Challenges to the delivery and utilisation of child healthcare services: a qualitative study of the experiences of nurses and caregivers in a rural district in Ghana.

BACKGROUND: Sub-Saharan Africa has one of the poorest child health outcomes in the world. Children born in this region face significant health challenges that jeopardise their proper growth and development. Even though the utilisation of child healthcare services safeguards the health of children, the challenges encountered by nurses in the delivery of services, and caregivers in the utilisation of these services, especially in rural areas, have contributed to poor child health outcomes in this region. AIM: This study explored the experiences of nurses and caregivers in respect of the nursing human resource challenges to the delivery and utilisation of child healthcare services in a rural district in Ghana. METHODS: Individual qualitative interviews were conducted with ten nurses, who rendered child healthcare services; nine caregivers, who regularly utilised the available child healthcare services; and seven caregivers, who were not regular users of these services. These participants were purposively selected for the study. Data were collected using individual semi-structured interview guides and analysed qualitatively using content analysis. Themes and sub-themes were generated during the data analysis. The Ghana Health Service Research Ethics Review Committee and the Nelson Mandela University's Research Ethics Committee approved the study protocol prior to data collection. RESULTS: Three main themes emerged from the data analysis. Theme One focused on the shortage of nurses, which affected the quality and availability of child healthcare services. Theme Two focused on inexperienced nurses, who struggled to cope with the demands related to the delivery of child healthcare services. Theme Three focused on the undesirable attitude displayed by nurses, which discouraged caregivers from utilising child healthcare services. CONCLUSION: Nurses contribute significantly to the delivery of child healthcare services; hence, the inadequacies amongst nurses, in terms of staff numbers and nursing expertise, affect the quality and availability of child healthcare services. Also, caregivers' perceptions of the quality of child healthcare services are based on the treatment they receive at the hands of nurses and other healthcare workers. In this respect, the bad attitude of nurses may disincentivise caregivers in terms of their utilisation of these services, as and when needed. There is an urgent need to comprehensively address these challenges to improve child healthcare outcomes in rural areas in Ghana. Relevant authorities should decentralise training workshops for nurses in rural areas to update their skills. Additionally, health facilities should institute proper orientation and mentoring systems to assist newly recruited nurses to acquire the requisite competences for the delivery of quality family-centred care child healthcare services.

Nurses' knowledge regarding recommended practices on using surgical attire in operating theatre.

Background: To reduce the risk for surgical site infections, nurses in the operating theatre environment must have knowledge of and adhere to recommended practices regarding the use of surgical attire. Aim: To evaluate the effect of an educational intervention on nurses' knowledge related to recommended practices regarding the use of surgical attire in operating theatre. Setting: Operating theatres in two public and two private hospitals in the Eastern Cape province, South Africa. Methods: An educational pilot study, using a quasi-experimental, two-group pre- and post-test design, was conducted. A convenience sample of n = 85 nurses was purposively allocated to a control group and an intervention group. An existing educational intervention consisting of an interactive training session, brochures based on the Association of periOperative Registered Nurses' (AORN) guidelines and a summary of these guidelines was implemented for the intervention group, while the control group received only the summary of the guidelines. Data were collected through self-administered pre- and post-test questionnaires from March 2019 to August 2019. Results: The overall knowledge score for nurses in the intervention group post-intervention improved with a large significance (p ≤ 0.000 and Cohen's d = 1.26). Conclusion: The intervention has shown potential to improve the knowledge related to recommended practices of nurses in operating theatres regarding the use of surgical attire. Contribution: This pilot study encourages the implementation of the intervention on the use of surgical attire but requires further development and a wider implementation to measure its impact, and access to resources, enhancing and sustaining its success.

Exploring the challenges of public health nurses in the management of infertility in Northern Ghana: a qualitative descriptive study.

