RP-School of Nursing

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Assessing Barriers to Implementation of Nursing Process among Nurses Working at a Tertiary Hospital in Kenya
(Researchjournali’s Journal of Public Health, 2018-01) Mbithi, Dennis N.; Blasio, Omuga; Ayieko, Antony; Githui, Simon N.; Wambugu, Paul
Background: Nursing process (NP) is a global concept, which forms the foundation of nursing as a profession, it is a scientific method for delivering holistic and quality nursing care and its effective implementation is critical for improved quality of nursing care. However, its implementation in most hospitals especially in low and middle-income countries reportedly remains a challenge despite efforts being made. Objective: To assess barriers to implementation of nursing process among nurses. Methods: A descriptive cross-sectional study was carried out where 134 nurses were recruited in the study. Data was collected through self-administered questionnaires. Results: One-third (33.1%) of nurses reported that they were actively implementing the nursing process but only 8.2 %( n=11) nurses correctly listed all the steps of the nursing process. Nursing process implementation was significantly associated with nurse’s demographics (age p <0.001, experience p = 0.001), training (p = 0.013), institutional factors (p = 0.048). Social (p>0.05) and cultural (p = 0.993) factors were not significantly associated with nursing process implementation. Conclusion: The Nursing Process implementation among nurses is significantly influenced by their demographic characteristics which include age and experience, training on nursing process and institutional factor like availability of relevant resources for NP implementation.
Assessing The Relationship Between Individual Factors And Pediatric Nurses’ Competence On Supplemental Oxygen Therapy In Kajiado County, Kenya
(iosrjournals, 2023-06) Kiruja, Gitonga Jason; Mbuthia, Nickcy; Ndambuki, James; Bett, Sarah
Background: An estimated 15% of global under-five deaths result from respiratory infections, with most of these deaths being reported in under-developed and developing countries. The most common respiratory infection in children being hypoxaemia whose recommended treatment is oxygen therapy. This means that healthcare workers' competency is important so as to identify when oxygen is needed, the right quantity, the correct dispensing equipment and the best way to administer the oxygen to a specific patient. Based on previous researches, nurses' competency in oxygen therapy is determined by several factors such as individual and institutional factors. However, researches conducted in Kenya have been limited in this area. This study therefore explores the relationship between individual factors and competence of pediatric nurses on supplemental oxygen therapy in Kajiado County, Kenya.
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.
Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County,Kenya
(IPRJB, 2023) Matheka, Seraphine Mbinya; Kabue, Priscilla; Wanyoro, Antony; Muoki, Francis Matheka
Purpose: Kangaroo Mother Care (KMC) entails infants and mothers having constant skin-to-skin contact. KMC is done in the hospital after delivery to preterm infants or after early discharge. Mothers or caregivers are sensitized on proper positioning, breastfeeding, hygiene, and preventive measures to protect infants from infections. Proper follow-up is critical to ensure effective results are achieved. The use of KMC was endorsed by the World Health Organization (WHO) as routine care for preterm infants with a birth weight of ≤2000 grams, especially the clinically stable infants. This recommendation was based on the available moderate-quality evidence that it works by providing warmth (thermal care) and increasing breastfeeding opportunities irrespective of setting, birth weight, or gestational age. Also, KMC has been strongly acclaimed and used as a natural thermoregulator, infection prevention, and nutrition for preterm infants, which are critical for physiological functions that are strongly affected by physical immaturity. Although this technique offers quality care to these babies, its implementation is low. There is a need to determine the suitable methods to improve its implementation in Kenya's healthcare facilities. This study aimed to determine factors influencing the implementation of KMC in Makueni County health facilities. Methodology: The study was conducted in maternity units of six subcounty hospitals (Makueni county referral hospital, Makindu sub-county hospital, Kibwezi sub-county hospital, Mbooni sub-county hospital, Kilungu sub-county hospital, and Sultan-Hamud sub-county hospital) in Makueni County. Cross-sectional study design with mixed methods was used. Semi-structured questionnaires and KMC checklist were filled by the researcher and research assistants. The convenience sampling technique was carried out, and 90 healthcare providers and 6 Key Informants were interviewed. Data was analyzed using version 23 of a statistical package for social sciences using descriptive and inferential statistics. Findings: The study results reveal that young health care providers portrayed better KMC implementation compared to the old (r=-.210, p=0.047). In relation to gender, female health care providers had better KMC implementation compared to the male (r= -.290, p=0.006).Knowledge (r=.282, p=0.007) and health workers' perception of KMC (r=.245, p=0.02) had a positive and significant relationship with implementing KMC. Perception (β=1.149, p=0.05) and funds (β=0.958, p=0.05) had a positive and significant effect on implementing KMC. R squared indicated that jointly, age, gender, perception, and budget accounted for 29.4% of the overall variation in the KMC implementation. Results demonstrated a high level of KMC (33.3%) implementation among the health facilities. The study concluded that funds and collaboration had a positive and significant effect on implementing KMC. Unique Contribution to Theory, Practice and Policy: The study recommends that the hospital management should ensure there is provision of adequate resources to support KMC implementation. In particular, the hospital management should focus on strengthening physical and human resources. There is also a need to link all relevant programs, such as essential newborn care and Integrated Management of Neonatal and Childhood Illnesses (IMNCI), to support KMC implementation.
