Browsing by Author "Mbuthia, Nickcy"

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    Determinants of Abcde Bundle Implementation by Healthcare Providers at Coast General Teaching and Referral Hospital Critical Care Unit, Mombasa County Kenya
    (Kenyan Journal of Nursing and Midwifery, 2024) Kahindi, Thomas Mwalimu; Githemo, Grace; Mbuthia, Nickcy
    Background. The Awakening, Breathing, Choice of analgesic and sedation, Delirium management and prevention and early Exercise/mobility (ABCDE) is evidenced based protocol associated with improved outcome of the critically ill patients. Fully implementation of this protocol optimizes the outcome of the mechanically ventilated patients. Objective. The study explored the determinants of ABCDE bundle implementation by healthcare providers Coast general teaching and referral hospital critical care unit. Methods. The study used descriptive design to explore the determinants that influence the ABCDE bundle implementation. Data collection was done through structured questionnaires in form of Likert scale. Study participants were selected using census sampling method. A total of (N=60) participants were involved in the study. Data was analysed using statistical package of social sciences (SPSS) version 25. Results. A total of 60 questionnaires were collected from the participants. The results showed that female were the majority of the participants with 68.3% (n=41). Majority of the participants were between 30-39 age group with 38.3% (n=23). The results further revealed that nursing profession contributed the majority of the participants with 75% (n=45). The results also showed that most of the participants had diploma as their level of education with 65% (n=39). Furthermore, the results revealed that majority of the participants had experience of 1-2 years. Additionally, the results revealed that implementation of the bundle varied with 71.7% (n=43) implementing SAT, 66.7% (n=40) SBT, 63.3% (n=38) pain, 75% (n=45) sedation, 75% (n=45) delirium and 76% (n=46) early exercise/mobility. Bivariate analysis of healthcare providers’ factors showed that both knowledge and experience has relationship with ABCDE bundle implementation. Similarly bivariate analysis of the healthcare system factors revealed that workload, staffing, protocol availability and training are both significantly related to the implementation of the bundle. Multivariate analysis using logistic regression revealed that knowledge predicts bundle implementation with p=0.009, experience with p=0.049, workload with p=0.021, protocol with p=0.029, training with p=0.035 and staffing with p=0.007. Conclusion. ABCDE bundle implementation is influenced by both healthcare provider factors and healthcare system factors as revealed by this study.
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    Integration of Critical Care Nurses in Antimicrobial Stewardship; Opportunities and Barriers at a County Referral Hospital in Kenya
    (IAJHMN, 2024-08) Chege, Joseph Waithanji; Mbuthia, Nickcy; Gachuiri, Grace
    Antimicrobial stewardship optimizes appropriate use of antimicrobials through agent selection, route, dosing, and duration of therapy. It serves to optimize clinical outcomes of patients and limit adverse reactions of antimicrobials. Nurses are frontline implementers of antimicrobial stewardship. However, they face issues on inter-professional jurisdiction, hierarchical power relations within hospitals and limited training on antimicrobial stewardship. The main objective of this study is to explore the integration of nurses into antimicrobial stewardship activities in the critical care unit at Thika Level 5 Hospital, Kenya. The study used exploratory descriptive qualitative research design. Data collection was done through semi-structured interviews and NVIVO 14 software was used for thematic analysis of data. A total of 11 nurses working in the intensive care unit were interviewed. Patient advocacy, communication and collaboration, monitoring and documenting, and patient education and empowerment emerged as important roles that nurses play in antimicrobial stewardship. Participants highlighted continuous medical education, inclusion of antimicrobial stewardship in formal nursing education, team work and organization support as major facilitators of nurses’ roles in antimicrobial stewardship. The study findings revealed that stringent regulatory requirements, heavy workload, poorly regulated systems and limited knowledge on antimicrobial stewardship as the major barriers that limit nurses’ role in antimicrobial stewardship. Nurses’ inputs in decision making process on treatment plans and antimicrobial use is invaluable in promoting judicious use of antimicrobials. Future research should focus on redefining the nature, scope and influence of perceived nurses’ role in antimicrobial stewardship.
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    Lived Experiences of Patients with End-Stage Kidney Disease on Dialysis at Scottish Livingstone Hospital, Kweneng District,Botswana
    (EdinBurg Peer-ReviewedJournals and BooksPublishers, 2025-12) Kooitse, Felicity N.; Onsongo, Lister; Mbuthia, Nickcy
    End-Stage Kidney Disease (ESKD) is a public health problem with increasing prevalence in Botswana. There is limited evidence on ESKD patients experience in managing the condition. Therefore, this research investigated the lived experiences of ESKD patientsundergoing dialysis in Botswana. This study adopted an interpretative phenomenological research design. The research used 16 ESKD patients undergoing dialysis at the Scottish Livingstone Hospital. Semi-structured, audiotaped interviews were used for data collection. Collected data was transcribed and analysed thematically to identify shared patterns related to the participantslived experiences.Thematic analysis yielded themes and sub-themes representing the participants’ experiences with ESKD. The themes included: Dialysis as demanding (subthemes: Time Burden, disrupted daily routines, Long Dialysis hours); Dialysis experiences (subthemes: predialysis anxiety, Mixed feelings during dialysis, Post dialysis Exhaustion) and Physical Symptoms (subthemes: Persistent fatigue and weakness, Pain and swelling, Respiratory and Systemic distress) In summary, this study showed ESKD and dialysis to be considerably demanding for the patients. Patients had mixed experiences before, during, and after dialysis. ESKD patients have to battle dialysis symptoms daily, which affect their well-being and quality of life. Based on the findings this study advocates for dialysis centres in Botswana to be increased to enhance treatment access and lower disease burden, more healthcare providers to be trained on renal care that include Patient-centred care to address healthcare disparities and increase treatment access, for ESKD patient support programs to be implemented to help them cope with predialysis anxiety, mixed feelings during dialysis and post dialysis exhaustion also to strengthen and support ESKD social programs. Policies and strategies that lessen ESKD disease burden and improve the quality of life for ESKD patients should be adopted.