OBJECTIVE: To explore the challenges public health nurses (PNHs) face in managing infertility in rural settings of the Talensi and Nabdam districts in the Upper East Region of Ghana. DESIGN: The study adopted a qualitative descriptive design approach where PHNs who worked in rural settings were interviewed using a semistructured interview guide. Thematic analysis was employed to analyse the data. SETTING: Primary healthcare setting in the Upper East Region of Ghana. PARTICIPANTS: The study participants were 15 PHNs working in primary health centres with a mean age of 36.9 years (SD=6.40). RESULTS: This study revealed that couples with infertility issues face challenges in seeking care for their condition. The challenges expressed by the participants that affect individual and couples' access to infertility care were (1) lack of material and human resources, (2) lack of specialists and guides for infertility treatment and (3) inadequate and inconsiderate communication. CONCLUSION: This study provides evidence of the challenges experienced by PHNs in managing infertility among couples. Adequate measures are therefore required to ameliorate these challenges to improve care provision for couples with infertility.

Home-based care of stroke patients in rural Zimbabwe: Knowledge of caregivers.

OBJECTIVES: To describe and explore the knowledge and practices of primary caregivers and information they get from village health workers on infection prevention and control among home-based stroke patients. MATERIALS AND METHODS: A descriptive and exploratory study was conducted on 200 primary caregivers and 200 village health workers selected using multistage random sampling method. Data were collected using questionnaires. Visual Basic for Applications package analysed the data and analysis of variance examined differences between demographic characteristics of participants. Chi-square test was used to determine whether the socio-demographic information and adequacy of information given were associated. Statistical significance was set at p < 0.05. RESULTS: Primary caregivers were not well informed of the measures to prevent chest infections and urinary tract infections as they rated themselves poor or very poor in practising these measures. There was a correlation between knowledge of prevention and control of infection to primary caregivers' level of education (chi-square=7.49; p=0.024), and residence (chi-square=72.33; p=0.001). There was an association between information given by village health workers on rated adequacy of information and information given on: chest infections (chi-square=20.65; p < 0.0005), skin infections (chi-square=13.42; p=0.009) and urinary tract infections (chi-square=19.20; p=0.001). The information given by village health workers to primary caregivers was also associated with residence (chi-square=107.15; p < 0.0005). CONCLUSION: Overall, primary caregivers had limited knowledge of infections in home-based stroke patients while the village health caregivers seldom gave them the necessary information. With the necessary training home-based care of stroke patient in Zimbabwe may improve.

Screening and diagnosis of women for chorioamnionitis: An integrative literature review.

OBJECTIVE: This integrative literature review provides an overview of current best research evidence on the screening and diagnosis of women for chorioamnionitis, as no current review has been conducted. An overview of best practices on screening and diagnosis of women for chorioamnionitis can assist midwives with an accurate diagnosis, allowing for early referral and adequate management of this infection. DESIGN: An integrative literature review was conducted using a systematic electronic literature search through EBSCOhost (CINAHL with Full Text, e-Book Collection, Health Source: Nursing/Academic Edition, MEDLINE, Open Dissertations and PsycINFO), Cochrane Online, PubMed, Scopus, followed by a manual search for grey literature using Google and a citation search. Guidelines, research studies, and reports in English related to chorioamnionitis from 2008 up until 2020 were included in the study. FINDINGS: After critical appraisal, using the Joanna Briggs Institution's checklists, Evaluation Tool for Quantitative Research Studies' tool and the Appraisal of Guidelines for Research & Evaluation instrument, 31 articles were included. More than half (64%) of the literature included ranked on the three highest levels of evidence (Level I, II and III). Data extracted regarding screening and diagnosis of women for chorioamnionitis was synthesised into four themes, namely: screening by clinical signs and symptoms, screening by causative factors of chorioamnionitis, screening of obstetric history, and essential biomarkers to diagnose chorioamnionitis. KEY CONCLUSIONS: Screening and recording of any risk factors will assist midwives in providing tailored health education to possibly prevent causative factors that could lead to chorioamnionitis. Although matrix-metalloproteinase-8 (MMP-8) seems the most suitable test to use for screening, an accurate diagnosis of chorioamnionitis requires a combination of screening methods and tests, such as clinical signs and symptoms, maternal biomarkers, amniotic fluid testing and histology. Screening for chorioamnionitis, particularly the parameters for maternal fever as a clinical symptom of chorioamnionitis, contributing factors and microbes responsible for chorioamnionitis, the usability of MMP-8 and the development of rapid, inexpensive, easy-to-use techniques for screening and diagnosis of chorioamnionitis, warrants further research. IMPLICATIONS FOR PRACTICE: Findings can be used by midwives in the screening and diagnosis of women for chorioamnionitis which allows for early referral and adequate management before maternal and neonatal complications arise.

