Evidence-Based Nursing Research is an international scientific open access, fully refereed journal published by EEP (https://eepublisher.net/). Our mission is to promote excellence in nursing and health care through the dissemination of evidence-based and peer-reviewed clinical information, original research, and discussion of relevant professional issues. EBNR provides an interdisciplinary forum for scholars of and from Africa and the Middle East region. Its contents cover both regional themes as well as global issues. EBNR will be published regularly four times a year in English. From day one, we set out to push the boundaries of Middle Eastern and African research to set a precedent for our scientific community
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Nursing Care for Thrombotic Thrombocytopenic Purpura: A Report of Six Cases
Context: Thrombotic thrombocytopenic purpura (TTP) is a rare, disseminated microvascular thrombosis-hemorrhagic syndrome with an extremely low incidence, rapid onset, and severe symptoms. The disease progresses rapidly, and if left untreated, it can lead to death. High-quality nursing management is crucial for ensuring patient prognosis during treatment. Currently, the development of nursing management systems for TTP patients has received relatively little attention, and evidence-based experience in TTP nursing interventions is limited. Aim: To summarize and analyze the nursing management experience of six patients with thrombotic thrombocytopenic purpura (TTP), focusing on key strategies such as emergency care, therapeutic plasma exchange (TPE) coordination, medication monitoring, and psychological support, to provide practical references for improving clinical nursing quality and patient outcomes. Methods: A retrospective descriptive case series was conducted at Affiliated Hospital of Youjiang Medical University for Nationalities. Baise, Guangxi, China, including six patients with secondary Thrombotic Thrombocytopenic Purpura (TTP) admitted between May and September 2023. Data were obtained from medical records, laboratory reports, treatment documentation, and nursing care notes. Results: Following therapeutic plasma exchange and pharmacological treatment, combined with comprehensive nursing interventions—including emergency care, TPE-associated nursing management, medication monitoring, and psychological support—five patients showed significant clinical improvement and were successfully discharged, while one patient unfortunately succumbed to the disease. Conclusion: TTP is a rare, rapidly progressive, and critical thrombotic microangiopathy that requires early diagnosis, standardized treatment, and systematic nursing care. Based on the experience of six cases, the study recommends key strategies for treating TTP, including emergency care, plasma exchange, drug monitoring, and psychological support. The employed nursing approach is highly practical and can serve as a valuable reference for the clinical management and nursing care of similar cases.
Case study, nursing management, thrombotic thrombocytopenic purpura
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Predictors of Workplace Violence Against Nurses Working at A Tertiary Hospital in Kisumu, Kenya
Context: Workplace violence (WPV) is any act in which a person is abused, threatened, intimidated, or assaulted in their work environment. It could involve physical, verbal, or written threatening behaviour or physical attacks. Workplace violence against nurses is increasingly becoming a major problem globally. Because of the nature of their work, nurses are at increased risk of workplace violence. Aim: To assess predictors of workplace violence against nurses working at Jaramogi Oginga Odinga Teaching and Referral Hospital. Methods: The study employed a cross-sectional study design among 184 nurses randomly selected from Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Data were collected using a self-administered questionnaire with questions regarding sociodemographic characteristics, nature of their work, experience with workplace violence, and institutional factors that could be associated with workplace violence. Results: The nurses had a mean age of 37±9.5 years, with 62% being female. The majority (88%; n=162) were primary care nurses, 2(1.1%) were supervisors, and 20(10.9%) were in senior management. Workplace violence was reported by 70% of respondents working in the general surgery department (p<0.001). The presence of safety measures (p = 0.020), workplace violence measures (p<0.001), and the effectiveness of workplace violence management (p = 0.009) were significantly associated with a reduced risk of workplace violence. Conclusion: The study found a high prevalence of WPV among nurses working at a teaching hospital in Western Kenya. Working in the general surgery department, without adequate safety measures, significantly increased the risk of WPV. There is a need to understand institutional processes, procedures, and operations that reduce the likelihood of workplace violence in other hospital departments and apply these findings to the general surgery unit, where there was a higher prevalence of workplace violence.
Hospital, nurses, predictors, violence, workplace
Evaluation of Nurses' Competence in the Prevention of Peripheral Intravenous Cannula-Related Infections in Sub-County Hospitals, Eldoret, Kenya
Context: Peripheral intravascular cannula, commonly used in inpatient settings for intravenous treatments, are frequently linked to complications such as infections, which can harm patient health and increase healthcare costs. Aim: This study aimed to evaluate the competence of nurses in the prevention of cannula-related infections in newly upgraded sub-county hospitals. Methods: An Analytical cross-sectional design was employed across four sub-county facilities, with a quantitative approach used to describe and analyze the knowledge and skills of 86 nurses during the census. Direct observation was also conducted to determine whether nurses applied their theoretical knowledge and skills in practice. A structured questionnaire and observational checklist were used. Results: The study found that most nurses (87%) demonstrated adequate knowledge, correctly answering≥50% of the 10 knowledge items. The highest awareness was observed in areas such as skin preparation before cannula insertion (100%) and the use of non-sterile gloves and adherence to aseptic technique (97.7%). However, only 36.1% correctly knew the recommended time for cannula removal (12–72 hours), indicating a significant knowledge gap. Most nurses (70%) were skilled in performing intravenous therapy, including inserting, removing, and caring for a peripheral intravenous cannula. The overall competence was 66.3% in nurses who scored >50% in both knowledge and skills. Logistic regression further revealed that nurses with ≥10 years of experience were 1.53 times more likely to be competent (OR = 1.53; 95% CI: 1.36–1.72; p<0.001), and those with 5–9 years had 1.22 times greater odds (OR = 1.22; 95% CI: 1.17–1.81; p=0.050) compared to nurses with <5 years of experience. Conclusion: The study concluded that most nurses had adequate knowledge, particularly in key infection prevention practices such as skin preparation and aseptic technique. Notable gaps exist in specific areas of knowledge of the recommended cannula dwell time. Nursing experience was significantly associated with higher competence, underscoring the importance of continuous training and mentorship to bridge identified gaps. Enhancing nurses' clinical competence and knowledge in IV cannulation through improved training, regular audits, and interdisciplinary collaboration is recommended. It also highlights the need to bridge the gap between theory and practice to ensure effective infection prevention in the insertion, removal, and care of intravenous cannula.
Peripheral intravenous cannula, infection, prevention, nurses' competence
Midwives' Support and Its Influence on Weight Gain for Neonates Under Kangaroo Mother Care in Western Kenya
Context: The World Health Organization strongly recommends Kangaroo Mother Care due to its favorable effects on reducing mortality among low-birth-weight neonates weighing less than 2500 grams. This nursing procedure has been approved as a therapeutic intervention due to a lack of incubators. Midwives are strongly encouraged to focus on developing the skill while adopting a functional approach to enhance the overall well-being of neonates with low birth weight. Aim: The study aims to examine midwives’ support and its influence on weight gain among neonates undergoing Kangaroo Mother Care in the Western Kenya sample region. Methods: The study used an analytical cross-sectional design. This design combined both qualitative and quantitative methods to examine midwives' support and its influence on KMC outcomes in Western Kenya. A multi-stage sampling approach was applied to select 275 mothers of low-birth-weight neonates enrolled in KMC in Busia, Kisii, and Migori counties. Data were collected using structured questionnaires for mothers and 12 key informant interviews (KIIs) for midwives. Quantitative data were analyzed using SPSS version 26, and binary logistic regression was employed to assess the effect of midwives' support on neonatal weight gain, with a significance level set at p ≤0.05. Thematic analysis of qualitative data from the 12 KIIs provided additional insights into how midwives’ support influences KMC outcomes. Results: The timing of Kangaroo Mother Care initiation significantly influenced weight-gain criteria (ꭓ2=46.89, p<0.0001), with immediate initiation associated with better outcomes. Maternal satisfaction with KMC strongly correlated with meeting weight gain (ꭓ2=43.72, p<0.0001). Support from midwives (OR 2.47, p=0.001) and midwives' knowledge (χ²=36.84, p<0.0001), as well as timely feedback on the neonate's progress (OR =3.92, p=0.0001), were also associated with meeting daily weight gain targets. The midwives described their roles in supporting KMC and influencing weight gain: "As a midwife in the KMC unit, I provide direct care to the mother and the neonate, ensuring early initiation, proper positioning, immediate and continuous breastfeeding." This support influenced weight gain. Conclusion: The assistance of midwives is essential to maximize the benefits of KMC, particularly by supporting the timely initiation of KMC in low-birthweight neonates, providing knowledge about KMC to enable them to educate mothers, and advocating for their needs. The hospital administration should identify opportunities to strengthen KMC implementation and improve neonatal health outcomes by continuously updating midwives on current KMC practice.
