Africa Journal of Nursing and Midwifery

Challenges of Nursing Students during Clinical Practice in Emergency Department: A Case Study

Wawan Febri Ramdani — 2024-04-29

Background: Transitioning from theoretical studies to practical scenarios, particularly in the Emergency Department (ED), poses significant challenges for nursing students. These challenges include high time pressure, the complexity of cases, and the urgent nature of situations often encountered. The impact can lead to increased stress levels, a higher workload, and a potential lack of confidence in handling situations that require quick and accurate responses. This study investigated the initial adaptation process of these students, known as Ners, emphasising their environmental adjustment, interpersonal skill enhancement, professional development, and emotional coping strategies.

Method: This qualitative study engaged 25 nursing students in ED rotations from November 2023 to March 2024. It utilised detailed interviews, participatory observation, and document analysis, employing thematic analysis to unearth key themes.

Results: Four central themes emerged: acclimatisation to the clinical environment, dynamics of relationships and interactions, skills and competencies enhancement, and coping with emotional and psychological challenges. Initially challenged, students gradually became accustomed to the ED's demands, enhancing their professional and social skills and developing effective stress management strategies.

Conclusion: The findings highlight the necessity for comprehensive preparation and ongoing support and suggest significant implications for improving nursing education and practices within the ED.

Uptake of Cervical Cancer Screening Services and Associated Factors among HIV-Positive Women at Mzuzu Central Hospital, Malawi

Ulemu Phiri — 2024-06-14

One of the major causes of death among women worldwide is cervical cancer (CC). The majority of the cases occur in underdeveloped nations, especially among human immunodeficiency virus (HIV)-positive women. The purpose of this study was to evaluate the uptake of CC screening and the factors that are related to it in these HIV-positive women at Mzuzu Central Hospital, Malawi. The study used a quantitative methodological approach. Secondary data for 397 women was extracted from hospital registers. It was then entered and analysed using STATA. Descriptive statistics, univariate analysis, multivariate analysis, and chi-square analysis were performed to test the association between the outcome variable and the independent variables. The results showed that a significant correlation between subsequent screenings and positive outcomes was found by multivariate analysis using ordered logistic regression (adjusted odds ratio (AOR) = 5.546; 95% confidence interval (CI) [4.718696, 6.373458]). A significant correlation between the number of screenings performed and marital status was found using chi-square analysis. Compared to married and widowed women, the proportion of divorced and single women who underwent multiple screenings was lower. In conclusion, the study found that among HIV-positive women in Mzuzu, Malawi, a complex interaction of demographic factors influenced the results of CC screening. Age and marital status showed varied effects, even though further screenings were positively associated with favourable outcomes.

The Effect of Training and Phone Counselling Provided to Hypertension Patients on their Medication Adherence and Rational Drug Use: A Single-blind Randomised Controlled Trial

Havagül Ayruk — 2024-04-16

Background: Hypertension is a chronic disease characterised by high blood pressure, which is an important public health problem that causes serious complications. It is very important to provide training and remote telephone counselling to patients for them to comply with the drug treatment of hypertension disease and to comply with the principles of rational drug use.

Aim: This study aimed to define the effect of training and phone counselling provided to hypertension patients on their medication adherence and rational drug use.

Methods: The study was conducted randomised controlled as a single-blind experimental study between July 2021 and June 2022. The study universe consisted of hypertension patients admitted to hospital, and the sample consisted of 92 patients. The block randomisation method was used. The study data were collected using a Patient Identification Form; the Medication Adherence Self-efficacy Scale; and the Rational Drug Use Scale. The experimental group received training once, in addition to a total of four phone counsellings (week 2-4-8-12).

Results: According to the group-by-time interaction of control/experimental group patients, a statistical difference was found between the median scores of the Medication Adherence Self-efficacy Scale and the Rational Drug Use Scale (p<0.001). The pre-test median of the Medication Adherence Self-efficacy Scale of the experimental group patients was 30.00, and the post-test median was 46.00. The pre-test median of the Rational Drug Use Scale of the experimental group patients was 43.00, and the post-test median was 68.00.

