RP-Department of Medical Surgical Nursing and Pre-clinical Services

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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 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.
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.
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.
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.
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
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.
Perception of Patient Safety among the Healthcare Professionals at the Kakamega County Referral Hospital, Kenya
(RJI, 2024-02) Mulusa, Elizabeth Osaga; Bett, Sarah; Gachuiri, Grace
One of the global parameters in measuring healthcare quality is patient safety. Patient safety plays a pivotal role in maintaining and promoting patient safety. The World Health Organization has opined that a weak patient safety culture among healthcare workers predisposes patients to adverse events which subsequently increasehospital stay, healthcare costs, patient morbidity, and mortality. Based on existing literature, the biggest challenge in understanding patient safety is how to assess it. Existing studies assess patient safety using different assessment approaches with most studies assessing patient safety using managerial, staff, or policy perspectives. There is, however, a paucity of studies reviewing the interaction of the three modes of safety assessments. Hence, it was imperative to establish the interaction of the three determinants influencing patient safety. Premised on this, this study sought to establish the determinants of patient safety among critical care clinical teams. Findings from this study posit to help inform patient safety in Kenya and act as a baseline to help trigger further research that could inform policy change. The study was conducted at the Kakamega County Referral Hospital in Kenya and did adopt an analytical cross-sectional design. The study included all healthcare providers working closely with the Critical Care Units (CCUs) since these units are the most critical in-patient safety. A self-administered questionnaire was used to collect data from the study participants. Collected data wascoded electronically using the Statistical Package for Social Sciences (SPSS) software version 21 before being subjected to analysis. Using the eight (8) sections of the questionnaire, data was first analyzed and reported descriptively as numbers, percentages, means, and standard deviations. Inferential statistics was then run on selected variables to help answer the research questions. After explaining the scope and rationale of the study, the respondents was required to first consent by signing a consent form before being included in the study. Study findings was communicated digitally and physically in print format and made available to the public through the university library and online through the university website and an accredited peer-reviewed journal.
Psychological Effects Experienced by Mothers who’s Neonates Are Admitted in ICU at a National Hospital with Gastroschisis: A Phenomenology Study
(Full Length Research, 2023) 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 that results in the abdominal wall having a protrusion of abdominal contents – small and large intestines and the stomach. Delivery of a neonate with chronic illnesses like gastroschisis greatly affects mothers and caregivers because neonates who do not receive surgical care immediately after delivery end up losing their lives, while those who do survive require extensive medical care that requires additional hospitalization and comprehensive care which many parents are unsure how to provide or able to afford. Broad Objective: To explore the psychological effect exhibited by mothers whose neonates are admitted in Neonatal Intensive Care Unit (NICU) in the Kenyatta National Hospital with gastroschisis. Methodology: A qualitative study guided by descriptive phenomenology was conducted. In-depth-interviews with twenty-five (25) mothers purposively sampled, Interviews were audiotaped, the data later transcribed inductively analyzed into themes and sub themes. Findings: Two themes were developed first, Stages of grieving. Some mothers experience shock when they saw the condition of the neonates with denial feeling that what they were seeing was not real. They felt angry with God and bargained on the same hoping that things would change. The mothers went into depression and finally accepted their situation as they came to terms with reality. The second theme was mental health issues: in this case, admission of the neonates in NICU caused mental negative psychological effects to the caregivers. They suffered separation anxiety from other family members. There was delegation of roles at home as some had other children. There was fear of stigma and lack of support from the families. In NICU, caregivers received peer support from themselves as they shared different experiences. Recommendations: Concerted efforts by the stakeholders in the Healthcare sector are necessary in order to alleviate the negative psychological effects felt by mothers of children born with gastroschisis.
Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre’s in Kenya
(Nursing & Primary Care, 2021) Mugi, Elizabeth; Githemo, Grace; Wala, Jonathan
disease, the modality is associated with multiple psychological stressors that confronts the hemodialysing patients and subject them to mental disturbances and poor quality of life. Study aim: The study aimed at describing the psychological stressors faced by the hemodialysis patients in the new county dialysis centers in Kenya and to correlate the psychological stressors to the patients’ demographic characteristics. Methodology: This was a descriptive correlation study among hemodialysis patients in four selected county dialysis centers in Kenya. Sample size was determined through a census method. Data was collected by means of a semi-structured questionnaire and analyzed using a Statistical Package for Social Sciences (SPSS) version 25.0.Findings were presented using graphs and frequency tables while Chi-square was used to test for the association between study variables. Results: Despite opening new county dialysis centers, majority of the respondents identified inadequate number of hemodialysis machines as the major psychological stressor (M=2.9, SD ± 0.8) uncertainty in life (M=2.74, SD ± 0.6) and lack of hemodialysis commodities (M=2.69, SD=0.7) as the leading psychological challenges faced by the patients who are dialyzing in the newly opened county dialysis centres in Kenya. There was a statistically significant association (p=0.016) between waiting time for hemodialysis sessions and gender and also a significant association (p=0.04) between marital status and dependency on others to bring them for dialysis session. Conclusion: Despite the Government initiative to increase the availability and accessibility of the hemodialysis services to hemodialysis patients, inadequate hemodialysis machines, lack of hemodialysis commodities and difficulties in raising the cost of treatment still remains the major psychological stressors among hemodialysis patients. Therefore, opening of new dialysis centers should be accompanied with adequate resource allocation to guarantee positive patient outcomes.