Influence, Kangaroo Mother Care, low-birthweight, midwives, neonate, support, weight gain
Impact of the Chemotherapy-Induced Nausea and Vomiting on Functional Daily Living among Patients with Colorectal Cancer: A Narrative Review
Context: Chemotherapy-Induced Nausea and Vomiting (CINV) is a common and unpleasant negative consequence of cancer therapy among colorectal cancer patients. It has the potential to significantly impact the patient's quality of life and may lead to reduced adherence to established therapeutic guidelines. Aim: The study aims to explore the impact of chemotherapy-induced nausea and vomiting on functional daily living among patients with colorectal cancer. Methods: An extensive literature search was conducted utilizing various electronic databases to locate pertinent studies, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Online (MEDLINE), and Google Scholar. Results: The review indicates that colorectal cancer (CRC) is one of the most prevalent malignancies worldwide, with increasing incidence particularly in low- and middle-income countries such as Saudi Arabia. Risk factors include age, genetics, and family history, along with modifiable behaviors such as unhealthy diet, obesity, smoking, alcohol intake, and physical inactivity. While early CRC is usually asymptomatic, advanced disease manifests with rectal bleeding, obstruction, and systemic complications. Preventive strategies such as screening and lifestyle modification reduce morbidity and mortality, and treatment varies by stage, incorporating surgery, chemotherapy, targeted therapy, and immunotherapy. Chemotherapy-induced nausea and vomiting (CINV) remains a major challenge, impairing daily functioning and quality of life. Still, evidence supports a combination of pharmacological, non-pharmacological, and nursing interventions to improve patient outcomes. Conclusion: Chemotherapy-Induced Nausea and Vomiting (CINV) represent a prevalent and unpleasant negative consequence of cancer therapy among colorectal cancer patients. It can significantly affect the patient's quality of life and reduce treatment adherence. Therefore, a personalized approach to managing CINV should be implemented for colorectal cancer patients, tailored to each individual's specific needs and preferences. Ongoing research regarding new therapies and the optimization of existing management strategies is necessary to diminish the frequency and severity of CINV. These therapies lead to improved patient outcomes and enhanced quality of life.
Chemotherapy-induced nausea and vomiting, functional daily living, impact
Nurses’ Performance on Intravenous Fluid Therapy and Associated Factors for Adult Medical-Surgical Patients in Kisumu County, Kenya
Context: Adult inpatients need intravenous fluid therapy to prevent or correct fluid and electrolyte status. Global surveys on nurses' performance in intravenous fluid therapy revealed considerable gaps in knowledge and skills, highlighting an urgent need for education and awareness regarding intravenous fluids. Aim: The study aims to determine nurses’ performance on intravenous fluid therapy and associated factors for adult patients in selected referral hospitals in Kisumu County, Kenya. Methods: This study employed a cross-sectional analytical design. The study area was selected from hospitals in Kisumu County. The study population included nurses working in medical and surgical units. A total of 110 nurses were included in the study. The data were analyzed using SPSS version 28. The tools utilized were a structured interview questionnaire that collected data on respondents' demographics and knowledge of intravenous fluid, and an intravenous fluid administration checklist with 20 steps of intravenous fluid administration adopted from the Nursing Procedure Manual of the Nursing Council of Kenya. Results: A total of 110 nurses participated in the study. Most respondents were aged between 31 and 40 years (55.4%); the majority, 62.7%, worked in surgical units. The majority of participants had a high level of knowledge, at 74 (67.0%). According to the checklist, 96.4% of nurses were able to review patients' records to verify intravenous fluid orders and medical histories, and 87.3% explained the procedure to patients. Preparation of the infusion bag which included verification of expiry date, placing bag on a flat surface, removing protective cap from the tubing, insertion of spike, hold port firmly with one hand then insert spike with other hand, priming tubing, calculation of drops and regulation of drops, inspect the IV site for complication, leaving patient comfortable and clears equipment was done by all the participant 110(100%), documentation of condition of IV site and any change of dressing (0.0%), and documentation of flow rate (0.0%) was poorly done 108(98.2%) did not label the infusion bag, 70.9% did not document patient's condition during and after infusion, 56.4% did not evaluate fluid intake and output charts, overall 59.1% had unsatisfactory performance. Only work experience (p=0.05) was significantly associated with the level of nurses’ performance. Conclusion: The study concludes that nurses possess a high level of knowledge but a low level of practice in intravenous fluid therapy, with documentation being a particular area of concern, as evidenced by the respondents' inadequate documentation. The study recommends that nurses should be encouraged to participate in continuing professional development to stay updated on the latest knowledge and guidelines in intravenous fluid therapy. Additionally, the units should have an intravenous fluid mentor to provide guidance, aiming to improve performance.
Adult, factors, fluid therapy, intravenous, medical-surgical, nurses’ performance, patients
Factors Affecting Sleep Quality among Nursing Students at the Faculty of Nursing at King Abdulaziz University: A Cross-Sectional Study
Context: Sleep is a basic human requirement. Sleep quality varies from one person to another due to multiple factors, including environmental, biological, psychological, and social factors. Aim: This study aims to assess factors affecting sleep quality among nursing students at the Faculty of Nursing at King Abdulaziz University. Methods: A cross-sectional descriptive design was used. This study was conducted at the Faculty of Nursing, King Abdulaziz University (KAU), using a convenience sample of 217 nursing students. The Pittsburgh Sleep Quality Index (PSQI) and a questionnaire assessing factors affecting sleep quality were utilized. Results: The average nursing student's total score of PSQI was 5.04±3.63, which was affected by several statistically significant factors such as academic year (p=0.002), gender (p=0.005), snoring while sleeping (p=0.018), noisy bedroom (p=0.038), uncomfortable bed or pillow (p=0.004), uncomfortable room lighting while sleeping (p=0.022), financial stress (p=0.000), social pressure (p=0.000), psychological stress (p=0.000), study loads and heavy homework (p=0.000), living away from family member (p=0.000). Smoking late in the day (p=0.000), taking a long nap during the day (p=0.000), thinking of the next day's engagements before bed (p=0.000), using bed for non-sleep related activities (p=0.004), studying or working intensively until late at night (p=0.000), eating fatty foods before bed (p=0.041), and no consistent bedtime routine (p=0.000) were among the statically significant factors that affect the sleep of nursing students at Faculty of Nursing, King Abdulaziz University. Conclusion: The sleep quality of nursing students was low, and it is influenced by demographic, biological, environmental, psychosocial, and behavioral factors. The study recommends educating nursing students about the effects of poor sleep and sleep-enhancing strategies, in conjunction with academic counseling to improve study skills, stress management, and time management, thereby fostering a healthier academic environment.