Conclusion: In the study, it was determined that the application of education and telephone counselling to hypertension patients increased patients’ medication compliance and rational drug use. In systolic-diastolic blood pressure levels, which are critical for hypertension patients, it was determined that the application of education and telephone counselling significantly decreased the blood pressure of patients.

Factors Associated with Adequate Antenatal Care among Pregnant Women in Rural Indonesia

Diyan Indriyani — 2024-02-08

Antenatal care (ANC) is crucial for the health of both mother and child. However, information on ANC in rural Indonesia is limited despite its essential role. This research examined the determinants of adequate antenatal care among rural Indonesian pregnant women. A cross-sectional study analysed pregnant Indonesian women aged 18-49, focusing on adequate antenatal care (ANC) during the third trimester. The study included sociodemographic variables and component factors (knowledge, motivation, social support, and health services). A multivariate logistic regression analysis was performed.

A total number of 350 pregnant women aged 18–49 years old enrolled in this study. Almost half (47.1) % of women received adequate ANC (≥ eight visits) during their pregnancy, and about 79.1% of participants had adequate ANC (4 or more visits). Mothers with higher education and married were more likely to have adequate ANC (AOR = 1.52; 95% CI [1.12–3.46]) and (AOR = 1.17; 95% CI [1.01–3.32]), respectively. Poor knowledge toward ANC (AOR = 0.41; 95% CI [0.12–0.65], low motivation (AOR = 0.73; 95% CI [0.31–0.97]), poor health service (AOR = 2.76; 95% CI [1.85–4.32]), and poor social support (AOR = 3.24; 95% CI [2.11–5.34]) was negatively associated with adequate ANC. The intervention aims to improve access to maternity care for women in rural Indonesia by enhancing social support, reproductive health awareness, and expanding safety net services

Perspectives of Pregnant Women Regarding the Use of Mobile Phones for Antenatal Health Education: A Qualitative Study in Rural Southwestern Kenya

Zillah Malachi — 2024-06-18

Introduction: Pregnant women face a myriad of challenges ranging from anxiety, myths and misconceptions concerning pregnancy, diet, and general antenatal care because of inadequate health education during the antenatal period. There are extensive studies on mobile phone use in primary care; however, only a few qualitative studies have been conducted to establish the usefulness of these devices in antenatal education. Therefore, this study aimed to explore pregnant women’s views on mobile phone use in antenatal education.

Methods: This study utilised a qualitative study design. It was conducted in rural health facilities in southwestern Kenya. Focus group discussions were used to collect data which were analysed thematically using ATLAS.ti version 23.

Results: The overall theme that emerged from the study was “antenatal education is beneficial, and if provided via a preferred mode of mobile phone communication, can bridge the gap in antenatal education content.” The participants perceived antenatal education through mobile phones as beneficial and complementary to the information received during routine antenatal care. Most of the participants felt that antenatal education should be given through a preferred mode of mobile phone communication.

Conclusion: Mobile phones have the potential to improve the quality of antenatal education provided during pregnancy.

Preparedness for Natural Disasters among Volunteers in East Java, Indonesia: A Cross-Sectional Study

