MST-School of Nursing

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    Adherence to Post Kidney Transplant Treatment and Lifestyle Changes among Kidney Recipients at Kenyatta National Hospital, Nairobi City County, Kenya
    (Kenyatta University, 2021) Nyambura, Anne Mumbi; Grace Githemo; Jonathan Wala
    End stage kidney disease (ESKD) prevalence has become a global public health burden. Kidney transplantation is the best remedy for cases suffering from ESKD. Adherence to post kidney transplant treatment and lifestyle changes is critical in maintaining graft function. However, non-adherence leads to graft loss necessitating the patients to revert to dialysis or re-transplantation. This descriptive cross-sectional study aimed at describing adherence to post kidney transplant treatment and lifestyle changes among kidney recipients at Kenyatta National Hospital. Census sampling method was used to recruit 106 study participants attending transplant clinic. Data collection was done using interviewer and self-administered questionnaire. Descriptive statistics were used to describe patients’ characteristics. Chi square test of significance was used to determine the relationship between the independent and dependent variable. A p value of less than 0.05 was considered statistically significant. Logistic regression was used to determine the predictors of adherence. The study findings revealed that most of the respondents 63(60%) were non adherent to clinic attendance while 49(46%) were non-adherent to medication. Forgetfulness and cost of medication were reported to be the major contributing factors to non-adherence to medication. Frequency of medication dosing was a statistically significant factor influencing non-adherence to medication (x2 (1) = 6.61, p = .019, p= <.005) while distance to the hospital statistically significance influence of non-adherence to clinic attendance, (x2 (2) = 12.63, p = .002, p<.005). The study concluded that non adherence is a major concern in post kidney transplant recipients occasioned by drug cost and distance to the hospital. The study recommends that the government and non-governmental organizations should offer financial support for medicines. Also decentralization of post kidney transplant services to the county referral hospitals and use of daily dose drugs should be embraced.
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    Compliance with Hemodialysis Treatment among End Stagekidney Disease Patients in Nyeri County, Kenya.
    (Kenyatta University, 2022) Chege, Jacinta Wanjiku; Grace Githemo; Lister Onsongo
    The number of End Stage Kidney Disease (ESKD) patients on hemodialysis (HD) globally has become a public health concern. Compliance with hemodialysis recommendation aids to improve health outcomes and prevent complications. However, non-compliance to hemodialysis among ESKD patients has been a major problem. The purpose of the study was aimed at describing the level of compliance with hemodialysis and the associated factors among ESKD patients in three selected dialysis centers in Nyeri County. A descriptive cross-sectional study, utilizing quantitative research method and targeting 80 participants was done. Census method was used to recruit the study participants. Data was collected through administration of a questionnaire and analyzed by use of computer software, statistical package for the social science (SPSS) version 24. Descriptive statistics was used to determine the level of compliance to hemodialysis. Inferential statistics was used to determine factors associated with compliance to hemodialysis. SPSS version 24 was used in data analysis.The study findings revealed that compliance with hemodialysis treatment was 53%. The findings showed that there was significant association between compliance and; marital status, x2 (2, N=30) = 5.151, p =0.029, income, x2 (4, N=12) = 11.322, p =0.045, and number of hospital admissions, x2 (3, N=I) = 38.069, p =0.0001. Shortened hemodialysis,(aOR = 5.5, p = 0.002) and waiting time for two hours prior to start their hemodialysis session (aOR =4.11, p =0.005) were independent predictors of noncompliance with hemodialysis treatment.Despite opening new hemodialysis centers in Nyeri County to increase availability and accessibility of hemodialysis services, compliance still remains a major challenge among patients. Shortening of hemodialysis sessions, low economic status, inadequate machines and failure to repair machines when they break down were major barriers to hemodialysis compliance. Therefore, adequate resource allocation should be considered when opening new hemodialysis centers.
