Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review.

Mental health problems, particularly depression and anxiety, are common in women and young girls living with HIV/ AIDS particularly in low- and middle-income (LMICs) countries where women's vulnerability to psychiatric symptoms is heightened due to the prevalent intersectional stressors such as stigma and intimate partner violence. However, no synthesized evidence exists on the mental health burden of females living with HIV/AIDS (FLWHA) in Africa. This systematic review aimed to synthesize the current evidence on the mental health burden among FLWHA in sub-Saharan Africa. A systematic literature review of articles published from 2013-2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Five electronic databases; PubMed, MEDLINE with full text, Scopus, Academic Search Complete, and Health Source: Nursing Academic Edition were searched for articles published in English. Nineteen articles (15 quantitative, 3 qualitative, and 1 case study) from over 7 African countries met the inclusion criteria. The majority of the studies' quality was determined to be moderate. The prevalence of depression ranged from 5.9 to 61% and anxiety from 28.9 to 61%. Mental health burden was a logical outcome of HIV diagnosis. Predictors of mental health outcomes in the context of HIV/AIDS were identified as intimate partner violence (IPV), stigma, childhood traumas, sexual abuse, poverty, unemployment, and social isolation. Social support and resilience were identified as protective factors against mental illness in FLWHA. Mental illness had a deleterious effect on viral suppression rates among FLWHA, resulting in delayed initiation of antiretroviral therapy treatment and increased mortality but had no impact on immune reconstitution in the face of ART adherence. Given the high prevalence rates of depression and anxiety and their relationship with HIV progression, it is crucial that mental health care services are integrated into routine HIV care.

Work-related psychosocial challenges and coping strategies among nursing workforce during the COVID-19 pandemic: a scoping review.

BACKGROUND: Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O'Malley's review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them. METHODS: We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria. RESULTS: Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping. CONCLUSIONS: The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

Exploring social media adoption by nurses for nursing practice in rural Volta, Ghana.

AIM: The purpose of the study was to inquire into social media adoption by nurses for nursing practice. DESIGN: An exploratory descriptive qualitative design was employed in understanding social media adoption for nursing care among nurses. METHOD: A purposive sampling technique was employed to recruit 12 participants for the study. A semi-structured interview guide was used to conduct in-depth interviews which were audiotaped, transcribed verbatim, coded and analysed. Thematic analysis was used to analyse the data with NVivo 12. RESULTS: The findings revealed nurses found social media to be useful for the dissemination, and reception of information, professional development and enhanced referral networks. Apart from its usefulness, participants believe that it is easy to navigate its apps, clear and understandable to use and does not involve much mental effort hence their favourable attitude towards use. Some participants also believe that inaccurate information, privacy and confidentiality concerns, distraction and addiction were some potential risks that are associated with its usage in nursing practice. Due to this, some participants developed a negative attitude towards its usage. PATIENT OR PUBLIC CONTRIBUTION: Twelve nurses actively participated in the study.

Perception of nurses on the use of mobile phone text messaging for the management of diabetes mellitus in rural Ghana.

AIM: This study aims to explore the perception of nurses on the use of mobile phone SMS for managing diabetes in rural Ghana. DESIGN: Exploratory Descriptive Qualitative Design. METHODS: Purposive sampling was used to recruit (13) participants relative to data saturation after ethical clearance (REDACTED); using a semi-structured interview guide. All interviews were transcribed verbatim and analysed using thematic content analysis. RESULTS: Participants believe SMS was useful in facilitating interaction between nurses, clients, family and statistically significant others; improving medication adherence and supporting blood glucose monitoring. The use of infographics was preferred to traditional SMS among digitally literate patients and voice calls for those who were illiterate. Participants had limited knowledge of downloadable diabetic applications. Participants were willing to accept and use SMS for the management of diabetes mellitus. PATIENT OR PUBLIC CONTRIBUTION: Thirteen nurses actively participated in the study.

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.

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.

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.

A Descriptive Exploratory Study of the Causes and Effects of Hypertension Among Ghanaian Soldiers and Their Families.

Introduction: The quality of life of any soldier can be affected by a simple diagnosis of Hypertension. Hypertension has not been directly linked to a single cause; however, knowing the associated risks and early diagnosis can help with its management. This study aimed to explore and describe the causes of hypertension among soldiers and its effects on their families. Objectives: To explore and describe the causes of hypertension and its effects on soldiers and their families. Methods: A qualitative technique and an exploratory descriptive design were used in this study. At saturation, a total of 10 soldiers were face-to-face interviewed and gathered data simultaneously transcribed and subjected to a content analytic method of analysis. Participants approved being audio recorded on tape with an audio recording device. Results: Effects of hypertension on personal lives of soldiers, effects of hypertension on family life, and effects of hypertension on social life were identified as the causes and risk factors of hypertension among the soldiers. These themes are further expanded by their subthemes in the areas of decreased physical activity including sex life, decrease interaction with family, and isolation from friends. Conclusion: This study revealed that hypertension does have effects on one's personal life, family life, and social life. Hence, it is recommended that frequent health education on hypertension and its effects should be organized in the various Garrisons by the public health department for all soldiers and their families. Screening programs should be organized for early hypertension detection. Soldiers should be educated on appropriate eating habits, weight and financial management, and reduction in tobacco and alcohol.