Apriyani Puji Hastuti — 2024-06-14

Indonesia is particularly vulnerable to natural disasters, especially geological and hydrometeorological disasters, which can adversely impact human life. Disaster management is a development carried out and integrated by the Regional Government. This study aimed to analyse the natural disaster preparedness among volunteers in the Poncokusumo Area, Malang Regency, East Java, Indonesia. The study used a cross-sectional design to determine the volunteers’ level of disaster preparedness. The sampling technique used randomised (cluster) sampling with 165 respondents. The research used a questionnaire with a 5-category Guttman Scale for disaster preparedness index (DPI) with the parameters divided into knowledge and attitude (KA), emergency planning (EP), disaster warning system (DWS) and resource mobilisation capacity (RMC). The research was conducted in the working area of Poncokusumo Public Health Center, Maofng Regency. Data analysis in the study used a one-way ANOVA. The results showed that the volunteer level of preparedness for landslides was 67±1.33 (ready). There was a relationship between characteristics of disaster preparedness, namely, age (p-value = 0.033) and years of experience as a volunteer (p-value = 0.02). Volunteers can contribute to relief operations by providing necessities, such as food, water and shelter to affected individuals. They can also assist in clean-up activities, infrastructure repair, and community rebuilding initiatives. It is important to note that volunteers should be well-trained and coordinated with local authorities and emergency management agencies to ensure their safety and effectiveness in disaster preparedness and management situations.

Evaluation of the Training Given to Emergency Department Nurses on Ventrogluteal Site Injection Administration: A Quasi-Experimental Study

Çisem Meteris — 2024-04-30

Evidence-based data recommends injection to the ventrogluteal (VG) site instead of the dorsogluteal (DG) site for intramuscular injection (IMI) due to the risk of sciatic nerve damage. Despite this, it has been seen that nurses do not prefer this site due to insufficient information and negative opinions. The aim of this study was to determine how the training on administering an injection to the site provided to the nurses affects their knowledge, view and preference for the practice. The study design was a single-group, quasi-experimental pretest-posttest. The study was conducted with 30 nurses in the Adult Emergency Service of Hacettepe University Hospitals in Ankara, Turkey, between May and August 2020. The data was collected by using a nurse information form and forms that evaluated the nurses’ knowledge, opinions and practices regarding using the VG site. The data was analysed by using number, percentage, mean, standard deviation, Friedman test, Wilcoxon test, and McNemar test. As a result of the study, it was found that while the views of 86.7% (n = 26) of the nurses about the VG site changed positively after the training, the mean score of the VG site was 14.80+3.09 before the training, and 18.50+1.68 after the training (p < .001). After the training, 7 of 16 nurses started to prefer the VG site for injection administration (p > .05). The training provided on the VG site increased the knowledge of nurses, changed their views, and affected their preference for the practice. It is recommended that nurses repeat the training on IMI administration to the VG site and assess their abilities on a regular basis.

Analysis of Dominant Factors Affecting Pre-Hospital Stroke Management in Kupang City

Yoany Maria Vianney Bita Aty — 2024-05-21

The incidence of stroke is increasing every year, and effective management comprises both pre-hospital and hospital care. The key to successful management is for families to recognise the clinical symptoms and promptly seek medical attention. Delayed assistance frequently leads to complications, underscoring the importance of timely intervention to save lives and prevent long-term disabilities. The key to successful management is identifying a stroke and prompt transportation to a medical facility. This study used a quantitative approach with a cross-sectional design, and the total sample was 300 people, while data analysis was performed using the Chi-Square test and logistic regression. The results showed that the family decision-making time in taking a stroke patient to the hospital, individually or collectively, significantly affected the Accuracy of Pre-Hospital Stroke Patient Management with a value of P (Sig) < 0.05. The magnitude of the influence was indicated by the value of EXP (B), also known as ODDS RATIO (OR). Specifically, the Decision-Making Time by the family to take stroke patients to the hospital exhibited an OR of 20.714. This implied that respondents capable of making the right decision to take stroke patients to the hospital were 20.714 times more likely to be accurate in pre-hospital stroke patient management. Based on the results, it can be concluded that the dominant factor influencing pre-hospital stroke attack management is the family decision-making time to take the stroke patient to the hospital. Therefore, the Kupang City government needs to improve ambulance facilities for the public, making it easier to access services, specifically in emergencies.

Magnitude and Factors Associated with Partner and Family-Based Index Case HIV Testing Among Clients on Anti-Retroviral Therapy Follow-ups at Holeta Health Centre, Oromia, Ethiopia

Fikadu Seyoum — 2024-01-26

Background: Index clients are HIV-positive individuals at HIV Testing and Counselling Centres who were enrolled in treatment, care, and support services. Most of the index cases did not test hard-to-reach groups, including children and adult sexual partners. The aim of this study was to assess the magnitude and factors associated with partner and family-based index case HIV testing among HIV-positive clients who are on Anti-Retroviral Therapy and follow up at Holeta Health Centre, Ethiopia, 2022 G.C.