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    Correlates associated with Adherence among Female Sex Workers on HIV pre-Exposure Prophylaxis in Nairobi City County, Kenya
    (Kenyatta University, 2024-03) Litiema, Edith Amahwa
    ::LC:C‘>§p?§llrg _prophylaxls (PrEP) is the use of ante-retroviral drug to prevent HIV .L,n ive lndmlduals who are at risk of acquiring HIV from becoming infected with HIV. l_’lEP use requires one to commit to taking the drug every day. The effectiveness of PrEP is conclalgd to adherence to regular uptake of medication. Barriers to good adherence should be identified and strategies to enhance adherence to PrEP be implemented. Female sex workers (FSW) are a susceptible group, and they face higher risk of HIV infections. Truvadz'a, a recommended drug for PrEP contains Tenofovir and emtricitabine. It is a nonnucleotides reverse transcriptase inhibitor (NRTI) that inhibits viral replications in the body, thus limiting number of HIV infected cells. The key objective of this study was to measure correlates for adherence in HIV negative Female Sex Workers to PrEP. This was accomplished by assessing the levels of knowledge about PrEP, evaluating adherence levels, examining factors influencing adherence, and analyzing strategies to improve PrEP adherence. A cross-sectional study design employing a mixed-method approach, incorporating both qualitative and quantitative data collection methods, was conducted from March to May 2021. The study enrolled 345 female sex workers (FSWs). Among them, 72% were unfamiliar with the name of PrEP, 39% reported missing PrEP doses, and 33% acknowledged missing appointments for PrEP refill. Qualitative data indicated a recommendation for monthly PrEP engagement meetings to bolster adherence. The research helped in identifying the need for clinical trials to test new products such as long acting injectable and monthly PrEP pills. This will reduce barriers to adherence thus enhancing HIV prevention.
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    Determinants of Chronic Kidney Disease among Type 2 Diabetes Mellitus Patients at Gatundu Level 5 Hospital, Kiambu County, Kenya
    (Kenyatta University, 2023-12) Mwega, Bernard
    The prevalence of chronic kidney disease (CKD) is rising throughout the world, and it is one of the major public health menaces due to the significant morbidity and mortality it is associated with. The burden of CKD inexplicably affects low-income nations like Kenya, where the two main public health concerns responsible for the growing prevalence of CKD are hypertension and diabetes mellitus. The aim of this study was to assess the determinants of chronic kidney disease among type 2 diabetes mellitus patients. A hospital-based cross-sectional study design was conducted at Gatundu level 5 Hospital in Kiambu County, central Kenya, among adult (≥18 years) diabetes mellitus patients. Sample size was determined using Yamane Taro formula. Informed written consent was obtained from each participant and data was collected by interview and chart review. Glomerular filtration rate (GFR) was estimated from serum creatinine using modification of diet in renal disease (MDRD) formula, while CKD was defined as estimated GFR (eGFR) of less than 60mls/min/1.73m2 for more than three months. Multivariate logistic regression was used to identify independent determinants of CKD and a p-value of <0.05 was considered statistically significant. Majority of the participants (43.42%) were aged between 50-60 years and 95 (62.5%) of them were female. The researcher found out low level of patient awareness (25.8%) and high prevalence of CKD (78.2%). Factors associated with chronic kidney disease were gender, high blood pressure, type 2 diabetes mellitus, smoking, family history of CKD, obesity, poor knowledge of CKD and long duration of hypertension. The researcher observed a high prevalence rate of CKD amomg diabetic patients and hence recommended that the National and County Governments‟ Department of Health should take measures to increase the awareness about CKD prevention among high risk populations such as patients with diabetic mellitus.
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    Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County, Kenya.
    (Kenyatta University, 2023-11) Matheka, Seraphine Mbinya; Priscilla Kabue; Anthony Wanyoro
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    Determinants of Kidney Transplantation Uptake among Patients with End Stage Kidney Disease on Haemodialysis at Selected National Referral Hospitals in Kenya
    (Kenyatta University, 2023-05) Nduati, Joseph Mwororo; Joseph Nduati; Grace Githemo
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    Determinants of Measles Vaccine Uptake among Mothers of Children between 9 and 24 Months in Narok-County, Kenya
    (Kenyatta University, 2023-02) Kiplagat, Alice J.
