Nurses' perceptions on pain behaviours among burn patients : a qualitative inquiry in a Ghanaian tertiary hospital

Background Pain sustained from burns is usually quite severe and has been linked to extreme distress, preventing patients from contributing to their care. Nurses have legal and professional obligations to promptly assess burns pain by using pain assessment tools and by relying on the patient’s behaviour and expressions. Objectives To explore nurses' perceptions on pain behaviours among burn patients in a Ghanaian tertiary hospital. Methods A qualitative descriptive design was used. A total of 11 nurses were recruited through a purposive sampling technique from a burns unit of a tertiary facility in Ghana. Semi-structured face-to-face interviews were conducted. Analysis was done using thematic content analysis, from which two major themes and nine subthemes were identified. Findings Patients express their pain by adopting both verbal and non-verbal communication means. However, due to the subjective nature of pain, nurses’ perceptions of pain were not sufficient to effectively assess the degree of pain. Verbal indicators that nurses perceived to be pain behaviours of burn patients were screaming, crying, praying and groaning, while frowning, reduced sense of humour, and body language were some non-verbal indicators nurses used to confirm the existence of burns pain. Nurses in Ghana must adopt the use of objective pain assessment tools, in conjunction with perceived pain behaviours, for optimal pain management outcomes. Conclusions Patients with burns experience intense pain from both the burns and the procedures that are done for them to aid in their healing. A systematic pain assessment by nurses, as part of the health care team, is a vital guide to pain management. To ensure consistency in the assessment of pain, there is a need to design protocols and policies to guide all nurses in the assessment of burns pain in the burns unit

Burns pain management in Ghana : the role of nurse–patient communication

Background: Nursing is an embodiment of knowledge, clinical work, and interpersonal communication. Effective nursing care has a distinct influence on the overall satisfaction and experience of the patient. Communication is said to be indispensable in the delivery of quality healthcare. Effective communication between nurses and patients has proven to yield better results with pain control and improved psychological status of patients. Objectives: The aim of the study is to explore nurses’ perceptions on the role of communication in the management of burns pain. Methods: A qualitative design with purposive sampling was carried out to recruit 11 registered nurses from a Reconstructive Plastic Surgery and Burns Center in Ghana. To identify the participants’ perception on the role of nurse–patient communication in the management of burns pain, a face to face semi-structured interviews were conducted using an interview guide to collect data. Results: Thematic analysis was done with various themes emerging. Helping patients manage pain, early detection of patient’s distress, improved patient participation in their care were some of the positive effects of nurse–patient communication whiles reduced level of cooperation during caregiving, and endurance of pain by the patient were the results of poor nurse–patient communication. Language and time facto were the barriers that were identified to hinder effective communication between nurses and patients. Conclusions: Due to the subjective nature of pain, the current study highlights the need for increased communication for an effective assessment and management of pain among patients with burns. It is, therefore, imperative that nurses be well trained in communication with an emphasis on patient-centered communication

Impact of the COVID-19 pandemic on adolescents’ sexual and reproductive health in low- and middle-income countries

Adolescents living in low- and middle-income countries (LMICs) are struggling with accessing sexual and reproductive health (SRH) services, and COVID-19 has escalated the problem. The purpose of this review was to identify and assess the existing literature on the impact of the pandemic on SRH needs and access to services by adolescents in LMICs. A scoping review was conducted to collate findings on the topic. Searches were performed on eight databases. Data were extracted and categorized into various themes. After removing duplicates and performing a full-text reading of all articles, nine articles were included in our review. Our findings generated several themes related to adolescents’ sexual and reproductive health during the COVID-19 pandemic. These include (1) limited access to sexual and reproductive health services, (2) school closure and increased rate of early marriages, (3) sexual or intimate partner violence during COVID-19, (4) disruption in maternity care, (5) adolescents’ involvement in risky or exploitative work, (6) intervention to improve sexual and reproductive health services during COVID-19, and (7) policy development related to adolescent sexual and reproductive health. Several recommendations were made on policies—for instance, the use of telemedicine and community-based programs as a way to deliver SRH services to adolescents during and after a pandemic

Behavioural beliefs of Ghanaian radiographers and reporting of child physical abuse.