Determinants of Quality of Hemodialysis Services in Selected County Dialysis Centers in Nyanza Region, Kenya
(IJSMR, 2024-09) Nyabaro, Doreen; Githemo, Grace; Onsongo, Lister
Background: Hemodialysis is a common management intervention in chronic kidney and End-Stage Renal Disease patients. Despite the increase in utilization of maintenance hemodialysis in low and medium-income countries, there needs to be more efforts to assess the quality of hemodialysis services. Objective: To evaluate the quality of hemodialysis services at selected county dialysis centres. Methodology: A cross-sectional descriptive study was used. Proportionate sampling was used with a sample size of 118 patients on hemodialysis. Chi squares test was used to determine the association between variables while binary logistic regression analysis was used to determine predictors of quality hemodialysis services. Results: Fifty-six percent of the participants perceived the quality of hemodialysis services as good. Gender, education level, co-morbidities, admission due to side effects, social support, waiting time, education before dialysis session, and satisfaction with care were associated with the quality of hemodialysis services. Moreover, being male (AOR =3.75, 95%CI: 1.11 – 12.64, p =0.033), having secondary level education (AOR =2.31, 95%CI: 1.41 – 4.97, p =0.046), having been admitted due to side effects since the beginning of hemodialysis sessions (AOR =0.22, 95%CI:0.15 – 0.86, p<0.001), having received social support from family and friends (AOR =11.49, 95%CI: 1.79 -73.95, p =0.010) and not waiting longer to be allocated a H.D. (AOR = 0.21, 95%CI: 0.05 – 0.93, p =0.041) as predictors of quality of hemodialysis services: Conclusion and recommendation: The quality of hemodialysis services in selected centres is slightly above average. Increased health education, training more staff on the needs of patients, and reviewing appointment period based on the number of machines available is essential to improve the quality of hemodialysis services.
Determinants of the Quality of Life of Caregivers of Children with Sickle Cell Disease at Siaya County Referral Hospital, Kenya
(Reviewed Journal of Social Science & Humanities, 2023) Okinyi, Joash; Githemo, Grace; Bett, Sarah
Sickle Cell Disease is a high-morbidity and early-mortality ailment if not managed and controlled properly. Several challenges are usually experience by both the caregiver as well the family unit since the children are usually highly dependent on them for their daily activities. This study, therefore, sought to establish the determinants of quality of life of individuals taking care of children with SCD attending care at Siaya County Referral Hospital, Kenya. The study adopted a descriptive analytic study design. This research was theorized by the Quality-of-Life Major Domains Model by Basavaraj et al (2010), and the WHOQOL tool for data collection. The study population were caregivers of children suffering from SCD seeking care at the Siaya County Referral Hospital in Kenya. Sixty (60) participants were sampled to collect the desired data. The identification of the study participants was achieved through a convenience sampling method. Data from both pretests and study population was analyzed using IBM’s SPSS version 25. Findings from the study indicated that 70% of the caregivers had good quality of life; employment X 2 (1, N = 60) = 9.3, p = .002, financial security X 2 (1, N = 60) = 7.1, p = .008, monthly income X 2 (1, N = 60) = 6.6, p = .01, acquisition of new information X 2 (1, N = 60) = 6.5, p = .011, support from friends X 2 (1, N = 60) = 4.4, p = 0.037, ability to get around life (X 2 (1, N = 60) = 13.6, p <0.001) and quality of sleep (X2 (1, N = 60) = 25.7, p<0.001) impacted positively on caregivers’ quality of life. Results also indicated that frequency of hospitalization (X 2 (1, N = 60) = 0.0510, p = .021) and frequent negative feelings (X 2 (1, N = 60) = 4.5, p = .033) impacted negatively on the caregivers’ quality of life. Predictors of QoL included source of income, ability to acquire new information and satisfaction with relationship. In conclusion, no association was observed between Socio-demographic factors and QoL however there is significance association between economic and psychosocial factors and Qol. Health education should be strengthened and incorporated in the special clinics to provide necessary information to the caregivers. All levels of government should provide financial empowerment to caregivers of children with chronic illnesses.