Methods: A facility-based cross-sectional study was conducted on 316 selected individuals using simple random sampling techniques. The data was collected using structured questionnaires. The data were entered into EPI Info version 7.14 and then exported to SPSS version 24 for analysis. Bivariate logistic regression was used for each independent variable to check its association with the dependent variable. All variables with a P-value <0.25 in bivariate analysis were entered into a multivariate logistic regression analysis to identify factors independently associated with the dependent variables with a P value <0.05 were considered statistically significant factors and an adjusted odds ratio with a 95% confidence interval was used to measure the strength of the association.

Result: This study showed that among the study participants, 86.8% had tested a partner and 92.9% had tested at least one child. Marital Status (AOR = 0.06 CI: 0.02-0.21), duration on ART (AOR = 2.71 CI: 1.17–6.25), and disclosure status (AOR = 4.26 CI: 1.21–15.05) were identified to be significantly associated with partner- and family-based index case HIV testing.

Conclusion: This study showed that most of the study participants had tested with a partner and at least one child. Partner and family-based index case HIV testing has a significant association with marital status, duration on ART, and disclosure status of index cases.

Developing an Android-Based Application Documentation System of Postpartum Care for Indonesian Midwifery Students

Cut Mutiah — 2024-01-26

Midwifery students still take notes the old-fashioned way, on paper, which has become very inconvenient. Students struggle to create accurate and complete care documentation due to the risk of losing important data, transferring data, and scribbling. Mobile Case Midwifery Notes (CMNotes) is an Android-based documentation system designed to develop learning methods and interactive consultations between students and lecturers. CMNotes facilitates digital and comprehensive recording of patient data starting from assessment, diagnosis, and plan of care to implementation and evaluation by applying Varney’s management principles and Subjective Objective Analysis Planning (SOAP) documentation. This study is research and development (R&D) to produce a documentation system for midwifery care emphasising postpartum and breastfeeding care. The researchers recruited 185 midwifery students from Aceh Health Polytechnics to be involved in a needs analysis. Out of the total number of students, 39 students took part in the implementation stage where their experience using the application was assessed. The needs analysis revealed that postpartum care and breastfeeding are important subjects, and their documentation is the most important aspect. The implementation results show that the CMNotes provide convenience and satisfaction for students when documenting childbirth and postpartum care. Since CMNotes could provide the reference range of data, the system allows students to identify and focus on the issue experienced by the patients. Due to user feedback on the system’s usability, it is necessary to create an Android-based CMNotes application to fill in patient data more easily and effectively without the need for internet access.

A Scoping Review of Nurse-Led Medical-Surgical Knowledge Translation Interventions to Improve In-Hospital Clinical Practice in the WHO Afro Region

Anna N. Haifete — 2024-05-22

The process of placing research knowledge into action and thereby ensuring its dissemination is very important in healthcare currently. Although nurse-led knowledge translation interventions have become an important focus in the high-income countries, the extent of such interventions in the World Health Organization (WHO) Afro Region is not well established. This scoping review aimed to map the evidence of nurse-led knowledge translation interventions in the countries in the WHO Afro Region using the Joanna Briggs Institute (JBI) Scoping Review Methodology. A systematic electronic search of articles was carried out in selected electronic data bases using various search engines. All 688 eligible identified articles were imported into the Systematic Reviews Web App (Beta) Rayyan. The selection process included title and abstract screening, and full text article screening. A Prisma flow diagram detailing the procedure was developed. The review process resulted in 21 selected articles. The results showed minimal publications between 2013 and 2019 with a sudden increase in 2020 (n = 5) and 2021 (n = 4). The Eastern WHO Afro Region contributed 48% of the studies, followed by the Western WHO Afro Region with 43%. Ten countries were selected through the process of screening according to where nurse-led medical-surgical knowledge translation interventions were found. Nigeria contributed 33%, followed by Uganda with 19%. The scoping review concluded that studies be appraised for their ability to promote evidence-based knowledge, skills and behaviour in both rural and urban clinical settings. More of these studies need to be conducted in the WHO Afro Region. More focused systematic reviews should be conducted to sum up the best available research on these specific questions, supported by findings by clinical setting, type of intervention, and outcomes.