Factors, nursing students, sleep quality
Relationship between Nurses’ Sexual Self-Concept and Performance of Sexual Health Care among Inpatients in South Rift, Kenya
Context: Sexual health is an essential component of human health and wellness, encompassing not only physical but also emotional and psychosocial well-being related to sexuality. This domain of life among hospitalized patients has, however, received little attention from health workers globally, with existing gaps between patients' care needs and sexual health services provided by nurses. Aim: This study determined the relationship between nurses’ sexual self-concept and performance of sexual health care among inpatients in the South Rift, Kenya. Methods: This study employed an analytical cross-sectional design, utilizing a self-administered questionnaire that was adapted to suit the study's aim. The study involved 171 nurses, drawn from a sample of 300 nurses working in medical and surgical units of level four and five hospitals in two counties. Results: The results showed that 65.5% of nurses had satisfactory performance in implementing sexual healthcare. Nurses' sexual self-concepts had a strong bearing on the performance of sexual health care (p-value =0.021; R Square=0.586) Conclusion: Nurses performed fairly in providing sexual health care services; however, there existed significant gaps related to nurses' sexual self-concept characteristics. A significant relationship was revealed between nurses’ self-concept and their performance of sexual health care. The study recommends that hospitals adopt guidelines to support the incorporation of sexual health care in every patient's routine care protocols in all clinical settings, and sexual health content should be expanded in nursing training curricular.
Inpatients, multidimensional, nurses' performance, sexual self-concept
Exploring Sleep Patterns of Children with ADHD: Mothers’ Perspectives in Saudi Arabia
Context: ADHD, a neuro-developmental disorder, is characterized by core psychopathological features including inattention, hyperactivity, and impulsivity. Sleep disturbances are commonly observed among children with ADHD, resulting in heightened consequences such as compromised impulse control, difficulties in sustaining attention, and long-term impacts on academic performance, social interactions, and overall well-being. Aim: Explore the sleep patterns of children with ADHD from their mothers’ perspectives in Saudi Arabia. Methods: A quantitative, cross-sectional research methodology was employed in this study, with a sample comprising 103 mothers whose children have been affected by ADHD. Data for the study was obtained through the utilization of online structured questionnaires as the primary data collection tool. Results: The study reveals that more than half of the children, specifically 58%, fell within the 6-12-year-old age range, boys constituted the predominant group, accounting for 74% of the children. 18% of mothers reported their children usually had sleeping problems, 49% reported their children had sleeping problems. 87% of mothers do not know about ADHD disorder, also 44% of them do not know about sleep problems. In terms of maternal interventions, a significant proportion of participants, namely 89%, took proactive measures, such as reading stories (89%), maintaining consistent sleep schedules, and creating a serene environment, as reported by 74% of the participants. The study identified several challenges associated with sleep, with bedtime resistance being the most reported issue at 74%. Conclusion: A significant number of mothers reported that their children with ADHD often experience significant sleep disturbances. This finding is particularly evident in boys aged 6 to 12, who are more susceptible to both ADHD symptoms and related sleep issues. Addressing these sleep challenges is crucial for improving their overall well-being. Parents need to understand the relationship between sleep disturbances and ADHD to implement healthy sleep habits. Interventions such as reading bedtime stories, co-sleeping, and adjusting head positions can be beneficial.
ADHD, children, mothers, Saudi Arabia, sleep pattern
Community Level Factors Influencing Contraceptives Use among Pastoralist Women in West Pokot County, Kenya: A Community-Based Cross-Sectional Study
Context: Family planning is an essential aspect of reproductive health, crucial for controlling population growth, improving maternal and child health, and empowering women. However, its use in the pastoralist communities is still low. There is limited evidence about the determinants for non-utilization of contraceptives by marginalized populations. Aim: The study assesses community-level determinants affecting contraceptive usage among pastoralist women in West Pokot County, Kenya. Methods: The study employed a community-based, cross-sectional, correlational design involving 578 women aged 15–49 years. Multistage sampling was used, with 40 out of 115 community units being sampled. Quantitative data were gathered through a structured interview questionnaire, while the key informant guide and focused group discussion guide were used for qualitative data. Results: The study shows that 328(56.7%) of the respondents were aged between 14 and 29 years. The majority, 514(88.9%) of the respondents were married, and only 33(5.7%) were singles. The findings reveal religion support (p<0.001), cultural support (p<0.039), discussion with spouse (p<0.001), person who decided number of children (p<0.043), type of health facility seeking services from, and instances that could not access Family Planning method were associated with the uptake (p<0.05). Religion support (OR= 1.80; 95% CI: 1.31-2-46), cultural support (OR= 1.54; 95% CI: 1.02-2.32), discussion on family planning method with husband (OR= 2.46; 95% CI: 1.8- 3.37), who decides number of children jointly (OR=1.48; 95% CI: 1.00-2.17, p=0.043), and type of health facility seeking family planning services, private clinic (OR= 1.99; 95% CI: 0.99-3.97, p=0.051) and faith based facility (OR= 2.91; 95% CI: 1.26- 6.72, p=0.012) were markedly correlated with the use of family planning. Qualitative data identified distance and cost as significant barriers to accessing family planning. A participant had this to say: “You can get family planning methods in a government hospital, but it is not always easy to get there because it is far (distance) from where we live...". Conclusion: The study concludes that socio-cultural factors and social norms influence the use of contraception within the pastoral community; their culture favors large families, gives men and mothers-in-law a say in making reproductive health choices. Health system factors were also identified as influencing family planning uptake; facility type and distance to a health facility were major factors.
Contraceptive use, community, pastoralist, West Pokot, women
Paternalistic Leadership Training Program and Its Effect on Nurse Managers' Organizational Citizenship Behavior
Context: Paternalistic leadership behavior emphasizes traditionally based authority and familial-based relationships by promoting work engagement, empowerment, loyalty, and trust in healthcare organizations. Additionally, it enhances organizational citizenship behavior by guiding activities that contribute to achieving organizational goals. Aim: This study was conducted to investigate the impact of a paternalistic leadership training program on the organizational citizenship behavior of nurse managers. Methods: A quasi-experimental research design (one-group pre-/post-test) was employed. The study setting was at Ain Shams University hospitals (Ain Shams University Hospital, El-Demerdash Hospital, Obstetrics and Gynecological Hospital, and Pediatric Hospitals). The study subjects included 98 nurse managers. Researchers gathered data using three tools, comprising the paternalistic leadership knowledge assessment questionnaire, the paternalistic leadership observational checklist, and the organizational citizenship behavior scale. Results: The study demonstrated a highly statistically significant improvement in nurse managers' knowledge, increasing from 12.2% pre-program to 77.3% post-program and then slightly declining to 70.2% at the follow-up phase. Additionally, significant improvements were observed in all dimensions of paternalistic leadership performance during both the post-program and follow-up phases of the intervention (p<0.001). Additionally, three-quarters (77.6%) of nurse managers had a negative level of organizational citizenship behavior before the program. Less than three-quarters of them (74.2% and 72.8%) had a positive level of organizational citizenship behavior post-program and in the follow-up, respectively. Conclusion: The paternalistic leadership training program enhances managers' knowledge of paternalistic leadership and improves their performance in this area, resulting in a positive impact on organizational citizenship behavior (OCB). Implementing paternalistic leadership training programs tailored for nurse managers in educational services within healthcare institutions holds significant promise for enhancing leadership effectiveness and fostering organizational citizenship behavior (OCB) among staff.
