Medicine and Health Sciences Commons^™

The Nursing Documentation Dilemma In Uganda: Neglected But Necessary. A Case Study At Mulago National Referral Hospital, Grace Nakate, Diane Dahl, Pammla Petrucka, Karen B. Drake, Ruby Dunlap

School of Nursing & Midwifery, East Africa

In Uganda, nursing documentation still remains a challenge, in most of the government hospitals and some private hospitals, it remains at a manual (non-technology driven) level and omissions have been observed. Nurses continue to capture standard elements in their documentation. A mixed methods intervention study was conducted to determine knowledge and attitudes of nurses towards documentation, including an evaluation of nurses’ response to a designed nursing documentation form. Forty participants were selected through convenience sampling from six wards of a Ugandan health institution. The study intervention involved teaching nurses the importance of documentation and using of the trial documentation tool. …

Prevalence Of Hypertension In Low- And Middle-Income Countries: A Systematic Review And Meta-Analysis., Ahmed Sarki, Chidozie U. Nduka, Saverio Stranges, Ngianga-Bakwin Kandala, Olalekan A. Uthman

School of Nursing & Midwifery, East Africa

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data …

Promoting Resilience For Hiv Prevention In Female Sex Workers In Hong Kong: A Randomised Controlled Trial, Winnie W-Y Yuen, William C-W Wong, Catherine S-K Tang, Eleanor Holroyd, Agnes F-Y Tiwari, Daniel Y-T Fong, Weng Y. Chin

School of Nursing & Midwifery, East Africa

Background: Female sex workers are considered a reservoir of HIV and their psychological health has a role to play in HIV infections. In China, commercial sex workers were reported to account for nearly 50% of heterosexual transmission of HIV. Therefore, HIV prevention targeted at mental health could be an innovative strategy in controlling the infection. We aimed to provide an evidence-based resilience-promoting intervention targeting mental health and ultimately safe sexual practices of female sex workers.

Methods: This randomised controlled trial was done at three Hong Kong non-governmental organisations, namely Action for REACH OUT, JJJ Association, and the Society of …

Fear, Blame And Transparency: Obstetric Caregivers' Rationales For High Caesarean Section Rates In A Low-Resource Setting, Helena Litorp, Andrew Mgaya, Columba Mbekenga, Hussein L. Kidanto, Sara Johnsdotter, Birgitta Essén

School of Nursing & Midwifery, East Africa

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings …

Women’S Perceptions Of Antenatal, Delivery, And Postpartum Services In Rural Tanzania, Gladys Reuben Mahit, Dickson Ally Mkoka, Angwara Dennis Kiwara, Columba Mbekenga, Anna-Karin Hurtig, Isabel Goicolea

School of Nursing & Midwifery, East Africa

Background: Maternal health care provision remains a major challenge in developing countries. There is agreement that the provision of quality clinical services is essential if high rates of maternal death are to be reduced. However, despite efforts to improve access to these services, a high number of women in Tanzania do not access them. The aim of this study is to explore women’s views about the maternal health services (pregnancy, delivery, and postpartum period) that they received at health facilities in order to identify gaps in service provision that may lead to low-quality maternal care and increased risks associated with …

Global Collaboration Between Tanzania And Japan To Advance Midwifery Profession: A Case Report Of A Partnership Model, Yoko Shimpuku, Shigeko Horiuchi, Sebalda C. Leshabari, Dickson Mkoka, Yasuko Nagamatsu, Miwako Matsutani, Hiromi Eto, Michiko Oguro, Yukari Yaju, Mariko Iida, Columba Mbekenga, Lilian Mselle, Agnes Mtawa

School of Nursing & Midwifery, East Africa

The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership …

Empowerment Model For Nurse Leaders' Participation In Health Policy Development: An East African Perspective, Nilufa Jivraj Shariff

School of Nursing & Midwifery, East Africa

Background: Nurses comprise the largest portion of the health care workforce in most countries; they interact closely with patients and communities, they work throughout the day and within all sectors of health care. Their breath of practice gives them a broad understanding of requirements of the health care system, of how factors in the environment affect the health outcomes of clients and communities. Nurses’ involvement in health policy development ensures that health services are: safe, effective, available and inexpensive.