Socio-cultural barriers to the delivery and utilisation of child healthcare services in rural Ghana: a qualitative study.

BACKGROUND: Over half of global deaths among children under five years of age occur in sub-Saharan Africa. Prompt and consistent access to and utilisation of child healthcare services improves child health outcomes. However, socio-cultural barriers impede the utilisation of child healthcare services among rural dwellers in Ghana. There is a paucity of studies that explore the experiences of nurses and caregivers regarding the socio-cultural barriers to the delivery and utilisation of child healthcare services in rural areas in Ghana such as the Nkwanta South Municipality. PURPOSE: The purpose of this study was to explore the experiences of nurses and caregivers regarding the socio-cultural barriers that impede the delivery and utilisation of child healthcare services by caregivers for their children in the Nkwanta South Municipality, Ghana. METHODS: Data were collected through semi-structured interviews conducted with a purposive sample of ten nurses and nine caregivers of children under five years of age who utilised the available child healthcare services in a rural setting. The consent of all participants was sought and given before interviews were conducted. Data analysis entailed coding and the generation of themes the codes. RESULTS: The exploration of experiences of nurses and caregivers of children under-five years of age revealed that certain socio-cultural beliefs and practices, language barriers and reliance of caregivers on self-medication were the main socio-cultural barriers that impeded the delivery and utilisation of child healthcare services in the Nkwanta South Municipality. CONCLUSION: Nurses and caregivers experienced several socio-cultural barriers which either delayed care seeking by caregivers for their sick children or interfered with the smooth and prompt delivery of needed child healthcare services by nurses. Some of the barriers negatively affected the interaction between nurses and caregivers with the tendency to affect subsequent child healthcare service utilisation. It is recommended that healthcare managers and nurses should foster close collaboration with caregivers and community leaders to address these socio-cultural barriers and facilitate prompt and consistent utilisation of child healthcare service in rural areas.

Integrative literature review of evidence-based patient-centred care guidelines.

AIM: To summarize what facilitates patient-centred care for adult patients in acute healthcare settings from evidence-based patient-centred care guidelines. DESIGN: An integrative literature review. DATA SOURCES: The following data sources were searched between 2002-2020: Citation databases: CINAHL, Medline, Biomed Central, Academic Search Complete, Health Source: Nursing/Academic Edition and Google Scholar. Guideline databases: US National Guideline Clearinghouse, Guidelines International Network, and National Institute for Health and Clinical Excellence (NICE). Websites of guideline developers: Scottish Intercollegiate Guidelines Network, Royal College of Nurses, Registered Nurses Association of Ontario, New Zealand Guidelines Group, National Health and Medical Research Council, and Canadian Medical Association. REVIEW METHODS: Whittemore and Knafl's five-step integrative literature review: (1) identification of research problem; (2) search of the literature; (3) evaluation of data; (4) analysis of data; and (5) presentation of results. RESULTS: Following critical appraisal, nine guidelines were included for data extraction and synthesis. The following three groups of factors were found to facilitate patient-centred care: 1) Patient care practices: embracing values foundational to patient-centred care, optimal communication in all aspects of care, rendering basic nursing care practices, and family involvement; 2) Educational factors: staff and patient education; and 3) Organizational and policy factors: organizational and managerial support, organizational champions, healthy work environment, and organizational structures promoting interdisciplinary partnership. CONCLUSION: Evidence from included guidelines can be used by nurses, with the required support and buy-in from management, to promote patient-centred care. IMPACT: Patient-centred care is essential for quality care. No other literature review has been conducted in the English language to summarize evidence-based patient-centred care guidelines. Patient care practices and educational, organizational, and policy factors promote patient-centred care to improve quality of care and raise levels of awareness of patient-centred care among nursing staff and patients.

Experiences and mentoring needs of novice nurse educators at a public nursing college in the Eastern Cape.