Impact of Mobile and Web Health Apps on Pediatric Chronic Disease Management and Quality of Life: An Update Systematic Review

Idyatul Hasanah — 2024-03-14

Mobile and web health applications have gained widespread usage worldwide for pediatric patients with chronic diseases, yet comprehensive research evaluating their impact remains limited. This research aims to determine the comprehensive impact of mobile and web health apps on pediatric chronic disease management and quality of life. Searches were performed on seven primary databases (Emerald Insight, Scopus, ScienceDirect, PubMed, ProQuest, Ebsco, and SpringerLink) from 2003 to 2023. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement guidelines. The quality study was conducted using JBI's critical appraisal tools. Descriptive and narrative analysis methods were used, and the findings were presented in text and tabular formats. Out of 1,840 articles reviewed, only 28 met the inclusion and exclusion criteria. The most identified outcomes in the study of mobile and web health apps on pediatric chronic disease management are psychological, cognitive, and behavioural outcomes and quality of life. However, biological markers seem to be the least evaluated outcome. Mobile and web health applications play a positive role in managing chronic diseases and enhancing the quality of life for pediatric patients. These applications offer a range of features, including symptom assessment, information dissemination, educational resources, caregiver communication, social support, and calendar reminders. Healthcare providers and caregivers should consider integrating these technologies into caring for children with chronic diseases. It can lead to improved outcomes and overall well-being.

Bibliometric Analysis of Research Trends and Novelty of Midwifery Policy

Fitriani Nur Damayanti — 2024-02-08

Midwifery policy is important in regulating services, and its significance cannot be overstated. Despite the ongoing efforts in formulating policy, there remains a need for further analysis. This is because evidence-based research in midwifery serves as a foundation for enhancing the professionalism of the service practices. Bibliometric analysis of publications pertaining to midwifery policy is absent, leaving a gap in understanding trends and concepts. Therefore, this research aimed to determine trends in the number of publications, and visualisation of the relationship on the topic of midwifery policy through bibliometric analysis. The method used systematic reviews with the stages following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram. Scientific publication data related to midwifery policy was retrieved through dimensions.ai from 2010 to 2022 and the data was analysed using VOSviewer. The results showed that first, there was an annual exponential growth in the number of publications and citations on the topic. Second, there were 224 items, 8 clusters, and 10047 links with a strength of 63352 on the topic of midwifery policy. Third, trends of research related to the topic were focused on hospitals, behaviour, and framework. Fourth, the research related to policy were topics with a low-density category, namely professional development, registration, and public health. Research results could identify trends and novelty in midwifery policy and recommend directions for further analysis.

Nursing Interventions to Improve Self-management in Patients with Type 2 Diabetes Mellitus: A Scoping Review

F Fitriani — 2024-01-26

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that remains a public health problem both in developed and developing countries. As the prevalence of diabetes mellitus increases, nurses can take part in managing this disease so that health outcomes can also be improved. Strategies for sustaining diabetes self-management are, therefore, pivotal.

Objective: This review aimed to identify existing evidence regarding interventions performed by nurses in enhancing self-management of patients with T2DM.

Methods: This study was a scoping review with T2DM adults as the population of interest. The literature search was conducted in May 2023 using PubMed, CINAHL, and Medline as the resource databases. The study selection followed PRISMA guidelines. The keywords were “nursing interventions,” “type 2 diabetes mellitus,” and “self-management.”