Nurse managers, organizational citizenship behavior, paternalistic leadership
Effect of an Alternative Birthing Positions Educational Intervention on Birth Outcomes among Parturient Women in Western Kenya
Context: The second stage of labor is a critical phase that significantly influences maternal and neonatal outcomes. Although alternative birthing positions such as squatting, side-lying, kneeling, and all-fours have been shown to improve birth outcomes, their adoption in many low-resource settings remains low. In Kenya, most women deliver in the lithotomy position, often due to limited awareness, lack of provider support, and restrictive facility practices. Antenatal education may play a vital role in empowering women to adopt evidence-based birthing positions that improve delivery outcomes. Aim: The study aims to assess the effect of an educational intervention regarding alternative birthing positions on birth outcomes among parturient women in Western Kenya. Methods: This study utilized a (nonequivalent control group) quasi-experimental design. A total of 481 pregnant women in their third trimester were enrolled from two comparable referral hospitals, with 238 allocated to the intervention group and 243 to the control group. The intervention group received a structured antenatal educational program on alternative birthing positions, while the control group received routine antenatal care. Data was collected using structured questionnaires, observational checklists, and maternity records. Results: The intervention group experienced a significantly shorter mean duration of second-stage labor (18.9 minutes vs. 62.1 minutes in the control group; t=-18.8, p<0.0001). There was a significant reduction in the rate of episiotomy among the intervention group (4.7% compared to the control group (95.3%), which remained high (χ2 = 306.7, p<0.0001) and intact perineum (62.1.1% vs. 37.9%, p <0.0001) in the intervention versus the control group. Spontaneous vaginal delivery was 56.0% among the intervention group vs. 44% in the control group with p<0.0001. Neonates born to mothers in the intervention group had higher Apgar scores at one minute (≥7) compared to those in the control group (57.4% vs. 42.6%, χ2 = 20.8, p<0.0001). Conclusion: The educational intervention significantly improved maternal and neonatal outcomes by promoting the use of alternative birthing positions. The use of alternative birthing positions during the second stage of labor results in shorter labor, fewer medical interventions, and improved maternal and neonatal outcomes.
Alternative birth position, birth outcomes, education intervention
Knowledge and Perceptions Towards Cervical Cancer and Screening among HIV-infected Women Attending Public Health Facilities in Kisii County, Kenya
Context: Knowledge of cancer of the cervix and perceptions of the disease and screening are key determinants for the utilization of screening services among HIV-infected women. HIV infection predisposes women to an increased risk of having cancer of the cervix. Utilization of cervical cancer screening services among women is important as it leads to early diagnosis of pre-cancerous lesions and their prompt treatment. Kenya is among those countries in Africa reporting low screening rates for cancer of the cervix among HIV-infected women. Aim: This study sought to investigate the knowledge and perceptions towards cervical cancer and screening and their association with the uptake of screening services among HIV-infected women in Kisii County, Kenya. Methods: A cross-sectional survey involving 612 HIV-infected women aged between 15-49 years who were attending HIV care clinics in two sub-county hospitals in Kisii County. The enrolled respondents were recruited through a systematic random sampling method. Data were collected through a structured questionnaire focusing on socio-demographic parameters, knowledge of the disease and screening, perceptions of the disease, and screening practices. Results: The median age of the respondents was 42 years. Those with a primary level of education were 52.9% (n=324). The respondents who were married were 53.7% (n=329). A large proportion of the respondents were aware of and had heard about the disease and screening, at 86.6% (n=530) and 75.5% (n=462), respectively. Only 10.6% (n=65) of them knew that human papillomavirus caused cancer of the cervix, and 31.5% (n=193) of them knew that HIV was a risk factor for cancer of the cervix. A large proportion of the respondents, 53.1% (n=325), had low levels of total knowledge of cervical cancer and screening scores. A statistically significant association (p ≤ 0.05) was observed between the uptake of screening and knowledge of cervical cancer screening, as well as perceived benefits and barriers to screening. Conclusion: The respondents in this study demonstrated low levels of knowledge about cervical cancer and cervical cancer screening. There was a direct relationship between knowledge of cervical cancer and screening, perceived benefits, perceived barriers of screening for cancer of the cervix, and uptake of screening. There is a need to enhance cervical cancer health education in HIV care clinics to improve knowledge and shift perceptions toward cancer of the cervix and screening among HIV-infected women.
Cervical cancer, HIV-infected women, knowledge, perceptions, screening
Assessment of Healthcare Providers’ Knowledge in Helping Babies Breathe Program at Birth in Turkana and West Pokot Counties, Kenya
Context: Globally, 2.3 million neonatal deaths were documented in the year 2022, predominantly occurring in low-income nations. Among these, roughly 23% are attributed to asphyxia. The initial minute after birth, often referred to as the "golden minute," holds immense significance in the lives of newborns. Therefore, it necessitates the newborn's initiation and continual maintenance of spontaneous breathing. A skill that healthcare providers (HCPs) must be well conversant with, especially those working in labor rooms. The Kenya Demographic Health Survey (KDHS) 2022 report indicated that West Pokot and Turkana counties had high neonatal mortality rates of 27 and 21 deaths per 1000 live births, respectively. Aim: The study aimed to assess the knowledge level of healthcare providers (HCPs) regarding helping babies breathe in Turkana County and West Pokot County. Methods: The study employed a cross-sectional descriptive design, utilizing quantitative methodologies to assess the knowledge of healthcare professionals (HCPs) regarding the facilitation of newborn respiration. Six facilities in West Pokot and Turkana Counties were purposefully selected. The study encompassed 71 healthcare professionals (HCPs), including nurses, medical officers, and clinical officers, from West Pokot and 74 from Turkana, who had served in the maternity, operating theatre, and newborn unit for the preceding year, allowing for a census approach. Data collection involved administering digitized, interviewer-administered questionnaires in three health facilities in Turkana County and three in West Pokot County to assess healthcare providers' (HCPs') knowledge of helping newborns breathe at birth. Results: Out of the total participants, 51(35.2%) HCPs demonstrated adequate knowledge in helping newborns breathe at birth, scoring ≥50%, while 94(64.8%) exhibited inadequate knowledge. Both the healthcare facility (p = 0.002) and cadre (p = 0.023) were identified as statistically significant determinants of knowledge levels. Conclusion: The overall level of knowledge among healthcare professionals (HCPs) in Turkana and West Pokot is suboptimal, with nearly two-thirds scoring below 50% in the study. The cadre and the facility where the HCPs were based had a significant influence on knowledge levels. The study recommends targeted training and continuous capacity building through competency-based simulations, on-the-job training, and structured mentorship to enhance knowledge and skills in managing neonatal asphyxia.
Healthcare providers, Helping Babies Breathe, knowledge, Turkana, West Pokot
Knowledge of Diabetes and its Herbal Treatment among Patients with Diabetes and Herbalists Living in Baringo County-Kenya
Context: The use of herbal medication in Baringo County-Kenya in managing ailments, especially chronic ones, is very common. Such chronic ailments include cancer, hypertension, and diabetes mellitus. This use is even though there is little information on whether the prescribers (herbalists) and those using the herbs (patients with diabetes) understand what generally diabetes mellitus is, its signs and symptoms, the sources of their herbs, and also the side effects of the herbs they are using. Aim: The investigation aims to determine the knowledge of herbalists and patients with diabetes about diabetes mellitus disease and its herbal treatment. Methods: The study was conducted in Baringo County, Kenya, known for using herbal medication. A prevalence study design was utilized. The sample size included thirty-nine (39) patients with diabetes and twelve (12) herbalists. The data collection instruments were an investigator-directed questionnaire and a face-to-face interview study guide for patients with diabetes and herbalists. Results: One-third (33% [4/12]) of the herbalists define diabetes mellitus as high and low blood sugar, while a few 16.7% (2/12) see it as 'blood sugar instability.' More than three-quarters of the diabetic patients (77% [30/39]) described diabetes as a disease with no cure, and slightly more than half (54% [21/39]) testified that hospital treatment of diabetes was exorbitant. According to patients with diabetes mellitus, xerostomia (69.2%), recurrent micturition (56.4%), and polyphagia (51.3%) were the major signs and symptoms of diabetes mellitus, while according to herbalists, asthenia (66.67% [8/12]), polydipsia (33.30% [4/12]), and chronic wounds (25% [3/12]). Only one (8% [1/39]) patient with diabetes reported using herbal medications alone, while the rest used in combination with other conventional drugs (medicines prescribed in health care settings). More than half (51% [20/39]) of patients diagnosed with diabetes used their herbal medications with metformin. Most (66.7% [8/12]) herbalists prescribe their herbs alone. Regarding the side effects of the herbs, patients with diabetes reported pruritus (46% [18/39]), and nausea (23% [9/39]), while a few herbalists (16.7% [2/12]) reported nausea, decreased desire for food, and stomach upset. The other herbalists (83.33% [10/12]) said they have not yet received any complaints or side effects from their clients (patients with diabetes). For most of the patients with diabetes, their index information on herbal medicine use was from their family members, acquaintances, and work colleagues (85% [33/39]). Patients with diabetes obtained their medications directly from the woodlands surrounding their homes (bush) (76.92%) and herbal clinics (69.23% [27/39]). At the same time, herbalists got their medications from either their kitchen garden (25% [3/12]), or a woodland surrounding areas of operation (bush) (75% [9/12]).