Methods: A Delphi survey was utilized and included the following criteria: expert panelists, three iterative rounds, qualitative and quantitative analysis, and …

Utilizing The Delphi Survey Approach: A Review, Nilufar Shariff

School of Nursing & Midwifery, East Africa

No abstract provided.

Hiv Testing For Pmtct In Tanzania: Time To Move From ‘Voluntary’ To ‘Mandatory’?, Kahabi Isangula, Audrey Holmes, Sharon Brownie

School of Nursing & Midwifery, East Africa

Introduction: Every year many infants are infected with HIV, mostly in sub Saharan Africa. This is predominantly attributed to mother-to-child or “vertical” transmission during pregnancy, labor and delivery, and breastfeeding. Advances in antiretroviral therapy (ART) and funding have made the prevention of mother-to-child transmission (PMTCT) of HIV more affordable in sub-Saharan Africa. However, despite this advance and its potential in PMTCT, the uptake of HIV testing among pregnant women as an entry point to PMTCT services remains unsatisfactory in many countries.

Methods & Results: In the present paper, authors’ present a viewpoint that supports mandatory HIV testing for pregnant women …

“We Have Been Working Overnight Without Sleeping”: Traditional Birth Attendants’ Practices And Perceptions Of Post-Partum Care Services In Rural Tanzania, Gladys R. Mahiti, Angwara D. Kiwara, Columba Mbekenga, Anna-Karin Hurtig, Isabel Goicolea

School of Nursing & Midwifery, East Africa

Background: In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs’ practices and perceptions in post-partum care in rural Tanzania.

Methods: Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and …

Establishing Policy Foundations And Regulatory Systems To Enhance Nursing Practice In The United Arab Emirates, Sharon Brownie, Lyndal H. Hunter, Salah Aqtash, Gary E. Day

School of Nursing & Midwifery, East Africa

In 2009, the United Arab Emirates (UAE) established a Nursing and Midwifery Council with a mandate to develop standards for the registration and regulation of nursing and midwifery and to strengthen the nursing and midwifery workforce. Priorities included workforce Emiratization and the development of regulatory standards to support advanced and speciality nursing practice and new models of care—particularly for the management of noncommunicable diseases. This article provides background, context for, and best practice inputs to the effort to provide one unified framework of nursing regulation and licensure across the whole of the UAE. This article is intended for nurse leaders, …

Exploring Unprotected Anal Intercourse Among Newly Diagnosed Hiv Positive Men Who Have Sex With Men In China: An Ethnographic Study, Haochu Li, Eleanor Holroyd, Joseph Lau

School of Nursing & Midwifery, East Africa

Background: Unprotected anal intercourse (UAI) is a major pathway towards secondary HIV transmission among men who have sex with men (MSM). We explored the socio-cultural environment and individual beliefs and experiences conducive to UAI in the context of Southern China.

Methods: We employed an ethnographic approach utilizing a socio-ecological framework to conduct repeated in-depth interviews with thirty one newly diagnosed HIV positive MSM as well as participant observations in Shenzhen based healthcare settings, MSM venues and NGO offices.

Results: Some men (6/31) reported continuing to practice UAI after an initial diagnosis of being HIV positive. For MSM who had existing …

Reducing Early Neonatal Heat Loss In Low Resourced Context An Indian Exemplar, Ramalingam Sindhu, P. V. Ramachandran, Clara M. Jothi, C. Susila, Pammla Petrucka

School of Nursing & Midwifery, East Africa

Background: Although there has been a favorable trend in the Infant Mortality Rate in India in the last decade, the country is still unlikely to meet the Millennium Development Goal #4. Of significance, there has been minimal improvement in the early neonatal mortality rate, which is an indicator of quality of perinatal care. In the efforts to address this aspect, a range of efforts and interventions have been considered. One such effort is in addressing and reducing hypothermia in neonates. Two low tech strategies, professional mummying/swaddling (PM/S) and ‘Kangaroo mother care’ (KMC), are seen as critical in the continuum …

Perceptions Of Patients Regarding Quality Nursing Care (Qnc) At A Tertiary Hospital In Karachi, Pakistan, Ayyub Rehan, Zeenatkhanu Kanji, Dias J., Roshan R.