Radiographers are well placed to flag non accidental injury in children due to their unique position within the imaging chain. Being able to identify (or suspect) physical abuse in children and reporting the incident are, however, two different issues. This study was conducted to explore the external influences in the decision making of the Ghanaian radiographer to report suspected child physical abuse (CPA). This was a qualitative study which applied interpretive phenomenology. Semi-structured interviews were conducted with 20 radiographers who were selected from various hospitals throughout the ten regions of Ghana using purposive sampling. Data was thematically analysed and managed with NVivo Version 10. Themes developed formed the basis of this discussion. Several socio-cultural beliefs and behaviours impacted on the Ghanaian radiographers' decisions to report suspected child physical abuse. The findings of this study indicated that cultural solidarity, superstition and police frustrations were among other factors that characterised the Ghanaian radiographer's inability to report child physical abuse when it occurred. Radiographers reported fear of both physical and spiritual attack when child physical abuse was reported. This paper argues that, to achieve the fight against child physical abuse in some African countries such as Ghana, radiographers would have to be educated and counselled against belief in superstition and adherence to some cultural values which affect child protection. [Abstract copyright: Copyright © 2018 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Access to adolescent sexual and reproductive health services in Accra, Ghana: An exploratory qualitative study

Nearly 31% of the Ghanaian population are adolescents, and these populations persistently face high rates of teenage pregnancies and unsafe abortions. This is despite sexual and reproductive health (SRH) being taught in the school curriculum. In this qualitative study, we explore the factors affecting adolescents’ access to, and experiences of, SRH services in Accra, Ghana. We conducted 12 focus group discussions (FGDs) with adolescents and 13 key informant interviews (KIs) in Ghana. The FGDs were conducted with school-going and out-of-school adolescents. KIIs were conducted with various stakeholders working with adolescents or in SRH services. All interviews were conducted in English, audio recorded and transcribed verbatim. We applied the Dahlgren-Whitehead Rainbow model of health determinants and used a thematic analysis. Eight themes were identified, across micro, meso and macro levels, that influence adolescents’ SRH access and experience in Accra. These included: family, social networks, the role of schools, health providers and services, the policy landscape, gender norms, cultural norms, and poverty. The findings highlight several factors that influence adolescents’ access to appropriate SRH services in this context and demonstrate the need for a multisectoral effort to address structural factors such as harmful gender norms and persistent poverty

Lifting and pregnancy outcomes : feasibility of a randomized controlled trial

Background: The highest incidence of preterm birth (18%) occurs in Africa but the causes are largely unknown. Some studies have reported adverse effects of maternal physical exertion on birth outcomes. A randomized controlled trial (RCT) is proposed to determine the effectiveness of an intervention reducing lifting and carrying in pregnant women in reducing preterm birth and low birthweight. Aims: To test the feasibility and acceptability of the proposed lift-less intervention RCT. Methods: We recruited pregnant women and midwives from antenatal clinics within the Greater Accra Region of Ghana. The midwives were trained to administer the intervention during a 5-week trial. Four intervention trial sessions were organized at weekly intervals. Results: Seven pregnant women and six midwives participated. After piloting, we observed a reduction in participants’ self-reported daily exposure to heavy lifting and carrying. The daily average frequency of lifting by a participant within the first seven days of the study was 3.5 (SD 1.7) with an estimated mean total weight of 41.1 kg (SD = 13.3 kg). This had decreased to 2.3 (SD = 1.0) and the amount to 13.4 kg (SD = 10.9) within the last seven days of the study. Conclusions: The findings provide insight into the daily physical exertion experienced by pregnant women in Ghana. The lift-less intervention trial is feasible with modifications and has the potential to reduce excessive physical exertion among pregnant women in Ghana to improve birth outcomes