Diabetes, herbal treatment, herbalists, knowledge, patients
Respectful Maternity Care and Its Associated Factors at Kitale County Referral Hospital, Trans Nzoia County, Kenya
Context: Respectful maternity care (RMC) comprises the seven elements as enlisted by the World Health Organization, including harm-free care, consensual care, confidentiality, dignity, non-detention, non-abandonment, and care without discrimination, which ensures that a pregnant mother is accorded respect whenever they seek maternal services at health facilities during pregnancy, labor, delivery and postnatal period. Various factors play a role in respectful maternity care, including maternal factors, singular health provider factors, health system factors, and other systemic factors. These factors have been known to play a critical role when a mother seeks care in a health facility, even determining the kind of care the mother will be offered. Aim: The study aimed to evaluate respectful maternity care and its associated factors at Kitale County Referral Hospital in Trans Nzoia County, Kenya. Methods: Institutional-based cross-sectional study design was used. Data was collected using pre-tested questionnaires among mothers (n=260) who had delivered and were in the postnatal ward at Kitale County Referral Hospital, Trans Nzoia County, Kenya. Results: Most (83.5%) mothers were accorded respectful maternity care while in the health facility. The following factors were significantly associated with respectful maternity care; marital status: Married [OR=1.51 (95% CI: 0.46-2.33), p=0.002], residence: Urban [OR=1.46 (95% CI: 0.35-3.01), p=0.025], employment type: Housewife [OR=1.83 (95% CI: 1.61-3.26), p=0.001], parity: Three [OR=1.74 (95% CI: 0.27-3.28), p=0.001], place of last delivery: Hospital [OR=2.01 (95% CI: 1.51-2.45), p=0.016], mode of delivery: Spontaneous vertex delivery [OR=1.13 (95% CI: 0.24-3.28), p=0.018], occurrence of complication after delivery: Yes [OR=2.17 (95% CI: 0.25-1.26), p=0.001], waiting time: Less than half an hour [OR=2.1 (95% CI: 1.32-3.21), p=0.003], waiting time was okay: Yes [OR=1.1 (95% CI: 1.46-3.68), p=0.018], number of health providers assisting a delivery: Two [OR=1.56 (95% CI: 0.45-1.31), p=0.041], intention to deliver in the facility later: Yes [OR=0.7 (95% CI: 1.36-2.19), p=0.002], and recommending others to deliver in the facility: Yes [OR=0.71 (95% CI: 0.21-1.34), p=0.039]. Conclusion: Most respondents reported respectful maternity care at Kitale County Referral Hospital. Factors such as marital status, place of residence, employment status, parity, previous birthplace, mode of delivery, occurrence of a complication, waiting time, being okay with the time, number of health providers assisting a delivery, intention to use the facility and recommending others to use the facility were significantly associated with respectful maternity care. The study recommends that the county department of health develops an education program so that all pregnant mothers are empowered on respectful maternity care when they seek antenatal services before they come to deliver in health facilities. Further, the hospital management ensures pregnant mothers' privacy in the maternity unit.
Associated factors, Kenya, Respectful maternity care
Factors Influencing the Utilization of Evidence-Based Practice among Nurse Clinicians in a Tertiary Hospital in Benin City, Nigeria
Context: The increased healthcare demand, technological advancements, and knowledge explosion have necessitated a paradigm shift from nursing practice based on intuition and tradition to evidence-based practice. Aim: The study aimed to assess factors influencing the utilization of evidence-based practice among nurse clinicians in a tertiary hospital in Benin City, Nigeria Methods: The study adopted a descriptive cross-sectional correlational study design among randomly selected 248 nurses at the University of Benin Teaching Hospital. The researchers developed a structured, validated questionnaire that was used as an instrument of data collection. Data collected was analyzed using descriptive statistics, while the hypothesis was tested using multiple logistic regression at a 5% significance level. Data analysis was done with SPSS version 28. Results: Results showed that 192(77%) of the nurses had a positive attitude toward evidence-based practice; the findings show 184(74.2%) of the nurses had a low level of utilization of evidence-based practice. Key barriers to implementing evidence-based practice (EBP) among nurses, including lack of confidence in judging research quality (Mean: 2.8), uncertainty about applying research to practice (Mean: 2.8), insufficient time (Mean: 2.8), heavy workload (Mean: 2.8), and lack of workplace authority (Mean: 2.8). Female: (p=0.071, OR = 5.813, 95% CI=2.117−2.254), 31-40 years: (p=0.829, OR=7.289 95% CI=0.118−2.230), 11-15 years of experience (p=0.120 [OR] = 4.812, 95%[CI] = 2.392-12.392), Principal Nursing Officer (p=0.219 [OR] = 6.89, 95%[CI] = 0.041-5.172, more likely to utilize evidence-based nursing practice compared to other categories of nurses. Conclusion: Utilization of evidence-based practice (EBP) remains low, primarily due to barriers such as time constraints, heavy workloads, and a lack of confidence. Despite these challenges, nurses exhibit a positive attitude toward EBP. Enhancing education, strengthening leadership support, and providing adequate resources are essential strategies for improving the integration of EBP into clinical practice.
Clinician, evidence-based practice, nurses, utilization
Effectiveness of Peer Support on Foot Self-Care Practices among Diabetic Patients in Western Kenya
Context: The global burden of diabetes is steadily rising with a parallel increase in related complications. Individuals with chronic conditions such as diabetes need assistance in learning, mastering, and sustaining complex self-care practices that support healthy living and prevent the development of complications. Peer support is an effective and cost-friendly intervention in the self-management of chronic health conditions to not only enhance self-care practices among diabetic patients but also prevent complications. Despite numerous literature showing evidence that peer support has benefits if implemented, its effectiveness on foot self-care practices among diabetic patients remains variable with very few studies documenting its use. Aim: The study aimed to assess the effectiveness of peer support on foot self-care practices among diabetic patients in Western Kenya. Methods: This was a quasi-experimental, nonequivalent control group post-test-only study. The intervention involved peer support in addition to standard treatment compared to standard treatment only in the control group. The study population was diabetic patients attending clinics in tiers five and six hospitals in Western Kenya. The sample size was calculated using the Charan and Biswas formula, and 58 participants per study site, totaling 116 individuals participated. Participants were conveniently sampled into the intervention and control groups. Data was collected using researcher-administered structured questionnaires while foot self-care practices were assessed using the Nottingham Assessment of Functional Footcare Questionnaire (NAFF). Results: The intervention group showed significantly higher mean foot care practice scores of 61.1 compared to the mean of 35.7 in the control group (F=444.7, p<.001) with a substantial partial Eta2 of 0.84. Level of education, employment status, positive attitude towards foot care, and self-evaluation significantly influenced foot self-care practices. Conclusion: Peer support significantly enhances foot self-care practices among diabetic patients, potentially preventing diabetic foot complications. Based on the study's findings, it is recommended to integrate peer support programs into diabetes care settings to improve foot self-care practices.