School of Nursing & Midwifery, East Africa

Background: Patients’ experiences regarding the quality of care continue to be a hot topic of discussion in the healthcare industry. Exploring the quality of nursing care from the patients’ perspectives is a vital element of quality evaluation. The purpose of this study was to explore the patients’ perspectives regarding quality nursing care.

Methodology: A qualitative descriptive exploratory design was used. A total of twelve participants were recruited from one medical and one surgical unit at a tertiary care hospital in Karachi, Pakistan. Purposive sampling was used to select the participants. Data was collected through semi-structured interviews. A thematic analysis approach …

Stigma, Subsistence, Intimacy, Face, Filial Piety, And Mental Health Problems Among Newly Hiv-Diagnosed Men Who Have Sex With Men In China, Haochu (Howard) Li, Eleanor Holroyd, Joseph Lau, Xiaoming Li

School of Nursing & Midwifery, East Africa

High rates of mental health problems among people living with HIV (PLWH) have been widely reported in the literature; however, an understanding of the socioecological contexts of these presentations remains limited, particularly in China. In order to explore potential socioecological factors associated with mental health problems among newly diagnosed HIV-infected migrant men who have sex with men (MSM), we employed a life profile approach conducting semistructured in-depth interviews with 31 newly diagnosed HIV-infected MSM residing in a city in Southern China. Participants’ life profile accounts outlined their concerns, including internalized stigma, subsistence living, difficulties finding a lover or a stable …

Psychobiobehavioral Model For Preterm Birth In Pregnant Women In Low- And Middle-Income Countries, Shahirose S. Premji, Ilona S. Yim, Aliyah Dosani (Mawji), Zeenatkhanu Kanji, Salima Sulaiman, Wangira Musana, Pauline Samia, Kiran Shaikh, Nicole Letourneau

School of Nursing & Midwifery, East Africa

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in …

Infectious Disease Outbreaks And Increased Complexity Of Care, Joan Musau, A. Baumann, C. Kolotylo, T. O’Shea, A. Bialachowski

School of Nursing & Midwifery, East Africa

Aim: This study examined the effects of healthcare-associated infectious disease outbreaks on nurses’ work in a large acute care hospital in Ontario, Canada.

Background: The incidence of healthcare-associated infections has increased. Previous research focuses on epidemiology, healthcare systems, and the economic burden of outbreaks. Few published studies focus on the impact of outbreaks on nurses’ work in acute care facilities.

Introduction: Since the severe acute respiratory syndrome epidemic in 2003, combating infectious diseases has become a key issue. Hospitals have implemented measures related to healthcare-associated infections. However, nurses experience challenges in preventing, controlling, and contending with outbreaks.

Methods: A retrospective …

Knowledge And Attitudes Of Select Ugandan Nurses Towards Documentation Of Patient Care, Grace Nakate, Diane Dahl, Karen B. Drake, Pammla Petrucka

School of Nursing & Midwifery, East Africa

Ideally through documentation, nurses track changes in a patient’s condition, make decisions about needs, and ensure continuity of care. However, nursing documentation has often not met these objectives. In Uganda, the systematic nursing specific approach is not reflected in documentation of nursing care. A mixed methods intervention study was conducted to determine knowledge and attitudes of nurses towards documentation, including an evaluation of nurses’ response to a designed nursing documentation form. Forty participants were selected through convenience sampling from six wards of a Ugandan health institution. The study intervention involved teaching nurses the importance of documentation and using of the …

Pedagogy And Culture: An Educational Initiative In Supporting Uae Nursing Graduates Prepare For A High-Stakes Nurse Licensing Examination, Sharon Brownie, Ged Williams, Kate Barnewall, Suzanne Bishaw, Jennifer L. Cooper, Walter Robb, Neima Younis, Dawn Kuzemski

School of Nursing & Midwifery, East Africa

Graduates of an Abu Dhabi transnational nursing degree struggled with the mandatory national licensing examination. Poor pass rates undermine graduate career futures and impact on the workforce capacity building contributions of the partnering transnational educational providers. This paper describes how the design and delivery of an intensive examination preparation program dramatically reversed this trend. The objectives of this educational initiative involved the design, delivery and evaluation of a program that would align with cultural learning preferences and which improve the success rates of graduates attempting the national nurse licensing examination. To achieve these objectives, the program combined a range of …