Effectiveness of a Facility-Based Health Education Intervention on Utilization of Emergency Obstetric and Newborn Care Services among Women of Reproductive Age in Nakuru County, Kenya
(IPRJB, 2023) Maingi, Nancy; Keraka, Margaret; Makworo, Drusilla
Purpose: Emergency obstetric and newborn care (EmONC) is the most important intervention to improve maternal survival. The study assessed facility based health education intervention on utilization of Emergency Obstetrics and Newborn care services. Methodology The study was a randomized control trial and utilized a mixed method. Multistage sampling was used. Key informants were purposefully selected Allocation to each study group was done on a 1:1 ratio; hence each group had 191 participants. The sample size was determined by Kelsey et al 1996 formula for calculation of sample size for randomized controlled trials and in order to take care of attrition 10% increase was done hence the sample size was 382 women. Pregnant mothers 26-32 weeks of gestation were enrolled. Structured questionnaire, focused group discussion and key informant interview schedules used. A pre-test was conducted at Kuresoi North Sub County. To ensure validity, research assistants were trained on the various research instruments. Descriptive statistics Fisher’s exact test at bivariate and odds ratio at multivariate analysis level were computed. Qualitative data was analysed using thematic content analysis. Ethical approval for the research was sought from the K.U research ethical committee, the National council for Science and Technology and Ministry of health. Informed consent was obtained from respondent prior to the study. Results: The intervention group had 95.93% (n =165) utilization of EmONC services in comparison to the control arm 75.29% (n = 128). There was no significance difference in the control group from base line to final survey OR 1.209, CI 0.742 to 1.969 and P-value 0.446. From the study findings the chances of EmONC services utilization after intervention was high. Those that received the intervention were seven times likely to utilize than those that did not receive the health education with an OR 7.734, 95% CI 3.363 to 17.787 and a P-value < 0.001 when we compare the intervention group and the control group. Unique Contribution to Theory, Practice and Policy: Administration of Health education is crucial in the utilization of EmONC services thus improving maternal mortality and morbidity. This study concurs with the Theory of Planned Behavior and the theory of Reasoned Action. Health education intervention may change the behavior intention of the client hence influencing utilization of EmONC services. It is recommended stakeholders to come up with a well-structured health education program in all regions of Kenya to improve emergency obstetric and newborn care services utilization.
Evaluation of Cardiopulmonary Resuscitation Knowledge and Its Impact on Practice among Clinicians at a County Referral Hospital in Kenya
(IISTE, 2019) Ndung’u, Paul; Kimani, Samuel; Kirui, Angeline; Mukonene, Jerusha
Background: Cardiopulmonary resuscitation (CPR) is a life-saving emergency procedure that ensures oxygen and blood supply in a victim who have had heart and/or breathing stoppage thereby maintaining the viability of vital organs until professional help arrives. All the health care workers should have adequate knowledge and skills to perform the procedure with ease in case of cardiac arrest. Sudden cardiac death in the western countries ranges from 300,000 to 400, 000 annually. This represents 0.36 to 1.28 per 1000 population in Europe and the United States. American Heart Association approximates that 100000 to 200000 adult lives could be saved annually if CPR is initiated early enough. The outcome of a patient with a cardiac event is determined by the knowledge and skills of the resuscitator and the promptness in which the procedure is instituted and the nature of the patient condition among others. Objective: To evaluate CPR knowledge and its impact on practice amongst clinicians working at Coast General Hospital, Mombasa Kenya. Methods: A descriptive cross sectional study was carried at the hospital in 2015 where a questionnaire was administered to 91 nurses, 27 clinical officers and 24 doctors. Results: The study comprised of 142 clinicians; 63.8% (n=90) nursing officers, 19.1% (n=27) clinical officers and 17.1% (n=24) medical officers. Their levels of training were; 57.4% (n=81) diploma, 25.5% (n=36) bachelors degree, 12.8% (n=18) higher diploma, 2.8% (n=4) certificate, and 1.4% (n=2) masters degree. The level of training was significant (P =0.04) on the way they rated their CPR practices. It’s only a quarter of the clinicians who trained CPR at their respective colleges. A majority 68.8% (n=97) had trained on CPR and the training was significant (P=0.000) on the way they rated their CPR practices. Three quarters 75.9% (n=104) were scored below average on specific aspects on CPR knowledge. This was significant (P =0.001) on their rating of CPR practices. A third 33.3% (n= 47) of the clinicians had taken more than three years since their last training. This significantly (P =0.000) affected the way they rated their CPR practices. Conclusion: The CPR practices at Coast General Hospital are significantly affected by the clinicians’ knowledge. The hospital administration needs to plan for frequent refresher trainings for all the staff. Professional bodies need to encompass CPR CPD points as a requirement to renewing practicing licences.