    Vaccine hesitancy is one of the major determinants of low vaccination coverage in both developed and developing countries. The measles vaccination coverage in Kenya is considered considerably low, which has contributed to sporadic measles outbreaks. The present study assessed the determinants of low uptake and hesitancy of measles vaccination among mothers or caregivers of children aged 9 – 24 months in Narok North Sub-County, Narok County, Kenya. Using an analytical cross-sectional study, a structured questionnaire was used to collect data from 100 mother and caregivers. Analyses were conducted through Pearson’s chi-square, Kruskal-Wallis H, and logistic regression tests. A total of 69(69%) of the children (N =100) who had qualified for the first dose of measle vaccines (MCV1) had received the vaccines, while 31(31%) had not. Thirteen (26.5%) of the children (n = 49) who had qualified for second dose of measle vaccine (MCV2) had received the vaccine, while 36(73.5%) had not. Thus, 48(48%) of the all the children (N = 100) were considered to be fully immunized against measles, while 52(52%) were either partially or not immunized. The main maternal determinants included; maternal age (p = .019), number of antenatal clinic visits (p = .04), vaccine hesitancy (p = .001), concerns about side effects and adverse reactions of the vaccines (p = .020), and maternal level of education (p = .030). The child’s determinants were; place of birth (p = .001), history of experiencing vaccine side effects (p = .004), and birth order (p = .032). The socioeconomic factors included; low socioeconomic background (p = .004) and cultural and religious issues (p = .003). The healthcare determinants included; provision of dates for vaccination to mothers or caregivers (p = .000), distance from the health facility (p = .020), availability of vaccines in the health centre (p = .000), outreaches (p = .000), and display of immunization guideline to mothers or caregivers (p = .002). The uptake of the measle vaccine was very low compared to the WHO recommended coverage rate of >95%. Thus there is need to provide health education and information to mothers or caregivers on measle vaccines uptake
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    Determinants of Neonatal Care Practices among Postnatal Mothers at the Kiambu and Thika Hospitals, Kiambu County, Kenya
    (Kenyatta University, 2022) Kariuki, Lilian .W.; Grace Githemo; Maina Ngugi
    Neonatal health is necessary in decreasing child mortality but often gets minimal attention. Research evidence in third world countries has shown that practices such as poor cord care and breastfeeding practices impact on neonatal health. This study aimed to determine the neonatal care practices among postnatal mothers and the relationships between various factors and these practices at the Kiambu and Thika County Hospitals. This was a cross sectional descriptive study design. Stratified sampling method was used to identify the sample for the study. Self-administered and interviewer administered questionnaires were used to collect data, practice was assessed through a likert scale, analyzed through SPSS and presented using descriptive statistics. Chi square test of significance (p ≤0.05) was used to test the relationships between the various explanatory factors and the neonatal care practices among postnatal mothers. A total of 128 postnatal mothers participated in the study with the mean age being 26 ±5.8 years. There was negative relationship between information received on breastfeeding, eye care, thermoregulation, immunization and actual care practices (p<0.05). Adequate knowledge was found towards cord care with gaps in practice existing in breastfeeding, eye care and thermoregulation. Social demographic, socio-economic, socio-cultural and institution factors did not influence neonatal care practices. More emphasis should be put on maternal education regarding neonatal care practices (thermoregulation, eye care, skin care and breastfeeding practices). Further research is recommended to find out why there are negative practices on breastfeeding and eye care despite being knowledgeable on those practices.