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.

Cognitive and emotional illness representation of people with chronic hepatitis B in Ghana: A qualitative inquiry.

Hepatitis B remains a public health concern in Ghana, with an estimated prevalence of 8.4% in adults and 14.3% in adolescents. This study explored the cognitive and emotional illness representations of persons with chronic hepatitis B who sought care at a tertiary hospital's liver clinic in Ghana. A qualitative exploratory descriptive design was adopted, and 15 participants were purposefully chosen for in-person interviews. The data was analyzed using the content analysis procedure. The findings revealed that participants' cognitive representations of hepatitis B infection varied. Some believed they got the infection through unsafe sexual practices, while others thought it was from their mother or spiritual sources. Participants' predominant emotional representations included shock, confusion, and fear. Education about the causes and management of hepatitis B should be addressed as part of patient care.

Midwives Experiences of Managing Clients with Eclampsia in a low Resource Setting: A Qualitative Descriptive Study.

Objective: Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives' experiences in managing patients with eclampsia in Ghana. Methods: This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings: The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives' attitude, and client education. Conclusion: Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.

Number of students in clinical placement and the quality of the clinical learning environment: A cross-sectional study of nursing and midwifery students.

BACKGROUND: Clinical placement is an important component of nursing and midwifery education. It exposes students to the real-world healthcare environment, where theoretical knowledge is put into practice. However, the quality of the clinical learning environment in sub-Sahara Africa has not been well explored. OBJECTIVE: The objectives of this study were to assess trainees' perceptions of the number of students on the ward or clinical unit, and the quality of the clinical learning environment. DESIGN: Cross-sectional survey. SETTING: Nursing and midwifery students were recruited from three public hospitals in the Upper East Region, Ghana, between July and August 2019. PARTICIPANTS: 254 nursing and midwifery students were recruited using the convenience sampling technique. METHODS: Data were collected with the Clinical Learning Environment and Supervision + Nurse Teacher questionnaire. Data were analysed using univariate, bivariate and multivariable analyses. RESULTS: It was found that the participants rated supervisory relationship; pedagogical atmosphere; role of nurse teacher; leadership style of ward managers; and premises of care on the ward as average. Students' perceptions of the quality of the clinical learning environment were predicted by supervisory relationship (ß = 0.219, 95% CI: 0.016-0.070), leadership style (ß = 0.199, 95% CI: 0.011-0.133) and perception of number of students in clinical placement (ß = 0.224, 95%CI: 0.022-0.093). The trainees indicated that the number of students on the ward did not correspond with the amount of medical equipment and supervisors. CONCLUSION: The quality of the clinical learning environment was perceived to be suboptimal. Leadership style, supervisory relationship and perception of the number of students on the ward were the salient factors that influenced students' perceptions of the quality of the clinical learning environment. Leaders of nursing and midwifery training institutions must liaise with stakeholders to enhance the quality of the clinical learning environment.

The Experiences of Ghanaian Midwives on the Use of Nonadjustable Delivery Beds: A Qualitative Study.

BACKGROUND: Hospital beds are of great assistance to both clients and caregivers as they give lots of choices to the users. More often, clients have difficulty getting in and out of beds, but the adjustable features of the beds make it possible for them to be comfortable, regardless of their condition. This situation may not be the same if nonadjustable delivery beds (NADBs) are used in conducting deliveries at health care facilities. This study explored the experiences of midwives using NADBs in selected Christian Health Association of Ghana (CHAG) hospitals in the Volta Region of Ghana. METHODS: The study employed an exploratory qualitative research design with purposive sampling. Semistructured interview data were audio recorded. The inclusion criteria were professional midwives with at least 1 year of working skills and the midwives should have conducted deliveries using NADBs during their practice. Data were collected concurrently with data transcription and analyzed using content analysis. Saturation was reached after the 20th interview. RESULTS: Three themes emerged from the study: NADBs not comfortable to work with, assumption of awkward postures, and the nature of the delivery beds. CONCLUSION: The findings of the study show that midwives experience several setbacks in the use of NADBs in conducting deliveries as they sacrifice their health for work.

Nurses' and midwives' perspectives on participation in national policy development, review and reforms in Ghana: a qualitative study.