Evaluation of Patient Satisfaction with Nursing Care at Two Public Hospitals in Kenya: An Interventional Study
(Medwin Publishers, 2018-05-14) Githemo, Grace K; Karani, AK; Ogutu, M; Gachoka, H
Introduction: Patients’ satisfaction with nursing care has been reported as the most important predictor of the overall satisfaction with hospital care. However, measuring patient satisfaction within health care settings still needs more emphasis. This is mainly because, as in other organizations and sectors, surveys have tended to focus on managers’ and clinician’s agendas and not on questions meaningful to patients which can be translated into actions. Study Design and Objectives: This quasi experimental study aimed at evaluating the level of patient satisfaction with quality of nursing in two public hospitals in Kenya after the nurses were trained on the use of the nursing process and nursing theory in patient care with an emphasis on patient participation in care. Structured self-administered questionnaires and a Likert like scale were used to collect data which analyzed by use of SPSS. Descriptive statistics were used in data presentation. Chisquare test of significance was used to determine the difference between pre-test and posttest while logistic regression analysis was used to predict the determinants of satisfaction at post-test. Findings: The findings showed a significant difference (p<0.05) between pre-test and post-test on the level of patient satisfaction with the variables evaluated. Logistic regression findings showed that females were more likely to be satisfied with the introduction they received in the ward (OR1.82,95%CI1.074-3.3098) compared to their male counter parts. Also patients with primary level of education were less likely to be satisfied with the information received on introduction (OR 0.568,95%CI0.334–0.967). Conclusion: The study concluded that Majority of the patients in both study groups were satisfied with the information received on admission, satisfied with orientation and with the overall quality of nursing care they received. Also the level of education influenced patients’ perception of individualized quality care. Therefore equipping patients with education can help them understand their health care needs and also appreciate quality when it’s provided.
Experiences of Professional Autonomy among Critical Care Nurses in Kenya: A Qualitative Study
(MDCAN, 2023-08) JK, Njoroge; Onsongo, L.; Githemo, G
Background: Exercising autonomy allows nurses to demonstrate their knowledge and skills. However, more information is needed about the critical care nurses' perceptions of their professional autonomy in rural areas. Objective: To explore the perceptions, facilitators and barriers to professional autonomy among critical care nurses in rural Kenya. Methods: The hermeneutic phenomenological study design was used in this study. Data were collected in a critical care unit using a semi-structured interview guide. A sample of 10 participants were recruited. The study was conducted in Nyeri County Referral Hospital. Results: Three themes emerged from the study on the nurses' experiences of professional autonomy, perceptions of autonomy, facilitators of autonomy, and barriers to autonomy. Conclusion: Autonomy undeniably plays a pivotal role in defining the professional status of the nursing profession. Perceptions, facilitators and barriers to professional autonomy form the background of the current professional status. Nurses, therefore, exercise autonomy effectively when it aligns with patient care needs and when a conducive environment supports it.