The Changing Role Of Nursing: Opportunities For Nurse-Led Services For The Management Of Chronic Disease And Diabetes In The Uae, Sharon Brownie

School of Nursing & Midwifery, East Africa

There is little debate that current and future healthcare is, and will continue to be, dominated by the prevention and management of increasingly complex chronic health disease; the UAE is no exception. Preventive and disease management services directed at groups and individuals at risk of unfavourable health outcomes are core to the make-up of an effective health system. The burden of noncommunicable, chronic and diabetes-related diseases places a heavy strain on health service cost and service delivery requirements. The UAE is faced with the challenge of identifying and developing effective strategies for the prevention and management of the burgeoning prevalence …

Difficult And Frustrating? Caring For Those With Chronic And Complex Conditions, Rachel Rossiter, Sharon Brownie

School of Nursing & Midwifery, East Africa

Caring for people with chronic and complex health needs has become an ever-larger part of everyday nursing. The World Health Organization has identified common and preventable risk factors that are the primary cause of chronic illness worldwide—hypertension, tobacco use, hyperglycaemia, physical inactivity, and overweight or obesity. Nurses now need an expanded range of skills and expertise that will enable them to work effectively with people whose chronic and frequently complex health issues may be seen as difficult and challenging.

This article invites you to think about your experiences of caring for people with chronic and complex conditions. Before you read …

Safe Motherhood Training For Rural Health Care Workers In Odukpani Local Government Area Of Cross River State, Nigeria, Josephine Etowa, Ekaete Asuquo, Ani Etokidem

School of Nursing & Midwifery, East Africa

Maternal mortality remains a challenge in developing countries which bear 99% of global maternal deaths (WHO, 2014). Nigeria, India, Pakistan, Afghanistan and Ethiopia carry more than 50% of the global burden of maternal mortality. According to the UNDP Human Development Report (2014), Nigeria’s maternal mortality ratio of 630 per 100,000 live births ranks among the highest in Africa. Two countries accounted for one third of all global maternal deaths: India at 17% (50 000) and Nigeria at 14% (40 000) (WHO, 2014).. Archibong and Aghan (2010) found that hospital based maternal mortality ratio in Cross River state was 1,513.4per 100,000 …

A Delphi Survey Of Leadership Attributes Necessary For National Nurse Leaders’ Participation In Health Policy Development: An East African Perspective, Nilufa Jivraj Shariff

School of Nursing & Midwifery, East Africa

Background: Nurses’ involvement in health policy development ensures that health services are: safe, effective, available and inexpensive. Nursing history reveals several legendary nurse leaders who have influenced policy and the course of nursing and health care. In the recent times there have been concerns regarding the availability of effective leaders physically, symbolically and functionally at clinical, organizational and national levels, who can effectively influence health policy. Exerting influence in the policy arena requires that nurse leaders acquire attributes that enable them to be effective in policy development activity.

This paper reports part of a larger study whose purpose included: “build …

Birth Preparedness And Complication Readiness – A Qualitative Study Among Community Members In Rural Tanzania, Furaha August, Andrea B. Pembe, Edmund Kayombo, Columba Mbekenga, Pia Axemo, Elisabeth Darj

School of Nursing & Midwifery, East Africa

Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR.

Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used …

Engagement Of Undergraduate Nursing Students In Virtual Learning Environment In Karachi Pakistan, Zohra Kurji, James Mwenda, Amina Aijaz

School of Nursing & Midwifery, East Africa

Aga Khan University (AKU) is implementing blended learning (BL) in their existing programs. This study reports the use of BL mode in one of the courses entitled Advanced Concepts of Community Health nursing (ACCHN), offered for undergraduate nursing students, for the first time in Karachi Pakistan. A qualitative exploratory design was adopted.The year II students of Post-RN BScN programme who were studying the course were invited to participate in the study. Data was collected by using focus group discussions (FGDs.). Students found ACCHN course flexible because of the use of blended modalities. They felt that their learning was enhanced by …