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    Stress Levels among Nurses in the Critical Care Units, at a Level 6 Hospital in Kenya
    (Kenyan Journal of Nursing & Midwifery, 2025) Kamau, Janet Nyambura; Meng’anyi, Lucy Wankuru; Gachuiri, Grace; Mbuthia, Nickcy
    Introduction: The critical care environment is inherently stressful due to the high-acuity patients, specialized equipment, and the need for healthcare providers to possess the necessary competencies to save lives or mitigate complications. Nurses, as integral members of the healthcare team, often face significant pressure to deliver quality care to patients experiencing potentially life-threatening conditions. It is therefore paramount to establish the causes of stress and stress levels of nurses in the critical care units. The aim of this study was to establish causes of stress and stress levels among nurses in critical care units at Kenyatta National Hospital. Methods: A quantitative cross-sectional analytical design was adopted, and, convenient sampling was used to recruit 149 nurses from May to June 2022. Findings: The majority of nurses were females 103 (69.6%) and had undergone critical care training 130 (87.8%). Inadequate staffing during shifts (n=69, 46.6%, Mean=3.01±1.1) was the most common cause of stress and majority of nurses had moderate stress level. Conclusion: The stress levels of nurses in the critical care units were moderate and main cause of stress was work-related. Therefore, the hospital should establish peer assistance programs in CCU like employees' stress management training curriculum, which will encourage an inclusive and diverse environment for active discussion on any concerns found in the clinical set-up.
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    The Practice of Assessing Intensive Care Unit Acquired Weakness by Nurses at Kenyatta National Hospital, Kenya
    (International Academic Journal of Health, Medicine and Nursing, 2026-03) Mbua, Dorcas Mbaika; Mbuthia, Nickcy; Musau, Joseph K.
    Intensive care unit-acquired weakness (ICUAW) is an acute dysfunction of the neuromuscular system in acutely ill patients admitted in intensive care unit. Best assessment practices initiated and maintained from time of admission leads to positive patient care outcomes. Nurses are the primary caregivers for critically ill patients and ICUAW clinical assessments by nurses mainly follows their clinical experiences. The research findings contribute in policy and guidelines development for all other Critical Care Units(CCU) in assessment of ICUAW practices. The main objective of this study was to evaluate the practices and influencing factors for ICUAW assessment by nurses working in the CCU in Kenyatta National Hospital. Research employed correlational research design. Multistage proportionate random sampling method used.193 nurses were recruited. Informed consent obtained before the study. Self-administered questionnaire used. Multivariate analysis employed. Results presented by use of frequency tables. Descriptive statistics utilized to make summaries of the research data. Permission obtained from Kenyatta University Graduate School, Kenyatta University Ethical and Research committee, National Council for Science and Technology through commission of university education, Kenyatta National Hospital/University of Nairobi Ethical and Research Committee, the Kenyatta National Hospital(KNH) administration and the relevant KNH CCUs nurse managers. Majority of the participants were female (n = 149, 77.2%) while male respondents accounted for 22.8% (n = 44), most participants aged between 36–45 years (n = 83, 43.0%). A statistically significant association was found between nurses' experience in the critical care unit (CCU) and ICU-AW assessment (χ² = 8.558, p = 0.032). Perception-related variables like severity of patients’ illness (χ² = 13.749, p = 0.001), patient’s age (χ² = 8.671, p = 0.013), patients with multiple conditions (χ² = 18.218, p < 0.001), physically inactive patients (χ² = 5.696, p = 0.045) showed significant associations with the assessment practice. The findings indicate that routine assessment of ICU-acquired muscle weakness (ICU-AW) is not yet widely institutionalized among nurses in the critical care units. Only 20.7% of the respondents reported that ICU-AW assessment is routinely performed on patients in their unit, whereas a significant majority (77.2%) stated it is not. A conclusion made that ICUAW assessment practice is majorly determined by nurses’ attitude and perceptions whereas the attitude and perceptions were influenced by knowledge and skills. Recommendations made for all healthcare facilities with a CCU to invest in modern methods of ICUAW assessment providing appropriate tools for assessing ICUAW and the nursing education policy be made on higher nursing education on ICUAW assessment training.