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    Determinants of Quality of Hemodialysis Services in Selected County Dialysis Centers in Nyanza Region, Kenya
    (Kenyatta University, 2024-05) Nyabaro, Doreen
    Background: Hemodialysis is a common management intervention in patients with Chronic Kidney Disease and End-Stage Renal Disease. Globally, there are approximately 1 billion renal patients on hemodialysis. Despite the increase in utilization of maintenance hemodialysis in low- and medium-income countries, there have been fewer efforts to assess the quality of hemodialysis services. Thus, there is a need to assess the quality of hemodialysis services. Objective: To evaluate the quality of hemodialysis services at selected county dialysis centers. Methodology: The study was a cross-section descriptive study. The study adopted a census method where 118 hemodialysis patients was considered. The participants were sampled consecutively based on the inclusion criteria. SERV-QUAL tool was used to measure perceived quality of hemodialysis services. Chi squares test for the association was used to determine the association between the patient, institutional factors, healthcare professional factors, and the quality of Hemodialysis services. Binary logistic regression analysis was used to determine predictors of quality hemodialysis services. Statistical Package for Social Sciences (SPSS version 26) was used for data analysis. Results: Majority of the patients 61.9%(n =73)were male, with 28.8%(n =34) of the respondents being aged 60 years and above. The findings further showed that 44.1% of the participants had secondary level education. The perceived quality of hemodialysis services was moderate with 56%. Bivariate analysis revealed that gender, level of education, presence of comorbidities, admission due to side effects, receiving social support, waiting time, receiving education before dialysis session and satisfaction with care were associated with quality of hemodialysis services. Multivariate analysis using logistic regression established that 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 HD (AOR = 0.21, 95%CI: 0.05 – 0.93, p =0.041) were significant predictors of perceived good quality of hemodialysis services: Conclusion and recommendation: The perceived quality of hemodialysis services remains moderate. Gender, education level, admission due to side effects waiting time and receiving social have been identified as predictors of perceived quality of hemodialysis services. Therefore, 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 improved care.
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    Determinants of Sexual Function among Female Patients with Gynaecological Cancers at Kenyatta National Hospital, Nairobi City County, Kenya
    (Kenyatta University, 2022) Obora, Maximillar; Lister Onsongo; James O. Ogutu,
    Background: Gynaecological cancer impacts approximately three million women globally. The problem is much intense in resource limited countries. Sexual health is attracting great focus as a key aspect of gynecological malignancy management and a component of Quality of Life. We have paucity of information in regards to the magnitude of sexual dysfunction among survivors with gynaecological cancers in Kenya. Therefore, investigating sexual function among survivors with gynaecological cancer is an important area of inquiry. Broad objective: To assess the determinants of sexual function among female patients with gynecological cancers at Kenyatta National Hospital. Methodology: Descriptive correlational study design was utilized where by 108 Female patients diagnosed with gynaecological cancers on treatment and regular follow up were consecutively recruited by simple random sampling. The study was conducted at Kenyatta National Hospital Cancer Treatment Centre. The main variables were socio-demographic, assessed with the socio-demographic questionnaire, clinical characteristics, extracted from medical records, psychological, assessed with the Body Image Scale (BIS), social, assessed with the Multidimensional Scale of perceived Social Support (MSPSS) and cultural, and assessed with the Sexual Dysfunction Beliefs Questionnaire. Sexual function was evaluated by female sexual function index. SPSS Version 25.0 was used in analysis .Chi square test, Pearson’s 𝑟 assessed correlations and logistic Regression were done to identify the predictors of sexual function. Results: Mean total score of Female Sexual Function Index scores was 10.0. Eighty-five (85%) of respondents had sexual dysfunction. Age (p=0.004), Employment status (p=0.002), cervical cancer (p =0.016), endometrial cancer (p=0.018), cancer staging 4 (p = 0.008) and social support (p =0.037) were significant predictors of sexual dysfunction. Age (p =0.001), education level (p =0.002), employment status (p<0.0001) and lifestyle adaptation (p =0.047) were significantly associated with sexual function. Respondents who had cancer of the cervix were 7 times more likely to have sexual dysfunction Conclusion and recommendations: These results signify that Sexual dysfunction is a disturbing and under managed problem among gynecological malignancy survivors. Assessment of sexual function using Female Sexual Function Index scores has yielded important information that predicted outcome of patients with gynecological cancers. Health professionals can contribute great impact on the Quality of Life of gynecologic malignancy survivors by focusing on sexual health issues. Therapeutic intervention at multidisciplinary level should incorporate sexual rehabilitative strategies in all oncology settings in order to provide relevant supportive care in addressing physical and psychosocial needs of patients with gynecological cancers across survivorship continuum of care and broadening sexual health training within the medical curriculum for all health professionals.
