Development of a pediatric pain educational program for nurses in a resource-limited setting

This study aimed at developing an evidence and theory-based pediatric pain educational program (PPEP) for nurses in a resource-limited setting, guided by the MRC’s framework. The PPEP was developed by identifying the evidence of need, identifying an existing theory and modelling the process and outcomes of the educational intervention. The first sub-study was an integrative literature review on the effectiveness of nursing educational interventions on pediatric pain management. The second and third studies examined the pediatric pain educational needs of nurses using quantitative and qualitative research approaches. The fourth was an ethnographic study examining the culture and context of pediatric pain management at four Ghanaian hospitals. A review of existing literature was also conducted to identify an appropriate behavioral change theory to guide the development of the PPEP. The proposed PPEP and its evaluation outcomes were then modeled to serve as a guide for the piloting (feasibility and acceptability) phase in the future. The integrative review of 37 primary studies revealed that nursing educational interventions mostly led to positive changes in nurses’ knowledge, attitudes and practice of managing children’s pain. The quantitative cross-sectional survey, identified insufficiency in pediatric pain knowledge and attitudes with a mean (SD) score of 36.7% (6.9%). In sub-study III, nurses expressed competencies and deficiencies in various aspects of children’s pain assessment and management. The ethnographic study revealed a variety of power-imbalances and resources affecting the assessment and management of children’s pain within the pediatric care settings. The social cognitive theory was chosen based on a review of behavior change theories to guide the educational program. The proposed PPEP was modeled to be pilot-tested as a two-arm cluster, randomized controlled trial with a three-month follow-up that will compare the same content of education delivered via different modes. Anticipated measurement outcomes include knowledge and attitudes regarding pediatric pain, self-efficacy, and evaluation of the acceptability of the educational program. The findings reveal a trend of unsatisfactory pediatric pain knowledge, attitude, and practice of assessment, management and documentation in Ghanaian hospitals and the urgent need and readiness of Ghanaian pediatric nurses to receive a pediatric pain educational intervention in the nearest future.Tämän tutkimuksen tavoitteena oli kehittää MRC:n viitekehyksen ohjaamana tutkimusnäyttöön ja teoriaan pohjatuva lasten kivun hoidon koulutusohjelma (Pediatric Pain Educational Program, PPEP) sairaanhoitajille toimintaympäristöön, jossa resurssit ovat rajalliset. Ensimmäinen osatutkimus oli integratiivinen kirjallisuuskatsaus, jossa tarkasteltiin sairaanhoitajille kehitettyjen lasten kivun hoidon koulutusinterventioiden tehokkuutta. Toinen ja kolmas osatutkimus kartoittivat sekä määrällisin että laadullisin menetelmin sairaanhoitajien oppimistarpeita lasten kivun hoidossa. Neljäs osatutkimus oli fokusoitu etnografia, missä tarkasteltiin lasten kivun hoidon kulttuuria ja toimintaympäristöä neljässä ghanalaisessa sairaalassa. Lisäksi tehtiin kirjallisuushaku soveltuvan käyttäytymisen muutosta selittävän teorian löytämiseksi. Tämä teoria ohjasi osaltaan koulutusohjelman kehittämistä. Tämän jälkeen koulutusohjelma kuvattiin ja sille laadittiin arviointiviitekehys tulevaisuudessa tehtävää pilottitutkimusta varten. Integratiiviseen kirjallisuuskatsaukseen valikoitujen 37 artikkelin perusteella lasten kivun hoitoon kehitetyt koulutusinterventiot saavat useimmiten aikaan positiivisia muutoksia sairaanhoitajien lasten kivun hoitoon liittyvissä tiedoissa, asenteissa ja toimintatavoissa. Poikkileikkaustutkimuksena tehty kyselytutkimus osoitti, että sairaanhoitajien lasten kivun hoitoon liittyvät tiedot ja asenteet olivat puutteelliset, ka 36,7% (kh 6,9%). Kolmannessa osatutkimuksessa tehdyistä haastatteluista kävi ilmi, että hoitajat kokivat puutteita osaamisessaan liittyen lasten kivun arviointiin ja lievitykseen. Fokusoitu etnografia puolestaan toi näkyväksi valta- ja resurssitekijöitä, jotka vaikuttivat lasten kivun hoidon toteutumiseen. Banduran Sosiaalisen oppimisen teoria valittiin koulutusohjelman teoreettiseksi perustaksi. Seuraavaksi kuvattu PPEP-koulutusohjelma esitestataan klusteroidun satunnaistetun kontrolloidun tutkimusasetelman avulla. Sama oppimissisältö opetetaan kahdelle ryhmälle eri opetusmenetelmillä, ja oppimistuloksia seurataan kolme kuukautta koulutuksen jälkeen. Vastemuuttujina käytetään lasten kivun hoitoon liittyvää tietoa ja asenteita, minäpystyvyyttä, sekä koulutusohjelman toteutettavuutta ja hyväksyttävyyttä. Tämän tutkimuksen tulokset osoittavat lasten kivun hoitoon liittyvien tietojen, asenteiden ja käytäntöjen olevan puutteellisia ghanalaisissa sairaaloissa. Perheiden ja hoitajien tarpeisiin vastaamiseksi on ghanalaisille lastensairaanhoitajille tarjottava aiheeseen liittyvää koulutusta mahdollisimman nopeasti

