as well as respect/dignity amongst clinicians, managers and families using a multidisciplinary approach are the fundamental concepts of FCC approach in Ghana. Acceptance and integration of FCC approach into neonatal intensive care units may reduce the burden of care as well as improve the quality of care. Further studies are needed to map out strategies and interventions for the integration of FCC into intensive care units.

Strategies to adapt and implement health system guidelines and recommendations: a scoping review.

BACKGROUND: Evidence-based health system guidelines are pivotal tools to help outline the important financial, policy and service components recommended to achieve a sustainable and resilient health system. However, not all guidelines are readily translatable into practice and/or policy without effective and tailored implementation and adaptation techniques. This scoping review mapped the evidence related to the adaptation and implementation of health system guidelines in low- and middle-income countries. METHODS: We conducted a scoping review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was implemented in MEDLINE (Ovid), Embase, CINAHL, LILACS (VHL Regional Portal), and Web of Science databases in late August 2020. We also searched sources of grey literature and reference lists of potentially relevant reviews. All findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: A total of 41 studies were included in the final set of papers. Common strategies were identified for adapting and implementing health system guidelines, related barriers and enablers, and indicators of success. The most common types of implementation strategies included education, clinical supervision, training and the formation of advisory groups. A paucity of reported information was also identified related to adaptation initiatives. Barriers to and enablers of implementation and adaptation were reported across studies, including the need for financial sustainability. Common approaches to evaluation were identified and included outcomes of interest at both the patient and health system level. CONCLUSIONS: The findings from this review suggest several themes in the literature and identify a need for future research to strengthen the evidence base for improving the implementation and adaptation of health system guidelines in low- and middle-income countries. The findings can serve as a future resource for researchers seeking to evaluate implementation and adaptation of health system guidelines. Our findings also suggest that more effort may be required across research, policy and practice sectors to support the adaptation and implementation of health system guidelines to local contexts and health system arrangements in low- and middle-income countries.

Meanings of quality of life among people living with epilepsy in Ghana; a qualitative exploratory study.

PURPOSE: The purpose of this study was to explore the meanings of quality of life among people living with epilepsy (PLWE) in Ghana. METHODS: An exploratory-qualitative study design was adopted. Face-to-face in-depth interviews, using a semi-structured interview guide, were conducted on 15 PLWE who were purposively selected for the study. The interviews were audio recorded and transcribed verbatim. The content analysis approach was then used to analyze the data. RESULTS: Four themes - "acceptance", "support", "seizure control", and "self-reliance" emerged from the study as meanings of Quality of life (QoL). Quality of life meant unconditional acceptance from family, friends, acquaintances at home, school, and work, and by the public despite epilepsy. Receiving support in the form of protection from injury during a seizure, financial assistance to meet individual and family demands, emotional warmth, and spiritual support through prayers and encouragement, was QoL for PLWE. Achievement of control over seizures and being self-reliant in terms of selfcare and daily activities in addition to having some form of financial independence meant QoL. CONCLUSION: Meanings of quality of life among PLWE is associated with being accepted and supported by family and friends as well as being in control of seizures and attaining a status of independence.

Impact of the COVID-19 Pandemic on Adolescents' Sexual and Reproductive Health in Low- and Middle-Income Countries.

Adolescents living in low- and middle-income countries (LMICs) are struggling with accessing sexual and reproductive health (SRH) services, and COVID-19 has escalated the problem. The purpose of this review was to identify and assess the existing literature on the impact of the pandemic on SRH needs and access to services by adolescents in LMICs. A scoping review was conducted to collate findings on the topic. Searches were performed on eight databases. Data were extracted and categorized into various themes. After removing duplicates and performing a full-text reading of all articles, nine articles were included in our review. Our findings generated several themes related to adolescents' sexual and reproductive health during the COVID-19 pandemic. These include (1) limited access to sexual and reproductive health services, (2) school closure and increased rate of early marriages, (3) sexual or intimate partner violence during COVID-19, (4) disruption in maternity care, (5) adolescents' involvement in risky or exploitative work, (6) intervention to improve sexual and reproductive health services during COVID-19, and (7) policy development related to adolescent sexual and reproductive health. Several recommendations were made on policies-for instance, the use of telemedicine and community-based programs as a way to deliver SRH services to adolescents during and after a pandemic.