Results: A total of 22 studies were included for review, including 10 RCT studies, one quasi-experimental study, two qualitative studies, one systematic review, one qualitative systematic review, and seven meta-analyses. The studies were undertaken in Australia, the United States of America, Norway, Spain, Turkey, South Korea, China, Singapore, Ethiopia, Taiwan, and Iran. Of those studies, 10 discussed technology-based intervention, five reported a nurse-led education approach, two reported a patient-centred self-management approach, one reported motivational interviewing, two discussed an empowerment-based approach, one reported psychological intervention, two reported a case management programme, and one reported structured as well as individualised education approaches.

Conclusion: Various nursing interventions can be implemented to improve self-management of T2DM patients. This review can inform nurses regarding intervention options applicable to their workplace conditions.

Perspectives Regarding Methodological Considerations and Challenges of Conducting Randomized Controlled Trials (RCTs) in Nursing Research

Nour Ali Alrida — 2024-01-26

Randomised Control Trials (RCT) serve as the gold standard in research design, offering valuable insights into evaluating the impact of nursing interventions on patient health outcomes. This paper explores the methodological considerations and challenges inherent in designing and conducting RCTs within the nursing context. The inclusion criteria involved a thorough search across reputable databases, including CEINAHL, EBSCO, Scopus, Google Scholar, and Cochrane Library, spanning any period due to the scarcity of relevant material. Articles were selected based on their alignment with key considerations such as randomisation, blinding, sample size calculations, outcome measures, and ethical aspects. Data extraction involved findings related to methodological considerations and challenges faced by nurse researchers in RCT design and implementation. Various challenges arise when applying these considerations due to the nature of nursing interventions and ethical concerns. Proposed solutions include comprehensive informed consent, mixed-methods approaches, and the cluster-randomization process. This paper underscores the role of nurse researchers in overcoming challenges and fostering evidence-based practice. Integrating robust methodological strategies and ethical considerations ensures the validity and reliability of nursing RCTs, contributing to improved patient care.

Bibliometric Analysis of Nursing Interventions to Improve Adherence to Treatment among Patients with Tuberculosis

Siti Aisah — 2024-01-26

Background: Interest in research on the topic of nursing interventions and medication adherence in tuberculosis (TB) patients has increased. In future research, researchers need information about trends and new things for the topic of nursing intervention research and medication adherence in tuberculosis patients in the future.

Purpose: The purpose of this research is to explore the trend of the number of publications, the trend of the number of citations, the journal with the highest number of publications, network visualisation, overlay visualisation, and density visualisation on the topic of nursing interventions and medication adherence in tuberculosis patients through bibliometric analysis.

Research method: Bibliometric analysis was used in this study. The data is identified through the https://app.dimensions.ai/ database, which is then selected using the PRISMA flowchart. Papers are limited to publication in 2018-2023, focusing on the fields of health sciences, nursing, public health, the science of services and health systems, information science, and types of publications are articles. Data were analysed using VOSviewer, and then the analysis results were reviewed by co-occurrence.

Results: A search for publications on nursing interventions to improve medication adherence in TB patients resulted in 60,204 articles. After being filtered through the specified criteria, the number of articles obtained was 3,237. The peak of publications on nursing interventions to improve medication adherence in TB patients occurred in 2018. Meanwhile, the lowest number of publications occurred in 2023. The health sector and other fields such as Human society, Information and computing science, and Psychology carry out research on nursing interventions to improve medication adherence in TB patients. In addition, health trends in nursing interventions to improve medication adherence in TB patients currently focus on using digital technology-based interventions such as mobile health applications, health education, and family support. The density visualisation shows that the topics not widely researched related to nursing interventions to improve medication adherence in TB patients are application, mobile health, health education, family, social support, stigma, and attitude.

Conclusion: The topic of nursing interventions to improve medication adherence in TB patients is a topic that needs to be further developed in various countries. Suggestions for other researchers: please choose a theme included in the visualisation category that has not been widely researched to find novelty for future studies.