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    Determinants of the Quality of Life of Caregivers of Children with Sickle Cell Disease at Siaya County Referral Hospital, Kenya
    (Kenyatta University, 2023-07) Okinyi, Joash; Sarah Bett; Grace Githemo
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    Determinants of Timely Referral and Safe Transport of Neonates Referred to and those Transferred Out of Makueni County Referral Hospital, Kenya
    (Kenyatta University, 2024-12) Iluka, Francisca Nduku
    Internationally, 2.5 million babies lose their lives before first 28 days of life, many of the deaths occurs in the under developed countries and a third occurs on day one of life. According to the World Health Organization, many neonate deaths are preventable by simple interventions. The primary goal of the study was to establish determinants of timely referral and safe transport of neonates in Makueni County Referral Hospital. The study employed cross-sectional study design. The researcher collected data from 50 neonates through consecutive sampling. The researcher used a self-administered questionnaire, document reviews of the patients’ files and structured data checklist. Patients condition on admission was obtained from the health record. The researcher analyzed the data quantitatively using the Statistical Package for Social Sciences version 26 (SPSS V26). The data obtained was summarized using frequency tables. Inferential statistics such as Chi-square tests Fishers Exact, bivariate and multivariate analysis were used to test for associations. Graphs, text, tables and pie charts were used to present the ultimate results. In total 50 admitted neonates were recruited to the study and results analyzed. According to the study findings, the researcher found out that there was no significant association between timely referral and safe transport and neonatal and maternal variables. Conversely, analysis of institutional characteristics highlights several significant factors associated with the likelihood of timely referral and safe transport during a referral. Patients who did not receive stabilization 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. The study concludes that institutional factors influenced safe transport and timely referral to include patient stabilization, 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 equipments so that in the event of a problem, the healthcare provider can intervene appropriately. Also, hospitals should be supplied with all the necessary equipments and drugs to aid in stabilization of patients.
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    Experiences of Mothers of Neonates Born with Gastroschisis in the Neonatal Intensive Care Unit at Kenyatta National Hospital: A PhenomeHlogical Study
    (Kenyatta university, 2023-11) Thaiya , Rosemary Muthoni
    The researcher carried out research on experiences of mothers with neonates born with gastroschisis in Kenyatta National Hospital and admitted in Neonatal Intensive Care Unit. The research focused on the lived experiences of mothers with neonates born with gastroschisis, the mental symptoms given by the mothers and the support needed by these mothers.The study employed phenomenological descriptive research design. The study assessed mothers whose neonates were admitted was conducted in the NICU at Kenyatta National Hospital. Purposive sampling technique was used to interview twenty-five (25) mothers. Primary data was collected using the semi-structured interview guide. The refined qualitative data was manually analysed. Data collected was transcribed verbatim and coded using structured code book. Thematic analysis was done inductively. The collected data was then developed into themes and subthemes then analysed.Data was presented using tables. The research indicated that 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. The study found that there was both positive and negative relationship between mothers and healthcare providers. It was also found that mental symptoms led to fatigue. The study found that mothers experienced support from spouses, family members, health care givers and peers.The study concluded Prenatal Experiences of Mothers with neonates with gastroschisis was positive and 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 close family members and inadequate information about the condition before their children were born. They too were unprepared to deal with the stress and difficulties related to the children's disease. Majority of the mothers received support from the family members and fellow mothers with similar experiencesA 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 the mothers with neonates born with congenital anomalies other than concentrating on the neonates alone.To assist in easing the mental and emotional strain placedspit on parents, hoal staff should provide professional counselling. They should also encourage peer counselling from among mothers.