Diabetic patients, foot self-care practices, peer support, Western Kenya
Targeted Postnatal Care Implementation for Mothers in Selected Health Facilities in Western Kenya
Context: Postnatal care (PNC) is essential in improving maternal health and reducing maternal mortality, especially in low-resource settings. Targeted Postnatal Care (TPNC) is an approach to postnatal care for mothers and newborns that involves a set of assessments and interventions given in four scheduled visits from birth to 6 months postpartum. The goal is to improve outcomes for these mothers and babies. Aim: This study aimed to assess the implementation of targeted postnatal care interventions for mothers and their variation across four scheduled visits at selected health facilities in Kakamega County, Western Kenya. Methods: This was a cross-sectional study conducted in the Maternal and Child Health (MCH) units of selected public health facilities in Kakamega County, a county in the Western region of Kenya. It employed quantitative methods in data collection using a combined tool containing a questionnaire and observation schedule. Data collected from 160 mothers was descriptively analyzed, where the mean, median, and standard deviation were computed and compared across the visits. Analysis of variance (ANOVA) was used to measure the significance of the variations in implementation across the various visits. Results: The study highlighted significant variations in the provision of maternal care between different visits, with the implementation of TPNC interventions highest within the first 48 hours after delivery (66.62%) and declining at subsequent visits 47.38% at 2-4 weeks, reaching 51.98, at 4-6 weeks, and 50% at 4-6 months. Despite the World Health Organization's recommendations for comprehensive postnatal assessments, the findings reveal gaps in care delivery, such as low rates of health education about maternal HIV testing (20%) within 48 hours and 21.25% at 2-4 weeks, physical examinations (46.88%) at 2-4 weeks and 27.5% at 4-6 months visits, mental health assessments (6.88%) at 2-4 weeks and STI screening at 4-6weeks was 16.10%. There were inconsistent reports on the implementation of key interventions such as early breastfeeding initiation, vital sign checks, and postpartum family planning. Conclusion: These results demonstrate suboptimal implementation of TPNC for mothers, which can frustrate efforts in achieving sustainable development goals. There was a significant decrease in implementation between the first and second visits and a significant increase from the second to third visits. Considerations should be made to make the second visits convenient for the mothers through community midwifery to ensure that mothers do not miss out on these important interventions. The third visit could be more comprehensive if a room and staff could be allocated to postnatal care and not assumed as a family planning room.
Mothers, target postnatal care, Western Kenya
Designing a Nursing Risk Management System
Context: Risk management identifies, assesses, and controls threats to an organization's goals. These risks stem from various sources, including financial uncertainties, legal liabilities, technology issues, strategic management errors, healthcare incidents, and natural disasters. Aim: The present study aimed to design a nursing risk management system and assess the effect of the designed nursing management system on the nurses' knowledge and performance regarding risk management. Methods: This study used a quasi-experimental (pre/post-test) design on 61 nurses working in critical care units and a 30-member jury group composed of four hospital nursing managers and 11 academic staff from the faculties of nursing and 15 physicians from the hospital and academic staff from the faculties of medicine. The study was conducted at critical care units in El-Demerdash Hospital. Two tools were used to collect data for this study: A knowledge assessment questionnaire, a nurses’ performance observation checklist, and a jury opinionnaire sheet. Results: The study reveals that 47.5% of the studied nurses were between 25-35 years of age, 63.9% were females, 63.9 had secondary school diplomas, and 44.3% had between 10 to 20 years of experience in nursing. There was a highly statistically significant improvement in nurses' knowledge of the risk overview dimensions, nurses’ knowledge related to nursing practice dimensions, and hospital infection and patient safety dimension and total mean knowledge score at p=0.00. A highly statistically significant difference was revealed between pre and post-test regarding the nurses’ performance regarding nursing risk management at p <0.05. Conclusion: Nurses' knowledge and performance in risk management are enhanced after designing and implementing a nursing risk management system. The study recommends conducting continuous training programs on all aspects of nursing risk management and establishing an orientation program for all new nurses about risk management.
Institutional Factors Influencing Student Performance in Management of Second Stage of Labour in Kakamega County Hospitals, Kenya
Context: The second stage of labour is a critical phase of childbirth, during which the mother is required to push the baby through the birth canal. Institutions have a key role in supporting student learning. Institutional factors encompass all factors that affect the performance of nursing students both at the training institution and at the clinical site. Information derived from data will be used to decide how to improve clinical learning in labour wards. Aim: The study's precise goal was to assess institutional factors influencing student performance in managing the second stage of labour in Kakamega County hospitals, Kenya. Methods: The study employed an analytical cross-sectional research design using a quantitative data collection approach. The study area was limited to labour wards of hospitals in Kakamega County that receive student nurses for clinical placement. The study population comprised 175 nursing students. Systematic sampling was used to select study participants. Data collection included interviewer-administered questionnaires and a student performance observation checklist to assess the student performance in managing the second stage of labor. Quantitative data analysis techniques included descriptive and inferential statistics. Results: Multiple regression was applied for inferential statistics, with a p-value of ≤0.05 considered statistically significant. Students in placement sites who reported having an easy time working with patients were 2.5 more likely to have had outstanding performance (OR: 2.5; 95% CI: 1.0–6.0; p=0.04), the association being statistically significant. Equally, those in placement sites with equipment in good condition were 2.3 times more likely to have reported outstanding performance (OR: 2.3; 95% CI: 1.1–4.7; p=0.02). In the same way, students who agreed that they could use the equipment with ease revealed statistically significant results compared to those who disagreed (OR: 2.3; 95% CI: 1.1–4.9; p=0.03). On support and guidance, students who agreed that they were guided by qualified staff when performing practical procedures were likely to have done better (OR: 0.4; 95% CI: 0.1–0.9; p=0.02). Conclusion: Institutional factors play a bigger role in successful student performance, particularly time spent working with patients, an equipped placement site, the ability to easily use equipment, and guidance by qualified staff. The study recommends training institutions and placement sites to provide adequate resources, including staff and clinical instructors.
Institutional factors, labour, second stage, student performance
Social Skills Training Program and its Effect on Quality of Life and Stigma among Patients with Schizophrenia
Context: Schizophrenia is a severe mental disorder that significantly disrupts an individual's social interactions, work performance, and overall quality of life. People with mental illnesses frequently encounter stigma due to various causes, which may result in self-stigmatization when they internalize these negative beliefs. Aim: Evaluate the effect of social skills training program on quality of life and stigma among patients with schizophrenia. Methods: The current study employs a quasi-experimental research design (one group pre/post-test). The research was conducted at the inpatient unit of El-Maamoura Hospital on 50 patients diagnosed with schizophrenia. They were selected purposefully for this study. Four study tools were selected to assess the sociodemographic and medical data, social skills, life quality, and stigmatization among patients with schizophrenia. Results: Most schizophrenic patients in this study initially exhibited low social skills before the program; however, this proportion declined to less than one-fifth after the program, showing a statistically significant improvement in all aspects of social skills. Similarly, while fewer than one-fifth of the participants initially reported a good quality of life, this figure rose to approximately two-thirds following the program, with significant improvements in all quality-of-life domains except for thought and speech, orientation and insight. Furthermore, 66% of the patients experienced a high stigma level before the program, which decreased to one-third afterward, with significant reductions across all stigma subscales. Additionally, a highly statistically significant correlation was found between overall scores of social skills, quality of life, and stigma across the program phases (p≤0.001). Conclusion: Social skills training has a notably beneficial influence on enhancing social abilities and life quality and reducing stigma among patients diagnosed with schizophrenia. Implementing a psychoeducational nursing intervention program is essential to mitigating the adverse effects of schizophrenia and fostering better insight among affected patients.