Utilisation and perceptions of cervical cancer screening services

CITATION: Kokuro, M. & Diji, A. K. A. 2020. Utilisation and perceptions of cervical cancer screening services. Africa Journal of Nursing and Midwifery, 22(1):6228, doi:10.25159/2520-5293/6228.The original publication is available at https://journals.co.zaCervical cancer is the second most frequently diagnosed and the fourth commonest cause of cancer death among women worldwide. Even though cervical cancer is preventable, its screening rate has been reported to be low in Ghana. To the best of our knowledge, no study has focused on the utilisation and perceptions of cervical cancer among women in their reproductive age in Ghana. The present study aimed at assessing the utilisation and perceptions of cervical cancer screening services among women who seek reproductive healthcare services. A descriptive cross-sectional study was carried out among women aged 18 years and above. Using a two-stage sampling technique, 369 participants were selected from 2 out of 4 eligible study sites. Data on the perceptions and utilisation of cervical cancer screening services were collected following ethical approval. The data were collected using both English and Twi versions of the questionnaire. The data were descriptively and inferentially analysed. A few of the participants had been previously screened for cervical cancer (n = 69; 18.7%), while a greater proportion of the participants appropriately perceived the screening benefits (> 70%), and an equally greater percentage of them harboured negative perceptions which prevented them from engaging in such endeavours (> 80%). Significant differences in perception were, however, observed in two-fifths of the studied areas (6/14) among the screened and unscreened participants. Cervical cancer screening services were not utilised by the majority of the participating women. Screening was associated with socio-demographic characteristics such as marital status, parity, education, and employment status. Inappropriate perceptions on cervical cancer screening may account for the low utilisation of cervical cancer screening. Therefore, all-inclusive health education on the benefits of cervical cancer screening for both women and men should be a priority for stakeholders and all health organisations.https://journals.co.za/doi/abs/10.25159/2520-5293/6228Publisher's versio

The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children : An Integrative Review

Background: Nurses play an important role in children's pain assessment and management because they spend the majority of the time with them and provide care on a 24-hour basis. However, research studies continue to report on nurses' inadequate assessment and management of children's pain, which may be partly attributed to their insufficient education in this area. Objectives: This integrative review sought to examine the effect of strategies used in educating nurses on pediatric pain assessment and management. Design: An integrative review. Data Sources: Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed/Medline and Scopus. Review/Analysis Methods: Four databases were searched up to February 2018 based on a prescribed eligibility criteria. The review included 37 studies with varied methodologic quality. Results: Our findings revealed that various types of educational strategies improve nurses' knowledge, attitudes, and practice of pain assessment, management, and/or documentation. Conclusions: Developing a responsive program that includes expectations of beneficiaries, integrating it into existing facility training systems and delivering it through multidisciplinary collaboration, offers the benefit of securing sustainability of the educational gains. (C) 2019 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.Peer reviewe