Exploring the Support Provided to Mothers whose Neonates are Diagnosed with Gastroschisis in Kenyatta National Hospital, Kenya
(2024-06) Thaiya, Rosemary Muthoni; Gachuiri, Grace; Bett, Sarah
Background: Gastroschisis is a rare congenital condition that occurs while a fetus is in the early stages of development which results in the abdominal wall having a protrusion of abdominal contents – large and small intestines and the stomach. Delivery of a neonate with chronic illnesses like gastroschisis greatly affects caregivers and mothers because neonates who do not receive surgical care immediately after delivery end up losing their lives, while those who do survive require extensive medical and comprehensive care and additional hospitalization which many parents are unsure of how to provide or are not able to afford. To contribute to the existing body of knowledge on gastroschisis, a phenomenological approach was used to draw from the experiences of mothers admitted at KNH providing care for their neonates diagnosed with gastroschisis; to ascertain whether they receive adequate support from the hospital and other people out of the hospital that are close to them. Broad Objective: To explore the support given to mothers whose neonates are diagnosed with gastroschisis in KNH. Methodology: Phenomenological descriptive research design was adopted in this study. In-depth interviews with twentyfive (25) mothers were purposively sampled, interviews were audiotaped, and the data was later transcribed and inductively analyzed into themes and subthemes. Findings: The results indicated that the mothers were positive about their pregnancies and attended antenatal clinics, mental symptoms exhibited by these mothers due to the nature of the neonates and the kind of support they needed from family and health care providers. Additionally, both positive and negative relationship was exhibited between the mothers and the healthcare providers. Moreover, as a result of fatigue due to caregiving for children diagnosed with gastroschisis mothers experienced support from spouses, family members, healthcare givers, and peers. The study concluded Prenatal Experiences of Mothers with neonates with gastroschisis were positive and the majority of them were happy that they were pregnant and were ready to follow doctors’ guidelines throughout the period. Postnatally, the mothers experienced various mental challenges due to inadequate support from their close family members and inadequate information concerning the condition before their children were born. They too were unprepared to deal with the stress and difficulties related to the neonates’ condition. The majority of the mothers received support from family members and fellow mothers with similar experiences. Recommendations: A more thorough prenatal screening is recommended to assist in the early detection of such congenital disorders, which can direct birth preparations for the mother and child. Healthcare providers should consider the mental health of mothers with neonates born with congenital anomalies rather than concentrating on the neonates alone. To assist in easing the mental and emotional strain placed on parents, hospital staff should provide professional counseling. They should also encourage peer counseling among mothers. Additionally, it is recommended that future researchers consider different methodological approaches in the collection and analysis of data related to gastrointestinal complications such as gastroschisis.
Facility Factors Influencing Utilization of Active Management of Third Stage Of Labour among Skilled Birth Attendants in Kiambu County, Kenya
(Supplement article, 2016-11-26) Felarmine, Muiruri; Joachim, Osur; Agina, Okello
Introduction: Post-Partum Hemorrhage (PPH) accounts for 34% of maternal deaths in Kenya. Active management of third stage of labour (AMTSL) is a World Health Organization and Ministry of Health of Kenya approved protocol for reducing maternal mortality and morbidity arising from postpartum hemorrhage. Kiambu County in Kenya records an average of six maternal deaths per month, out of which, two are due to PPH. This paper analyses how facility factors influence utilization of this protocol in Kiambu County. Methods: this was a cross sectional study among 431 skilled birth attendants in 52 health facilities. Two hundred and three birth attendants were selected using multistage sampling. Data was collected using questionnaires and observation checklists and analyzed using STATA version 11. Chi square, Fisher’s exact and Logistic regressions tests were used. Results: AMTSL was utilized by 31.5% of the birth attendants. Controlled cord traction (96.5%) was the most utilized. Uterine message after every 15 minutes was the least utilized component. Utilization was more in government facilities (37.4%) (Logistic regression p=0.006) and in level four health facilities (49.5%) (p<0.001). Utilization was higher (34.7%) among birth attendants who experienced less frequent stock outs (p=0.027) and in facilities with more than two staff authorized to order supplies (34.9%) (p=0.020). Utilization was higher in facilities with a fridge (44.5%) (p=0.001) and in facilities with standards documents in the labour ward (68.0%) (p=0.001). Conclusion: health facility factors significantly influence utilization of AMTSL and therefore the county government should put in place strategies to enhance the factors that influence utilization of AMTSL positively
Factors Influencing Quality of Life among Cancer Survivors in Kenya
(AJOL, 2022) Kung’u, Mary; Onsongo, Lister; Ogutu, James O
Background: The number of cancer survivors is growing continuously due to advances in treatment of cancer patients. In developed countries, numerous studies on quality of life (QoL) of cancer survivors have been conducted. Little is known regarding the QoL of cancer survivors in Kenya. Therefore, the aim of this study was to explore the factors that contribute to QoL of cancer survivors in Kenya. Methods: A descriptive cross-sectional design was used for the study. Participants were 108 adult cancer survivors. Self and interviewer administered QoL Patient/Cancer Survivor Questionnaire was used Results: Findings indicate a statistically significant relationship between QoL and age (rs =-.055 p<.05), marital status (rs=.490 p<.01), income (rs =.228 p<.05), stage of cancer diagnosis (rs =-.269. p<.01), year of cancer diagnosis (rs =-.295 p<.01), religious affiliation (rs =-.279, p<.01) and the religion one belonged to (rs =-.198 p<.05). Regression analysis showed that age, stage of cancer diagnosis, time off treatment, educational level, and religious affiliation are significant predictors of QoL in cancer survivors. Conclusions: The findings highlight the importance of key factors associated to QoL in cancer survivors in Kenya. Interventions aimed at early cancer detection, treatment, and spiritual support among cancer survivors will improve QoL