Social skills, training program, quality of life, stigma, schizophrenia
Educational Intervention Project: Enhancing Satisfaction with the Annual Performance Review Process Through Tailored Training and Evaluation Among Nurses and Midwives
Context: Nursing performance appraisals are essential for aligning individual performance with organizational goals, promoting merit-based growth, and maintaining a motivated and competent workforce. Aim: To improve overall staff satisfaction with APR through targeted training and tailored evaluation practices at Al Khor Hospital, Hamad Medical Corporation, Qatar. Methods: An educational intervention project at Al Khor Hospital focused on enhancing the Annual Performance Review (APR) process for nurses and midwives. All staff received training from November 2019 to January 2020, with refresher sessions in December 2020 and 2021. A semi-structured questionnaire, with 24 Likert scale and five open-ended questions, was used to assess understanding and satisfaction with the APR process among 63 participants in January 2022. To evaluate the training's effectiveness, nurse educators audited APR files from the 2018 -2020 year, covering 52 nurses and midwives. Results: Satisfaction levels with the Annual Performance Review (APR) varied across different aspects. The highest level of satisfaction is with the APR Process, where 66% of respondents expressed satisfaction. Following this, the APR Meeting has a 64% satisfaction rate, and the APR Form has a 60% satisfaction rate. In contrast, APR Documentation shows the lowest satisfaction level, with only 44% of respondents indicating satisfaction. The APR audit results demonstrated the significant abilities of nurses and midwives to collect, identify, and document relevant evidence within each APR domain. Conclusion: The project reveals varying satisfaction levels with different aspects of the Annual Performance Review (APR), with the highest satisfaction in the APR Process, followed by the APR Meeting and APR Form. The project successfully enhanced nurses' and midwives' awareness of maintaining evidence aligned with APR domains, raised awareness of the APR process, and improved proficiency in developing SMART goals. It highlights the need for ongoing evaluation and refinement of the APR process to address challenges and meet the evolving needs of staff.
Annual Performance Review (APR), nurses, midwives, tailored training
Qualitative Assessment of Undergraduate Nursing Students' Perceptions of Combined Virtual Reality and Group Discussion Learning Interventions: A Focus Group Study
Context: The coronavirus disease 2019 (COVID-19) pandemic has forced major changes in the learning environment. The author’s institution created virtual reality (VR) learning content to enhance readiness for on-the-job training students by allowing them to enter situations and circumstances beyond traditional learning, experience simulations of target individuals, and think about the nursing assistance needed. The education combined VR and 360-degree video content with group discussions to increase learning depth. A qualitative analysis of the evaluations from the participating students’ perception was performed to obtain suggestions for future educational methods. Aim: This study aimed to elucidate how undergraduate nursing students perceive the effectiveness of education that combines VR learning content with group discussions. Methods: This qualitative descriptive study summarizes the educational effectiveness from data obtained through focus group interviews (FGI). In the data collection process, two focus group interviews were conducted with five nursing students at a nursing university in the Tokyo metropolitan area in March 2023, using an interview guide that was independently created. The study subjects participated in the nursing practical training and exercises that combined VR learning content with group discussions. Results: Based on the FGI of five participants, two main themes were identified, "educational effectiveness" and "challenges." Educational effectiveness" contains the following four subthemes as effects of the combination of VR learning content and group discussions: Opportunities to think about the experiences of patients receiving care and the ethical behavior of nurses, promotion of understanding of clinical situations that are normally inaccessible, opportunities for reflection through recollection of previous experiences, and expanding and deepening learning in group discussions. Moreover, "challenges" contains two subthemes: Introducing mechanisms and devices to enhance learning effectiveness and VR sickness while viewing the VR learning content. Conclusion: The introduction of VR learning interventions allows for the simulated experience of three-dimensional reconstructed scenes of places and situations that are normally inaccessible and is provided for learners to be useful as a learning opportunity intended to reconstruct knowledge and understanding. Additionally, the emotional experience of VR learning content based on learners' different perspectives and sensitivities can be combined with group discussions to deepen learning through multifaceted opinions and realizations. An effective educational method for fostering critical thinking skills is to incorporate group work into VR-based educational programs.
Focus group study, discussion, learning interventions, nursing students, virtual reality
Factors Influencing the Quality of Managing Severe Malaria among Children under Five Years at Selected County Hospitals in Kisumu, Kenya
Context: Severe Malaria in children under the age of five is a major public health issue in Kisumu County, a malaria-endemic area in Kenya. Moreover, most severe Malaria cases in Kisumu West Subcounty are managed at Kombewa and Chulaimbo County hospitals. However, the influence of patient-related, caregiver-related, healthcare provider (HCP), and institutional-related factors on the management of severe Malaria in the area is not known. Aim: The present study aimed to determine the factors influencing the quality of managing severe Malaria among children under five years at selected County hospitals in Kisumu, Kenya, namely Chulaimbo County Hospital and Kombewa County Hospital. Methods: A mixed-methods prospective cross-sectional study was conducted between April and July 2023. Qualitative data was collected from eight key informants (hospital administrators and ward in charge), while quantitative data was collected from 344 caregivers of children under five years of age who were managed for severe Malaria and 78 healthcare providers (nurses, clinical officers, and doctors) using survey questionnaires. An observational checklist was also used to collect quantitative data. Thematic analysis was used to analyze qualitative data, while descriptive statistics and logistic regression were used to analyze quantitative data. p<0.05 was considered significant. Conclusion: These findings suggest that the optimal management of severe Malaria in children under the age of five in the study area is influenced by the gender of the patient, characteristics of the caregivers, on-job training of healthcare providers, and the availability of antimalarial medication. Moreover, these findings suggest that while healthcare providers are knowledgeable and committed to quality malaria management, systemic challenges such as resource limitations, caregiver education gaps, and treatment non-adherence impact their ability to deliver optimal care. Addressing these issues through resource allocation, continuous provider training, and community health education could strengthen severe malaria management in Kisumu County.
Children under five, Kisumu County, severe Malaria
Relation between Hydration Status and Cognitive Function among Critically Ill Patients
Context: Proper hydration is important for optimal cognitive functioning as it plays an important role in neural conductivity. Failure to consume sufficient water leads to the deterioration of cognitive and neurologic functions, and dehydration is a risk factor for delirium. Aim: This study assessed the relation between hydration status and cognitive function among critically ill patients. Methods: The study used a descriptive correlational research design and was conducted in medical intensive care units I and II at Ain Shams University Hospitals. A purposive sample of 86 critically ill patients was selected. Four tools were used: A patient's hydration status physical assessment, a mini-mental state examination, a motor activity assessment scale, and an intensive care delirium screening checklist. Results: Clarified that 46.5% of the studied patients had Euhydration, 30.2% had dehydration, and 23.3% had overhydration on the day of admission. Regarding cognitive functions, 29.1% of the studied patients had no cognitive impairment, 34.9% had mild cognitive impairment, 36% had severe cognitive impairment, and 53.5% had delirium on the day of admission. A statistically significant negative correlation between the total score of hydration and the total score of cognitive function throughout the four assessments was revealed in this study. Conclusion: The current study concluded a statistically significant negative correlation between hydration status and cognitive function among critically ill patients. Integrating simple assessment tools, including the intensive care delirium screening checklist, into the routine assessment formats or the assessment flow sheet of critically ill patients, is recommended. Conducting training programs for the critical care nurses regarding caring for critically ill patients who experience hydration and cognitive problems to keep them up-to-date experience, knowledge, and evidence-based practice related to caring for such a group of patients.
Cognitive function, critically ill patients, hydration status
Factors Associated with Nurses' Intention to Leave from Different Critical Care Units
Context: Nurses' likelihood of leaving the intensive care unit is substantially high. The high turnover intention among nurses significantly contributes to nursing shortages, although several other factors also play a role. Aim: This study sought to identify the factors associated with nurses' intention to leave from different critical care units. Methods: A quantitative cross-sectional analytical study was conducted at Dammam Medical Complex on 291 critical care nurses. Data were gathered through a self-administered questionnaire that included demographic and employment information, the Nurses' Intention to Leave Scale, and the Job Content and Work Factors Assessment tool. Results: 55.3% of nurses are uncertain about their intent to leave, 32.6% have high intent to leave, and 12.1% have low intent to leave. The age group below 30 is significantly associated with intent to leave work in critical care units (p<0.05). Also, decreased job-skill discretion for nurses in the critical care units contributed significantly to their intent to leave the ICU (p<0.05). Conclusion: One-third of the studied nurses are highly intent on leaving the ICU because of their young age and job-skill discretion. The hospital manager must promote continuing education and training to motivate new nurses to decrease their intention to leave the ICU. Nursing management should consider implementing a competency-based evaluation system alongside compensation adjustments that reflect clinical experience to address nurse turnover. Ensuring competitive compensation aligned with skill levels can improve retention rates among skilled nurses. Furthermore, maintaining adequate staffing levels is essential to uphold quality care, emphasizing the need for strategic hiring practices in nursing departments.