Perceptions of the functioning and effectiveness of nursing regulators in Ghana and South Africa: a cross-sectional study.

OBJECTIVE: Nursing regulators are important governance structures for nurses who are critical to the achievement of universal health coverage (UHC). This study examined the perspectives of the heads of nursing education institutions (NEIs) in Ghana and South Africa on the functioning and effectiveness of the respective nursing regulators. DESIGN: This was a cross-sectional survey. SETTING: This study was conducted in Ghana and South Africa PARTICIPANTS: Heads of accredited NEIs in Ghana (n=65) and in South Africa (n=39). RESULTS: In South Africa, the mean score for overall functioning of the South African Nursing Council (SANC) was 4.6 (SD 1.97), whereas the mean score for overall functioning of the Nursing and Midwifery Council of Ghana (N&MC) was 7.1 (SD 1.7) (p<0.0001). Similarly, the mean score for effectiveness of the SANC by NEIs was 5.1, compared with the mean effectiveness score of 7.2 for the N&MC (p<0.001).Compared to the SANC, the heads of NEIs scored the N&MC higher on each of the six functional areas of policy-making (Ghana=7.06; SA=4.56); accreditation (Ghana=7.40; SA=4.10) legal and disciplinary actions (Ghana=6.45; SA=5.52); examination (Ghana=7.84; SA=5.00); registration (Ghana=8.27; SA=5.96) and communication and transparency (Ghana=6.87; SA=6.05). CONCLUSION: Both the N&MC and SANC are well-established regulators and are vital to ensure that the nursing workforce in each country is able to deliver quality healthcare, thereby contributing to UHC and population health improvements. However, the study findings suggest the need for concerted efforts to improve the functioning and effectiveness of the regulators, especially the SANC. The six functional areas could guide the necessary improvements in regulator functioning and effectiveness, in partnership with relevant stakeholders.

Perspectives of nurses on preparedness for combating COVID-19 crisis in Ghana: A qualitative inquiry.

BACKGROUND: COVID-19 has impacted negatively on people physically, psychologically, spiritually, and socioeconomically worldwide. Nurses' ability to prepare towards case management is imperative because the potential of one coming across the virus at the hospital is inevitable. This study intended to explore and describe nurses' perspectives on preparation towards fighting COVID 19 in Ghana. METHODS: A qualitative exploratory descriptive design was adopted. Nine major health facilities designated for COVID-19 treatment centres in four regions in Ghana were involved in the study. A semi structured interview guide was used to interview twenty-nine nurses via telephone based on data saturation. Ethics approval was obtained from the Ethics Review Committee of the Nursing and Midwifery Council of Ghana. RESULT: data yielded two major themes and four subthemes. The two main themes were 1. Health facilities' preparation of nurses towards COVID-19, with its subthemes; targeted training, and selection of experienced staff. 2. Nurses' individual preparedness towards COVID-19 with the subthemes; information sourcing and sharing. Nurses in Ghana prepared for combating COVID-19 by going through training on infection prevention and control, and case management using demonstrations and simulations. Experienced nurses in Ghana volunteered to be at the frontline managing cases. Continuous updates on the virus and its management through information tracking sharing played a key role. CONCLUSION: Nurses in Ghana need to have more specialty training targeted at diseases of public health importance. Key words: Nurse; preparedness; covid-19.

Facilitators and barriers to the clinical administration of herbal medicine in Ghana: a qualitative study.