General Ward Nurses Detection and Response to Clinical Deterioration in Three Hospitals at the Kenyan Coast: A Convergent Parallel Mixed Methods Study
(Research square, 2023-03) Nickcy, Mbuthia; Nancy, Kagwanja; Moses, Ngari ; Mwanamvua, Boga
Background In low and middle-income countries like Kenya, critical care facilities are limited, which means acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors inuencing their ability to detect and respond to clinical deterioration. Methods This convergent parallel mixed-methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the patients' vital signs 24 hours before a cardiac arrest (death) occurred was retrieved from patients' medical records. Additionally, in-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards. Results This study reviewed 405 patient records and found that most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 hours prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points. Thematic analysis of the interview data identied ve broad themes related to detecting and responding promptly to deterioration. These were insucient monitoring of vital signs, availability of equipment and supplies, stang conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers. Conclusion The study showed that nurses did not consistently monitor and record vital signs in the general wards. The nurses worked in suboptimal ward environments characterised by inadequate and malfunctioning monitoring equipment, high workload due to staff shortages, communication and teamwork gaps, and little training on handling patient deterioration at the ward level; factors that negatively impact patient safety and outcomes. The ndings provide an opportunity for future research to test interventions to improve nurses' assessment and management of clinical deterioration in general wards.
Home Deliveries in Rural and Urban Districts in Kenya
(paper publication, 2017-03) Kabue, Priscilla
Home deliveries is common in developing countries Kenya included where mothers are assisted by Traditional Birth Attendant during delivery. Most birth which occur at home can result in complications which cannot be handled in the absence of qualified health personel and a health facility. To reduce maternal mortality its important that mothers deliver in a hospital with qualified health personnel. Objective: The study aimed at establishing the factors that contribute to home deliveries in both rural and urban Districts in Kenya. Methodology: A cross sectional study design was preferred. A sample of four hundred postnatal mothers in Rural and Urban hospital attending maternal child health clinics were selected for the study. Eligibility was mothers who had delivered at home within one year prior to the study. Focus group discussion guides were used to collect data. Data was analyzed by correspondence and thematic analysis and presented in figures and summary narratives. Results: Most mothers in rural area delivered at home compared to urban 119 Mothers delivered at home in rural while only 47 did so in rural area. This is associated with lack of money and transport. Home deliveries are preferred because they are cheap, no cost of travelling, TBA have a positive attitude and use polite language, there is one to one care so chances of self-delivery do not arise and mothers are in familiar environment. Conclusion: Home deliveries are still common in Kenya despite availability of health services. Recommendation: Health worker should improve during delivery on the care they give to the mother irrespective of their socio-economic status
Institutional Factors Affecting Timely Referral and Safe Transport of Neonates in Makueni County Referral Hospital, Kenya
(EdinBurg, 2024-09) Iluka, Francisca Nduku; Bett, Sarah; Barako, Talaso
Purpose: Internationally, 2.5 million babies lose their lives before first 28 days of life, many of the deaths occur in underdeveloped countries and a third occur on day one of life. According to the World Health Organization, many infant deaths are preventable by simple interventions. Some of the early interventions are proper preparedness and early identification of danger signs, timely referral, and safe transport of sick newborns to ensure reductions in newborn deaths. The purpose of this study was to identify institutional factors that affect timely referral and safe transport of neonates in Makueni County Referral Hospital. Methodology: The study employed an analytic cross-sectional study design. The researcher collected data from 50 primary caregivers or the mothers. The researcher used a self-administered questionnaire, document reviews of the patients’ files, and a structured data checklist. Patients condition on admission was obtained from the patient’s file. The researcher analyzed the data quantitatively using the Statistical Package for Social Sciences version 26 (SPSS V26). Results: According to the study findings, institutional characteristics highlight several significant factors associated with the likelihood of timely referral and safe transport during a referral. Patients who did not receive stabilization treatment were found to be more prone to experiencing a lack of timeliness and safe transport during referral (P=0.004), patients who did not undergo vital signs monitoring were 9.25 times more prone to experiencing delays and unsafe transportation (P = 0.035). The results suggest that patients with a response time exceeding 2 hours were more likely to face a lack of timeliness and safe transport during referral (P=0.032). The availability of an ambulance emerged as a significant factor, with 59.5% (25) reporting waiting for an ambulance as the reason for the delay. Conclusion: The study concludes that institutional factors influenced safe transport and timely referral including stabilization treatment, vital signs monitoring, response time for referral, and the availability of an ambulance. The study recommends that ambulances should be availed timely, in adequate numbers, and be equipped with the necessary drugs and equipment so that in the event of a problem, the healthcare provider can intervene appropriately. Also, hospitals should be supplied with all the necessary equipment and drugs to aid in stabilization of patients.