BACKGROUND: The World Health Organization has admonished member countries to strive towards achieving universal health coverage (UHC) through actionable health policies and strategies. Nurses and midwives have instrumental roles in achieving UHC via health policy development and implementation. However, there is a paucity of empirical data on nurses and midwives' participation in policy development in Ghana. The current study explored nurses and midwives' participation in policy development, reviews and reforms in Ghana. METHODS: A qualitative descriptive exploratory design was adopted for this study. One-on-one individual interviews were conducted after 30 participants were purposefully selected. Data was audiotaped with permission, transcribed and analyzed inductively using the content analysis procedures. RESULTS: Two main themes emerged from the data: participation in policy development and perspectives on policy reviews and reforms. The findings showed that during health policy development and reviews, nurses in Ghana were overlooked and unacknowledged. Policy reforms regarding bridging the pre-service preparation gap, staff development and motivation mechanisms and influence on admission into nursing schools were raised. CONCLUSION: The authors concluded that nurses and midwives are crucial members of the healthcare systems and their inputs in policy development and reviews would improve health delivery in Ghana.

'I don't want to think about it': Psychosocial experiences of road traffic accident survivors in Ghana.

INTRODUCTION: Road traffic injuries are among the top ten traumatic events that affect the psychosocial wellbeing and quality of life of survivors. The aim of this study was to explore the experiences of road traffic accident survivors in Ghana, a low-middle-income country in sub-Saharan Africa. METHODS: The study adopted an interpretive qualitative research design. Thirteen (13) participants were purposively selected from the Accident Centre of the largest public teaching hospital in Ghana. Data collection employed in-depth face-to-face interviews using a semi-structured guide. Data analysis occurred concurrently using thematic analysis methods. The right to participate or withdraw from study was protected. FINDINGS: Three major themes deductively generated from the research were cognitive experiences, affective responses and social experiences of Road Traffic Accident survivors. Nearly all survivors of road traffic accidents experience repetitive episodes of intrusive thoughts, nightmares, anxiety and other extreme emotions suggesting post-traumatic stress, which is often unrecognized. CONCLUSION: Immediate reactions of survivors of road traffic accident are affected by their experiences, accessibility of support, and the responses of the larger community. We propose that a focused assessment and management of accident survivors for post-traumatic disorder be included in existing care modalities to promote a holistic care and recovery for survivors.

Promoters and inhibitors of treatment adherence among HIV/AIDS patients receiving antiretroviral therapy in Ghana: Narratives from an underserved population.

Adherence to antiretroviral therapy (ART) is essential to achieving an improved cluster of differentiation-4 (CD4) count, viral load, and quality of life while preventing drug resistance. Medication adherence among people living with Human Immunodeficiency Virus (HIV) is influenced by different factors. Several studies have identified adherence promoters and inhibitors that emanate from the internal and external environment. We conducted six (6) individual in-depth interviews and three (3) focus group discussions to explore adherence behaviour among patients diagnosed with HIV in a teaching hospital in Accra, Ghana. Participants were drawn from the intervention arm of a mobile phone adherence intervention program. They had been enrolled in the study for at least six (6) months before the interviews are conducted. Results revealed that participants adhered to treatment irrespective of prompts from significant others. Adherence promoters included perception of ART as part of daily routines, benefits of the ART, awareness of regimen, access to food, and transparency. Adherence inhibitors were forgetfulness, secrecy, waiting time, religious beliefs, and sleep. People living with HIV (PLWHIV) have the personal motivation to take medication; however, negative perceptions about HIV must be addressed to ensure optimum adherence behaviour.

Effects of perceived workplace politics in hospitals on nurses' behavioural intentions in Ghana.

AIM: To examine the effects of perceived workplace politics in hospitals on nurses' job satisfaction, commitment, exit intention, job neglect, absenteeism and performance. BACKGROUND: One of the factors contributing to nurses' poor advancement in clinical practice is the existence of petty politics, which has given rise to competing self-interest. However, little evidence exists to inform policy direction on the implication of politics on nurses' behaviour. METHOD: A total of 610 nurses comprising associate and nursing professionals completed a structured questionnaire modelled on workplace politics and its outcome variables. Descriptive statistics and mean comparisons were used to analyse data. A multivariate regression model was computed to examine association between perceived politics and nurses' behavioural intentions. RESULT: Perceived politics potentially leads to decline in job satisfaction, commitment and work performance. However, perceived workplace politics is associated with high intention to leave, negligent behaviour and absenteeism. CONCLUSION: Measures aimed at improving nursing management and health-care delivery should be directed at minimising the use of politics to promote self-interest. IMPLICATION FOR NURSING MANAGEMENT: Evidence-based best practices in nursing management centred on the creation of an enabling environment for nurses to participate in decision-making should be given critical attention.