BACKGROUND: When novice nurse educators enter academia, they are expected to demonstrate and implement knowledge in the clinical and classroom environment. However, when one enters academia without proper guidance and support, these expectations create lack of role models. Although mentorship has proved to make the transition easier, there is a lack of mentoring in most nursing schools and/or departments at higher education institutions in South Africa because of scarcity of mentoring programmes for novice nurse educators. AIM: The aim of this study was to explore and describe the experiences and mentoring needs of novice (newly qualified) nurse educators at a public nursing college in the Eastern Cape, to make recommendations for the mentoring of novice nurse educators. SETTING: Urban and rural public nursing college campuses and sub-campuses in the Eastern Cape. METHODS: Qualitative research approach and exploratory, descriptive, contextual and phenomenological designs were used. Sampling was purposive, data were collected by using semi-structured individual interviews and analysed using Tesch's method. RESULTS: Five themes emerged from this study. Findings indicated that novice nurse educators experienced lack of theoretical and clinical mentoring and lack of orientation and resources. Participants also provided recommendations to optimise the experience and performance of novice nurse educators. CONCLUSION: Lack of mentoring causes difficult transition by novice nurse educators from the nursing role into the nurse educator role. The implementation of the recommendations on mentoring of novice nurse educators would optimise the experience and performance of the novice nurse educators, thus enhance their smooth transition into academia.

Job satisfaction of nurses working in public hospitals: perceptions of nurse unit managers in South Africa.

BACKGROUND: Job satisfaction among nurses often determines whether they choose to remain in the profession or in the facility where they work. AIM: The study sought to explore and describe the job satisfaction of registered nurses in South Africa through the lens of their nurse unit managers. METHODS: A qualitative, exploratory, descriptive design was undertaken. Fourteen unit managers were interviewed and Tesch's method of data analysis was used. FINDINGS: Four themes emerged: 'staff shortages lead to nurses feeling overwhelmed and frustrated', 'nurses' work performance is undermined by limited resources and poor infrastructure', 'discontent among nurses with regard to poor top level and human resource management' and 'despite challenges, nurses experience rare moments of job satisfaction'. CONCLUSION: Unit managers need to find ways to enhance existing elements of job satisfaction by emphasising the nurse-patient relationship and teamwork among their staff in order to improve the overall job satisfaction of staff.

Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review.

Aims and objectives: An integrative literature review searched for, selected, appraised, extracted and synthesized data from existing available guidelines on the nursing management of gestational diabetes mellitus as no such analysis has been found. Background: Early screening, diagnosis and management of gestational diabetes mellitus are important to prevent or reduce complications during and postpregnancy for both mother and child. A variety of guidelines exists, which assist nurses and midwives in the screening, diagnosis and management of gestational diabetes mellitus. Design: An integrative literature review. Methods: The review was conducted in June 2018 following an extensive search of available guidelines according to an adaptation of the stages reported by Whittemore and Knafl (2005, Journal of Advanced Nursing, 52, 546). Thus, a five-step process was used, namely formulation of the review question, literature search, critical appraisal of guidelines identified, data extraction and data analysis. All relevant guidelines were subsequently appraised for rigour and quality by two independent reviewers using the AGREE II tool. Content analysis was used analysing the extracted data. Results: Following extraction and analysis of data, two major themes were identified from eighteen (N = 18) guidelines. These were the need for early screening and diagnosis of gestational diabetes mellitus and for nursing management of gestational diabetes mellitus (during pregnancy, intra- and postpartum management). Various guidelines on the nursing management of gestational diabetes mellitus were found; however, guidelines were not always comprehensive, sometimes differed in their recommended practices and did not consider a variety of contextual barriers to the implementation of the recommendations. Conclusion: Critically, scrutiny of the guidelines is required, both in terms of the best evidence used in their development and in terms of the feasibility of implementation for its context. Relevance to clinical practice: This study provides a summary of best practices regarding the diagnosis, screening and nursing management of gestational diabetes mellitus that provide guidance for nurse-midwives on maternal and postpartum follow-up care for women at risk or diagnosed with gestational diabetes mellitus.