Level of Knowledge among Adolescent Girls on Modern Contraception at Tsangano Turnoff Community, Ntcheu District, Malawi
(IPRJB, 2019) Damson, Ellen Chifundo; Keraka, M; Kabue, P
Purpose: The purpose of this study was to establish level of knowledge among adolescent girls on modern contraception at Tsangano Turnoff community, Ntcheu District, Malawi Methods: The study used a cross sectional study employing both simple random sampling technique for quantitative data and purposive random sampling technique for qualitative. The research instruments were self-administered questionnaires and Focused Group Discussions (FGD). Quantitative data was analyzed using Statistical Package for Social Sciences version 22.0. Analysis proceeded in two steps. First, univariate descriptive statistics were used to describe sample characteristics and estimate contraceptive prevalence among the adolescents. Contingency table methods were used to test associations between independent (categorical) variable and utilization of contraception and the qualitative data from the FGDs was transcribed and analyzed by thematic content analysis techniques. Results: This study found that a lot of adolescent girls had general knowledge regarding modern contraception as majority reported to have knowledge about modern contraception (73.9%). This study has shown that utilization increases with the increase in the level of knowledge as it has shown that out of the all the 54 respondents who reported to be utilizing modern contraception all of them had moderate to high knowledge regarding contraception. The results shows that utilization is highly significant statistically to knowledge as those respondents who had adequate knowledge they are four times more likely to utilize modern contraception than those who has little or no knowledge. Unique Contribution to Theory, Practice and Policy: The study recommended that Knowledge on modern contraception is very important in the utilization of the contraceptive hence since education is one way of empowering the girl child to be a reliable citizen in future therefore the high existing knowledge reported in this study should be encouraged and be related to utilization of modern contraception and other sexual and reproductive health services.
Nurses’ Management of Patients with Pressure Ulcers in Selected Health Facilities in Murang’a County, Kenya.
(eajhs, 2021) Njoroge, Jane Muthoni; Kabue, Priscillah Njeri; Ochieng, James
Pressure ulcers are a common health problem in hospitalized patients, especially among patients with chronic illnesses and those with reduced mobility. The prevalence of pressure ulcers varies with health care settings and is highest in critically ill patients ranging between 15-20%. They affect the quality of life of patients and caregivers and have been associated with heavy financial burdens, extended hospital stays, higher morbidity and mortality. Inadequate prevention measures and lack of active management of pressure ulcers in early stages especially in high-risk patients result in recurrence and complicated pressure ulcers. In view of this, a descriptive cross-sectional study was conducted in Murang’a County, Kenya in selected health facilities with the objective of determining the management of patients with pressure ulcers. The study population was composed of one hundred and twenty-four (124) nurses working in medical and surgical wards in selected health facilities. Semi-structured questionnaires, observational checklists and focused group discussions were used to collect data. The qualitative data from the focus group discussions and observational checklist were transcribed and a summary written. The relationship between nurse’s knowledge, nurse-oriented factors and institutional factors affecting management of pressure ulcers among nurses were examined using Pearson correlation analysis and multiple regression analysis. The median age of the respondents was 37 years with at least 112 (90.3%) having diploma level of education, and 63 (50.9%) were from the medical department. The majority of the nurses (93.6%) agreed pressure ulcers can be avoided, while 58.1% preferred pressure ulcer risk assessment tools compared to 27.5% who preferred clinical judgment in the management of pressure ulcers. The majority of nurses (87.5%) who had adequate knowledge on the management of pressure ulcers mentioned immobility and bedridden patients, stroke, spinal injury, dry skin, stool and urine incontinence asmajor contributors to pressure ulcers. Regarding pressure ulcer risk assessment, 62.9% of nurses assessed patients for pressure ulcers though they relied on clinical judgement as 93.9% indicated there was no risk assessment scale in the wards and 5.1% were not sure. On institutional factors 61.3% of the nurses indicated that health facilities were lacking pressure ulcer reducing devices and those that had pillows and a few ripple mattresses. Regarding guidelines in the management of pressure ulcers, 75.8% of nurses indicated they were not available in the hospital. The study found an association between age and knowledge