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    Health Related Quality of Life for Caregivers of Psychiatric Patients, Mathari National Teaching and Refferal Hospital, Nairobi City County, Kenya
    (Kenyatta University, 2022) Nyamwaro, Yuniah Bitutu; Lister Onsongo; Grace Githemo
    The mentally ill patients have been shifted from institutions to home based care involving the family and the community than the straight in-hospital treatment. Consequently, the prevalence of mental illness is rising which is proportional to increased burden among the primary caregivers’ thus affecting their Health-related quality of life (HRQoL). The average prevalence of mental disorders in the world is 13.4%. In Kenya, mental health is a real concern and has been ranked 4th in Africa and 9th globally with highest number (1.9 million) of depressed persons leading to an increase in cases of suicides among mentally ill patients. The aim of this study was to determine the HRQoL and associated factors of primary caregivers of the mentally ill patients at Mathari National Teaching and Referral Hospital which is the largest teaching and referral psychiatry hospital in Kenya as at now. . The study used descriptive cross-sectional research design. Systemic random sampling was used to recruit 310 caregivers of mentally ill patients in the outpatient clinic. The WHOQoL-BREF questionnaire was used to assess Caregivers HRQoL. Statistical package for social sciences version 25.0 was used for analysis. Pearson was used to test relationships between variables and multivariate regression models were used to determine predictors of HRQoL. The findings revealed that on quality rating 1-5, Majority (34.4%, mean 2.61 SD 1.05) of the participants reported poor HRQoL. Caregivers’ marital status (.292, =0.000), relationship with the patient (.166, =0.004) and patient gender (.188, =0.001) significantly correlated with primary caregivers’ HRQoL. Patients’ review with compliance to treatment (61.5%), and health system support (.420, P=0.000), were significantly associated with primary caregivers’ HRQoL. The adjusted R squared revealed that jointly, caregiver characteristics, patient characteristics and health system support accounted for 20.1% of changes in the physical health, 10.3% in the mental health, 24% in the social relationships and 36.9% in environment health of primary caregivers these being the predictors of HRQoL. Specialized psychiatric, mental health professionals and policy designers to realize these characteristics which impact the caregivers ’HRQoL so as to intervene by providing psycho-education on patient care, encourage social support groups, improve environment and health support system of the primary caregivers hence improving t
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    Male Involvement in Birth Preparedness through Health Facility Community Dialogue in Kajiado County- Kenya
    (Kenyatta University, 2023-04) Mutsi, Hellen
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    Midwives Preparedness in Management of Postpartum Hemorrhage in Muranga County, Kenya
    (Kenyatta University, 2021) Muthoni, Doris Mumbi; Priscilla Kabue; Elizabeth Kurwa Ambani
    ABSTRACT Postpartum hemorrhage is the cumulative blood loss of about 500 milliliters in a spontaneous vagina delivery and approximately 1,000 milliliters for cesarean section birth and is one of the leading causes of maternal mortality. World Health Organization estimates that more than 300,000 women world-wide died from pregnancy-related cases in 2015, which means a total of 830 women die every day. In Kenya, it translates to 362 deaths per 100,000 live births. Postpartum hemorrhage is the major cause of maternal mortality resulting to a woman dying every 4 min, worldwide due to massive PPH. It is more tragic to have a well mother dying in the process of giving birth with complications that can be prevented. A woman’s death has some negative impact on the family, community, and the government due to the role the mother plays in a home setup. In view of the above a study was conducted in Muranga County with an objective of determining the preparedness of midwives in prevention and management of PPH. The study adopted a descriptive cross-sectional study that employed a quantitative approach through the use of a research self-administered questionnaire and an observational checklist targeting midwives. A total of 85 midwives filled the questionnaire and 71 midwives were observed respectively. The convenience sampling technique was used to select the midwives in the study sites. The analysis was done using SPSS. The study findings showed midwives factors that had an association in their preparedness in the management of PPH as follows: age ( p-value= 0.021), professional qualification (P-value= 0.047), experience in the management of PPH (P= 0.032) and training on emergency management of PPH (P= 0.010). Midwives knowledge that influenced their preparedness in the management of PPH was knowledge on; uterotonics use ( Fischer’s exact value= 0.000), recommended time for uterotonic drug administration (P= 0.043), uterine massage during 3rd stage of labour (P= 0.012), examination of the placenta (P= 0.034), management of PPH (P= 0.028), causes of PPH (P= 0.001) and on diagnosing PPH (Fischer’s exact value= 0.043). Institutional factors influencing the midwives preparedness in the management of PPH were availability of uterotonic supplies (P= 0.040), availability of transport in case of a referral (P= 0.032), staff to patient ratio (P= 0.028), and availability of Management guidelines (P= 0.012). On current practice deliveries observed showed, 27.2% competently prepared for birth, 18.3% offered emotional support, 26.2% competently prepared for the second stage, 35.5% administered uterotonics, 25.9% practiced controlled cord traction and 27.1% performed uterine massage. Finally, the study concluded that Midwives factors, institutional factors, and the use of current guidelines influence midwives preparedness in the management of PPH. The study recommends that the county government be providing continuous training to midwives on emergency management of PPH, ensure the availability of equipment, uterotonic drugs and transport facilities in case of referral. Also the Ministry of Health should provide current Standard Management Guidelines on PPH, orientate the midwives on their usage and ensure the guidelines are displayed.