BACKGROUND: Herbal medicine administration in conventional health care services is gaining popularity lately. Much has not been documented on the perceived enhancers and challenges to herbal medicine administration at the hospital. The study sought to explore the facilitators and barriers to the clinical administration of herbal medicine in Ghana. METHOD: Qualitative descriptive exploratory design was employed. Fourteen participants among the consented and purposively sampled nurses were interviewed. Data was transcribed and analysed using content analysis. RESULTS: The participants disclosed that facilitators to the clinical administration of herbal medicine include doctors' prescription, affordability of herbal medications by patients, patients' willingness to use herbal medicine and availability of herbal medicine. Barriers to the clinical administration of herbal medicine were inadequate knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration and policies on herbal medicine administration at the hospital. Other barriers were negative mindset of patients and lack of national health insurance scheme (NHIS) coverage. CONCLUSION: Clinical administration of herbal medicine is faced with an array of challenges. Doctor's prescription, nursing education on herbal medicine and NHIS coverage of herbal medicine are imperative to improve herbal medicine administration in hospitals. Herbal medicine addition into mainstream health care services is surging high in many countries. This study aimed at finding out what nurses consider as the issues that make it easy or difficult to serve herbal medicine in the hospital. Qualitative method was employed, in-depth face-to-face interviews were conducted and data collected was typed verbatim. The typed data was content analysed and findings supported with the nurses' statements. The findings of the study showed that facilitators to the clinical use of herbal medicine include doctors' prescription, affordability of the herbal drug, patient's willingness to use the herbal medication, patient's belief about herbal medicine and availability of herbal medicine. Challenges to the clinical use of herbal medicine disclosed were lack of knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration between health professionals and herbal medicine providers. Other barriers include negative mindset of patients and lack of national health insurance (NHIS) coverage. The researchers came to a consensus that nurses need further training on herbal medicine to enhance herbal medicine use at the hospital. Health professionals need to collaborate with herbal medicine service providers and NHIS must be reviewed to cover herbal medications.

The Nurse or Midwife at the Crossroads of Caring for Patients With Suicidal and Rigid Religious Ideations in Africa.

Nurses and midwives are the majority of healthcare professionals globally, including Africa, and they provide care at all levels of the health system including community levels. Nurses and midwives contribute to the care of patients with rigid or dogmatic religious beliefs or those with suicidal ideations. This review paper discusses acute and chronic diseases that have suicidal tendencies such as terminal cancer, diseases with excruciating pain, physical disability, stroke, end-stage renal failure, and diabetics who are amputated. It was reiterated that nurses and midwives taking care of these patients should be alert and observant to identify their suicidal tendencies. The paper also discusses religious or spiritual inclinations that negatively affect healthcare access and adherence, especially to biomedical or western medicine. It was emphasized that some religious beliefs do not allow their followers to employ biomedical treatment and nurses and midwives should not impose their faith on patients and their families. The paper ends with a discussion on the specific roles of nurses and midwives in the care of patients with suicidal ideations such as assessment, counseling, administering medication, observation, social interaction, ensuring safety measures, and providing an enabling environment for the family to part of the care and for the observation of religious coping strategies. Nurses and midwives should enhance their knowledge and skills on suicide and increase public education on suicide prevention and identification of those at risk.

A qualitative exploration of the norms and intentions of nurses toward the clinical use of herbal medicine in Ghana.

PURPOSE: The purpose of the study was to determine the norms and intentions of nurses towards the clinical use of herbal medicine. METHOD: Information on nurses' demographics, norms and intentions was gathered through individual face-to-face interviews. Interviews were analysed using the process of content analysis. RESULTS: Beliefs of the nurses and motivational factors formed their norms. The nurses believed herbal medicine was God-given and was used by their ancestors with good outcomes. Some were self-motivated to serve herbal medicine while others counted on patient's recovery upon the use of herbal medicine to motivate them. Positive and negative intentions were discovered; thus, preparedness and unpreparedness to serve herbal medicine in the future. CONCLUSIONS: Though some nurses believe herbal medicine is God-given, used by their ancestors and motivated to serve, others were unwilling because of inadequate training. Training of professional nurses on herbal medicine may improve their negative intentions.