Correlates of Sleep Quality: A Pilot Descriptive Cross-Sectional Survey among Undergraduate Students in a Ghanaian University

Background and Objective: A gap exists in evidence of the association between sleep quality and the academic performance of university students in sub-Saharan Africa. A limited number of studies have been conducted in this regard, which have mainly focused on medical students, thus neglecting the larger population of undergraduate non-medical students. Materials and Methods: This pilot study evaluated the correlates of sleep quality and the academic performance of 500 randomly sampled undergraduate non-medical students at Kwame Nkrumah University of Science and Technology, Ghana. Data was collected using the Pittsburgh Sleep Quality Index (PSQI) and a demographic questionnaire. The par-ticipants' demographic characteristics, academic performance, and sleep quality were first analyzed, descriptively, using SPSS software. Relationships between participants’ sleep quality and demographic factors, and sleep quality and aca-demic performance were determined using Spearman’s rank correlation. The causation between these variables was then determined using simple linear regression. Results: Poor quality of sleep was prevalent among undergraduate students with a mean (SD) PSQI score of 6.43 (2.78). The respondent’s sleep quality had a weak correlation with their academic performance (rs = -0.146; P = 0.001), although poor quality of sleep was a predictor of academic performance [R2 = 0.022; 95% CI (-0.640, -0.168)]. Conclusion: Health education and sleep promotion interventions should be used to encourage good sleep quality and practices among students. Furthermore, the findings point to the need for further studies using a larger population

Dynamics on the field: a focused study on the culture and context of pediatric pain management at four Ghanaian hospitals

BackgroundAs part of efforts to develop and implement a short course educational program on pediatric pain management, the current study sought to understand the culture and contextual factors that influence children’s pain management in order to improve the practice in pediatric care settings.MethodsGuided by Bourdieu’s theory of practice, a focused ethnographic study was conducted from October, 2018 to February, 2019. The study was contextualized at four Ghanaian hospitals among purposefully sampled nurses, physicians, hospitalized children and their families. During the 20-week study period, three ethnographers spent 144 h conducting participant-observation sessions. Formal and informal interviews were held with participants in addition to review of hospital records.ResultsAnalysis of the field data resulted in four themes. “Children’s pain expression and response of caregivers” described the disposition (habitus) of both children and caregivers to act in particular ways due to children’s incomplete health status (bodily capital) which caused them pain and also resulted in discomforting procedures. “Pharmacological pain management practices and attitudes” elucidated the use of analgesics as the mainstay disposition (habitus) in children’s pain management due to high level of respect (symbolic capital) given to such interventions on the pediatric units (field). “Managing pain without drugs” illustrated healthcare providers and family caregivers’ disposition (habitus) of using diverse nonpharmacological methods in managing children’s pain. “Communication and interaction between pain actors” depicted how children’s access to care givers (social capital) can serve as a powerful tool in influencing pediatric pain assessment and management disposition (habitus) on the pediatric units (field).ConclusionsThe habitus of pediatric pain actors toward pain assessment and management practices are influenced by various forms of capital (social, cultural, symbolic, bodily and economic) operating at different levels on the pediatric care field. Quality improvement programs that seek to enhance pediatric pain management should use the insights obtained in this study to guide the development, implementation and evaluation stages.</p

Final Year Nursing Students' Knowledge and Attitudes regarding Children's Pain

Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively affect their physical, psychological, and social well-being; it also places financial burden on families of affected children and healthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students are insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing student's knowledge and attitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate nursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the 42 individual items on the Pediatric Nurses' Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive statistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the final year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an average (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that were related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of pre-emptive analgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items that focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological pain management interventions. Final year nursing students have insufficient knowledge and attitudes toward children's pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered when designing and implementing educational interventions on this subject. Curricular revisions should be made on existing nursing curriculum to lay more emphasis on children's pain management and use educational interventions that support knowledge translation for improved care