Quality Of Life for Kidney Donors after Donation at A national teaching and Referral Hospital in Kenya
(Numid Publishers, 2021) Nyahera, Diviner K; Githemo, Grace; Onsongo, Lister N
Introduction: Kidney transplantation is the best renal replacement therapy for patients withend stage kidney disease. Living kidney donor transplant has better graft and recipient outcome. Information regarding quality of life of kidney donors has a positive influence onapotential donor’s attitude towards kidney donation. The aim of the study was to examinekidney donors’ quality of life in Kenya. Methods: This was a cross-sectional descriptive study design that aimed at examiningthequality of life of kidney donors’ after donation at a national teaching and referral hospital inKenya. A total of 99 donors participated in the study. Descriptive and inferential statistical tests were used to analyze data. Predictors of quality of life were determined using multipleregression models. Findings: Majority of the respondents had high quality of life. There was a strongsignificant relationship between donor’s Body Mass Index and Health Functioningcomponent of QoL r (0.835), p<0.05 with a moderate relationship in Psychological factors r (0.492), p > 05. Also there was a statistically significant association between, current monthly income, x 2(1, � = 99) =24.793, (p <0.05), marital status x 2( 1, � −99) =10.261(p<0.05) and employment status x 2( 1, � = 99) =11.474 (p <0.05) and quality of lifeof kidney donors. Multiple regression analysis revealed that Health functioning quality of lifecomponent explained 27.5% of the total variance of quality of life while psychological factors explained 12.5%. Conclusions: The overall quality of life of kidney donors was high. Kidney donor’semployment status had a significant predictive association with their quality of life.
A Training Program for Obstetrics Point-of-Care Ultrasound to 514 Rural Healthcare Providers in Kenya
(BMC Medical Education, 2023) Wachira, James; Matheka, Duncan Mwangangi; Masheti, Sheila Ayesa; Githemo, Grace Kirigo; Shah, Sachita; Haldeman, Matthew S.; Ramos, Mena; Bergman, Kevin
Background Ultrasound is a crucial and efective diagnostic tool in medicine. Recent advancements in technology have led to increased use of point-of-care ultrasound (POCUS). Access to ultrasound equipment and training programs in low-and middle-income countries (LMICs) is limited. Despite the World Health Organization (WHO) recommendations for universal antenatal ultrasounds, POCUS for reproductive health applications has not been widely used in LMICs. We describe here the feasibility of implementation of a training of obstetrics point-of-care ultrasound (OB POCUS) for high-risk conditions in rural public healthcare facilities in Kenya with partnership from Butterfy Network, Global Ultrasound Institute, and Kenyatta University. Methods As part of the initiation of a large-scale implementation study of OB POCUS, clinician trainees were recruited from rural Kenyan hospitals for participation in a series of fve-day POCUS workshops held between September and December 2022. Trainers provided brief didactic lessons followed by hands-on training with live models and at regional clinical sites for 5 OB POCUS applications. Instructor-observed assessment of students’ scanning and image interpretation occurred over the training period. Assessment of knowledge and confdence was performed via an online pre-test and post-test as well as Objective Structured Clinical Examination (OSCE) was administered at course completion. Results Five hundred and fourteen mid-level Health Care Providers (HCPs) in Kenya were trained over a threemonth period through in-person didactic sessions, bedside instruction, and clinical practice over a 5-day period with a trainer: trainee ratio of approximately 1:5. Out of the 514 trained HCPs, 468 were from 8 rural counties with poor maternal and neonatal outcomes, while the remaining 46 were from nearby facilities. OB POCUS topics covered included: malpresentation, multiple gestation, fetal cardiac activity, abnormalities of the placenta and amniotic fuid volume. There was marked improvement in the post training test scores compared to the pretest scores. Conclusion Our implementation description serves as a guide for successful rapid dissemination of OB POCUS training for mid-level providers. Our experience demonstrates the feasibility of a short intensive POCUS training to rapidly establish specifc POCUS skills in eforts to rapidly scale POCUS access and services. There is a widespread need for expanding access to ultrasound in pregnancy through accessible OB POCUS training programs. An implementation study is currently underway to assess the patient and systems-level impact of the training.
Utilization of Reflective Practice by Nurses Working in the Critical Care Units at a Level Six Hospital in Kenya
(eviewed International Jour-nal of Medicine, Nursing & Public Health, 2024-07) Samoita, Lillian Nyanduko; Bett, Sarah; Meng’anyi, lucy Wankuru; Gachuiri, Grace
This study aimed to investigate the Utilization of Reflective practice among nurses in the critical care units (CCUs) at Kenyatta National Hospital (KNH). The specific objectives of the study weredetermining the practice of reflection,the perception towards utilization of reflective practice,the relationshipbetween nurse characteristics, and facility associatedfactorsand utilization of reflective practice.Across sectional quantitative study was conducted with 154 sampled respondents. A structured self-administered questionnairewas used for data collection. Statistical Package for Social Sciences (SPSS) version 25.0 was utilized for data analysis, incorporating Logisticregression and Chi-square tests to evaluate relationships.Formal training in reflective practice was strongly associated with increased utilization, as those who received training had a utilization rate of (92.6%), while those without training had a utilization rate of (47%). Nurses who indicated that their nursing practice had been altered by engaging in reflection demonstrated a greater utilization rate (68.2%) in comparison to those who did not report any such modification. Majority (88.2%) of the respondents reported they did not have a designated space for reflective practice, (76.3%) lacked supportive institutional policies,(80.8%) missed opportunities for training, and (68.7%) experienced workload related obstacles.The study underscores the importance of promoting formal training in reflective practice, establishing supportiveinstitutionalpolicies, and providing dedicated spaces for reflection among CCN

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