increasing the odds of effective management age (AOR = 6.83, p = 0.001); experience (AOR = 4.08, p = 0.01), and education (AOR = 22.9, p = 0.000). The nurse-oriented factors increasing the odds of effective management of pressure ulcers include nurse’s positive attitude on prevention of pressure ulcers (AOR = 2.3, p = 0.040) and nurse use of pressure ulcer risk assessment tool (AOR = 4.3, p = 0.010). On institutional factors, nurses trained on management of pressure ulcers were 4.47 times likely to effectively manage patients with pressure ulcers. Nurses who lack in-service training about pressure ulcers were less likely to effectively manage patients with pressure ulcers (AOR = 0.11, p = 0.000). The study concludes that the nurses had adequate knowledge in management of pressure ulcers, the nurses-oriented factors and institutional factors also influence the management of pressure ulcers
Nurse’s Knowledge Aspects of Enhancing Haemoglobin Level and Safety through Delayed Cord Clamping Time in a Semi-urban Hospital in South Rift Region, Kenya
(Kabarak Journal of Research & Innovation, 2019) Bor, Wesley; Mbithe, Dorcus; Ogada, Irene; Too, Wesley
The clamping of the umbilical cord can be done at different times after delivery, although delaying the clamping of the cord for ≥ 1 minute after birth improves the haemoglobin levels for newborn and variation may lead to safety issues and influence of the haemoglobin status of the infants. There is limited literature on the knowledge of health care providers on the optimal time to clamp the umblical cord after delivery. The objective was to assess the nurse’s knowledge aspect on enhancing haemoglobin levels through delayed cord clamping in a Semi Urban Hospital in South Rift Region, Kenya. The Participants nurses in the study were enrolled through simple random sampling in maternity and delivery rooms and the aspect of knowledge was assessed using Pre-test questionnaire. Half of the nurses (50%) had knowledge that delayed clamping is recommended. However, 69% had knowledge that delayed cord clamping should be performed for those infants requiring essential care under maximum safety conditions while 94% reported that delayed cord clamping is beneficial to the infant and does not interfere assessment of the baby and administration of uterotonic drugs. A bout 31% had incorrect knowledge that delayed umblical cord clamping increases the infant’s risk of acquiring HIV. Half of the nurses (50%) of nurses had knowledge that the World Health Organization (WHO) 2014 guidelines recommended delayed cord clamping for all infants without medical complications including infants of women who are HIV positive. The nurse’s knowledge on the optimal time to clamp the umblical cord after delivery was not uniform. Majority of the nurses had knowledge that delayed cord clamping increases the risk of mother to child HIV transmission and aspect of knowledge affected the safety level of infant haemoglobin levels. Relevant stakeholders should consider developing national guideline and standard operational procedures on Umblical Cord Clamping after delivery.
Nursing Handover: Experiences and Perspectives in the Critical Care Unit at Murang’a County Referral Hospital
(Stratford Peer Reviewed Journals and Book Publishing, 2022-11) Murigi, Mwangi; Mbuthia, Nickcy; Meng’anyi, Lucy
Continuity in delivery of nursing care to patient in the critical care unit is of utmost importance. Although nurses have a variety of guidelines and formats to conduct the handover, gaps have been detected regarding the contents of the handover and its effects on the continuity of care in the critical care unit. The focus of the study was to explore the experiences and perspectives of nurses with nursing handover in the critical care unit. The study adopted a phenomenological qualitative design. A sample of 9 critical care nurses participated in this study. The study found critical care nurses believed they were individually equipped with adequate knowledge to carry out effective departmental and interdepartmental nursing handover. The existence of handover policies in the critical care unit was considered a major enabler of the handover. The participants also believed that strained human resource, lack of standardized handover tools and deviation from the set handover rules negatively impacted the handover process. Furthermore, they reported perceived insufficiency in the management’s role in handover evaluation and feedback. Moreover, all participants advocated for improvement of the current handover practices for improved quality of patient care as well as sense of self-accomplishment among the nurses. There are pertinent implications in the findings of this research for critical care nurses, nurses in other departments and policy makers. The resultant implication for each group of stakeholders promotes the adoption and formulation of effective handover practices and consequently enhanced quality of patient care through transfer of adequate patient information and sense of self-accomplishment among nurses.

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