Exploring the educational needs of nurses on children's pain management: A descriptive qualitative study

Aim To explore the educational needs of nurses on children's passin management. Design A descriptive qualitative study. Methods Individual and group interviews were conducted among 28 nurses and four nurse managers at four hospitals in the Ashanti region of Ghana. The recorded interviews were later transcribed verbatim and thematically analysed based on a conceptual interest in the educational needs on paediatric pain management.Results Nurses were acquainted with pain assessment of children who can verbally communicate. They mainly used drugs in treating pain and were familiar with the use of some non-pharmacological interventions. Notwithstanding, they desired to know more about pain assessment for children with non-functional speech. Additionally, they were interested in learning more about both drug and nondrug pain relief methods for children. The sampled nurses and nurse managers indicated diverse preferences on the nature of the paediatric pain educational programme based on their personal choices and working dynamics.</p

Emergency preparedness capacity of a university hospital in Ghana: a cross-sectional study

Background: The health and safety of people are often endangered during emergencies and disasters. Efficient emergency management systems ensure that mitigation, preparedness, response, and recovery actions exist to preserve the health, safety, and welfare of the public. Failure to carry out appropriate responses can have adverse consequences for both emergency responders and casualties; hence, the need for emergency preparedness. This study sought to assess the state of emergency preparedness capacity of the Kwame Nkrumah University of Science and Technology hospital in Ghana. Methods: A facility-based cross-sectional study was conducted between December 2018 and February 2019 using three guidelines developed respectively by the World Health Organization, the Ministry of Health-Ghana, and the Ghana Health Service. The hospital's emergency preparedness was assessed regarding the emergency policies, plan, protocol, equipment, and medications. Results: Overall, the hospital's emergency preparedness level was weak (57.36%). Findings revealed that the hospital had inadequate emergency equipment, and supplies for emergency care delivery, especially during upsurge. It also did not have an emergency planning committee. There were noticeable deficiencies in some emergency resources such as chest tubes, basic airway supplies, and many emergency drugs. Other vital emergency tools such as pulse oximeter, thermometer, and emergency medications were inadequate. The hospital had a strong emergency plan and policies on assessment (77.8% and 78%) respectively. Conclusion: The Kwame Nkrumah University of Science and Technology hospital is not prepared sufficiently for an emergency surge, and this poses a major health challenge. Emergency items must be made available, and the organization and planning of emergency service provisions must be improved to avoid preventable deaths during an emergency surge

Women's knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana:A cross-sectional study

IntroductionImproving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana.MethodsA cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0.ResultsOf the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16–8.80), p&lt;0.001], educational level [OR = 10.18 (95%CI: 3.86–26.87), p&lt;0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72–6.82), p&lt;0.001]. Not married [OR = 0.65 (0.39–1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13–0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care.ConclusionAlthough the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana

Parents in Neonatal Pain Management—An International Survey of Parent-Delivered Interventions and Parental Pain Assessment

Background: While parent-delivered pain management has been demonstrated to effectively reduce neonatal procedural pain responses, little is known about to what extent it is utilized. Our aim was to explore the utilization of parents in neonatal pain management and investigate whether local guidelines promote parent-delivered interventions. Methods: A web-based survey was distributed to neonatal units worldwide. Results: The majority of the 303 responding neonatal intensive care units (NICUs) from 44 countries were situated in high-income countries from Europe and Central Asia. Of the responding units, 67% had local guidelines about neonatal pain management, and of these, 40% answered that parental involvement was recommended, 27% answered that the role of parents in pain management was mentioned as optional, and 32% responded that it was not mentioned in the guidelines. According to the free-text responses, parent-delivered interventions of skin-to-skin contact, breastfeeding, and parental live singing were the most frequently performed in the NICUs. Of the responding units, 65% answered that parents performed some form of pain management regularly or always. Conclusions: There appears to be some practice uptake of parent-delivered pain management to reduce neonatal pain in high-income countries. Additional incorporation of these interventions into NICU pain guidelines is needed, as well as a better understanding of the use of parent-delivered pain management in low- and middle-income countries.</p