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    ntegration of Critical Care Nurses in Antimicrobial Stewardship; Opportunities and Barriers at Thika Level 5 Hospital, Kiambu County, Kenya
    (Kenyatta University, 2025-05) Chege, Joseph Waithanji
    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. TL5H was selected for this study due to the availability of an antimicrobial stewardship program whose implementation suffers a disconnect among healthcare providers. 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 critical care unit were purposively selected and 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. Education, teamwork, open communication and organizational support increase nurses’ awareness of AMS and ensures a coordinated approach in its implementation. 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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    Nurses’ Perception of the Quality of Patient Care in Selected County Hospital Critical Care Units in Kenya
    (Kenyatta University, 2023-05) Mulinge, Kelvin
    The global Intensive Care Units (ICUs) perception of quality of care remains below :\e:;?‘g:t\]:u:czz:; ]l:(?ca:ors such as highv mor?a.lity and high infection rates been reported 9 | gical advancements in critical care medicine. Studies have reported ;‘:::;:‘;:“:: :::011;;31!::6 1;1;rses anld the institutior} to havcf. a profound impact on the i perspectiveci) ” y]‘ car'e the Patlent rece.lvfs. This study assessed the CCU S quality patient care, the association between nurses’ characteristics and the perception of patient care, the association between institutional characteristics and perception of patient care and the predictors of the perception of care in selected hospitals critical care units in Kenya. The study was a correlational study that’s used stratified sampling and census sampling to collect data. Over a 6-month period between May and December 2021, a questionnaire named, nurses’ perception of the quality of patient care in selected county hospital critical care units in Kenya was distributed to 103 nurses in Machakos, Embu, Muranga and Nyeri CCUs. The study findings revealed that one third (33%)of the nurses rated the quality of care as good while the rest two thirds (67%) rated the quality of care in their unit as fair or poor. Test for association (Chisquare) was conducted to investigate demographic characteristics and nurses’ perception of quality of patient care and revealed that years worked in ICU (p<0.001), specialization in CCU (p=0.023) and © sadre (p<0.001) were significantly associated with the nurses’ perception of quality patient care. In investigating the association between institutional characteristics and the nurses’ perception of quality patient care provided using chi-square, the findings revealed that all institutional factors assessed were significantly associated with the nurses’ perception of quality patient care .(pfoAOOI) apart from multidisciplinary teamwork in the unit where there was no assocm.tlon f.ound (] =0.253). Regression analysis revealed that determinants like: years of experience in CCU, specialized in CCU, adherence to aseptic procedure, moisture and incontinence checks t resources were independently associated with the and availability of VAP managemen , . nurses’ perception of quality patient care. This study concluded that nurses perceptions of quality of patient care in selected critical care units was below average and was greatly i ializati rsing cadre and institutional influenced by nurses’ experience, specialization, nursing characteristics.