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Efficacy of Lemon and Lemongrass Essential Oils on Stress among Parents of Children with Intellectual Disabilities
Context: Essential oils act as alternative medicine and have great therapeutic benefits. Oils derived from Lemon (Citrus limon) and Lemongrass (Cymbopogon citratus) have great importance for stress reduction. No holistic studies compare their chemical composition, essential oil constituents, and efficacy in stress control. Parents who have children with intellectual disabilities (ID) go through the highest levels of stress, which can lead to significant psychological and physical health problems. Therefore, there is a great need for effective stress management interventions that are non-pharmacological. If widely spread interventions work, it can lead to reduced chemical usage rates. Aim: The study's objective was to assess the effects of Lemon (Citrus limon) and Lemongrass (Cymbopogon citratus) essential oils, singly and in combination, on stress and biomotor variables among parents of children with ID. Methods: Quasi-experimental design incorporating a pre-test and post-test control group was conducted. Aromatherapy singly with Lemon, singly with Lemongrass, a blend of both oils individually mixed, a placebo, and the base oil (Sweet almond oil) were given for eight weeks by drops onto an absorbent paper attached to their clothing collar while the parents sat in the shed with fan and fresh air. A purposive sampling method was employed in identifying the participants and community health promoters in identified wards of Kakamega County, Kenya contacted the target households and a simple random formation of groups was employed. Two hundred twenty-eight parents (N=57 per group) completed the study exposures from 250 with a 91.2% response; follow-up rates were maintained at 95%. Stress indicator tools were used to measure stress, and separate blood pressure and heart rate were measured. The essential oils were subject to phytochemical analysis through Gas Chromatography-Mass Spectrometry (GC-MS). Data was analyzed using one-way ANOVA with the Tukey HSD post hoc test (continuous variables). Results: The three aromatherapy exposures, singly and in combination (Lemongrass, Lemon, and a blend of both Lemon and Lemongrass), significantly reduced physical stress, promoted sleep, and improved the emotion of the parents of children with ID (p < 0.0001). A blend of both oils reduced both systolic blood pressure and heart rate. All three aromatherapy interventions (Lemongrass, Lemon, and Blended) demonstrated statistically significant decreases in Systolic Blood Pressure and Heart Rate post-intervention compared to the pre-intervention (p < 0.0001 for both outcomes). Significant reduction was highest for systolic blood pressure (-14.0; p < 0.0001) and heart rate (-5.3; p < 0.0001) for the blend group (a blend of both Lemon and Lemongrass). There were no changes in the control group. Conclusion: Lemon essential oil and Lemongrass essential oil, singly and combined, reduced stress among parents of children with ID. The blend of both oils offers the best stress reduction benefits and cardiovascular health. This study recommends that parent of children with intellectual disabilities use Lemongrass and Lemon essential oils to reduce stress and improve systolic blood pressure and heart rate since it is natural, safe, cost-effective, and readily available.
Children, intellectual disability, Lemon, Lemongrass essential oil, stress
Educational Program for Patients with Cerebrovascular Stroke: Self-Efficacy and Quality of Life
Context: Stroke is a main cause of disability and death worldwide. Stroke can have devastating consequences for the individual and their families. The effects can be both physical, social, and psychological. One-third of people are left with long-term disabilities, which can, in turn, have effects on the quality of life and self-efficacy. Aim: To assess the patient's knowledge, self-efficacy, and quality of life regarding ischemic cerebrovascular stroke. Moreover, develop, implement, and evaluate the effect of an educational program on self-efficacy and quality of life of patients with ischemic cerebrovascular stroke. Methods: A quasi-experimental (one group pre/post-test) design was utilized in the current study. This study was conducted in the Intensive Neurological Care Units (Intermediate Care) and Stroke Outpatient Clinics at El Demerdash Hospital, affiliated to Ain Shams University Hospitals, on a purposive sample of 46 patients with ischemic cerebrovascular stroke from both genders, excluding patients with comorbid conditions. Tools of the data collection include a structured interview questionnaire to assess the study sample's sociodemographic characteristics, medical data, and knowledge regarding cerebrovascular stroke; the new general self-efficacy scale to assess the patients' self-efficacy; and the 12-item Stroke-Specific Quality of Life Scale (SSQOL) to assess the quality of life of patients with ischemic stroke. Results: 67.4% and 56.5% of the studied patients had a satisfactory level of knowledge regarding cerebrovascular stroke immediately after educational program implementation and at the follow-up phase, respectively, with a statistically significant difference between pre-, post, and follow-up at p=0.000; it was improved compared to pre educational program implementation. Furthermore, 67.4% of the studied patients had high self-efficacy at follow-up compared with 28.3% immediately post-educational intervention and 21.7% preintervention, with a statistically significant difference between the three study phases (p=0.000). Moreover, 54.3% of the studied patients had a good quality of life after three months of educational program implementation compared to 15.2% after one month (p=0.000); there was a positive correlation between patients' total knowledge and their self-efficacy and quality of life. Conclusion: The educational program implementation had a statistically significant positive effect on the studied patients' knowledge and consequently affected the self-efficacy and quality of life of the patients with ischemic stroke, supporting the stated research hypothesis. The study suggests that the current educational program be applied to patients and their caregivers about warning signs of stroke, risk factors of stroke, and how to cope with disabilities that a stroke can cause to improve their self-efficacy and quality of life.
Cerebrovascular stroke, knowledge, quality of life, self-efficacy
Predictors of Cervical Cancer Screening Uptake among Healthcare Providers in Siaya County, Kenya
Context: Cervical cancer ranks as the second most frequent cancer among women in Kenya and the second most frequent cancer among women between 15 and 44 years of age. Cases of cervical cancer among health professionals have equally been on the rise. Aim: This study sought to establish the proportion of healthcare providers who have undergone cervical cancer screening and examine individual and health system predictors that influence cervical cancer screening uptake among healthcare providers. Methods: The study was conducted in Siaya County hospitals and adopted analytical cross-sectional study design. Quantitative data was collected using a structured self-administered questionnaire from 186 healthcare providers working at six level four hospitals in Siaya County. In addition, key informant interviews were conducted involving the in charge (6 healthcare providers) of the six hospitals selected. SPSS software version 28 was used for statistical analysis of quantitative data at 95% CI; p = 0.05. Multivariate logistic regression analysis was done for all the independent variables with p < 0.02 in the model to determine predictors of uptake of cervical cancer screening. Qualitative data were organized into themes and coded according to the study objectives. Results: The results show that only 77.4% of the healthcare providers had gone for the screening. There was a significant association (OR: 0.4; 95% CI: 0.2 – 0.8; p = 0.009) between age and uptake of cervical cancer screening. Further results showed that perceived susceptibility (OR: 0.2; 95% CI: 0.1 – 0.6; p = 0.003) and self-efficacy (OR: 0.3; 95% CI: 0.1 – 0.6; p = 0.0008) significantly associated with the uptake of cervical cancer screening services. As for the health system predictors that influence the uptake of cervical cancer screening, availability of transportation (OR: 4.4; 95% CI: 1.5 – 13.2; p = 0.004) and acceptability (OR: 5.0; 95% CI: 1.7 – 15.0; p = 0.001) had a significant association with the uptake of cervical cancer screening services. Conclusion: Only 77.4% of healthcare providers have been screened for cervical cancer. Perceived susceptibility, self-efficacy, availability of transportation, and acceptability were the main predictors of uptake of cervical cancer screening services. The study recommends routine awareness and sensitization programs about cervical cancer screening among healthcare providers on special days.
Cervical cancer screening, healthcare providers, predictors, Siaya County