Clinical experiences of perioperative nursing Masters students in selected Rwandan referral hospitals

Background: Clinical experiences allow nursing students to apply theoretical knowledge into practice hence socialize with their future professional roles and responsibilities. This is a report of observations made by thirteen perioperative nursing students in the first cohort of Master of sciences in nursing training program during their practicum in selected Rwandan Referral Hospitals aimed at improving students’ learning outcomes in future.Methods: Teams of four to five students were allocated to the operating theatres in three selected referral and teaching hospitals in Rwanda for thirteen weeks. At the end of their clinical placement, they wrote clinical reports that highlighted their observations informed by theoretical knowledge of perioperative nursing care using a structure, process and outcome format. These reports focused on the strengths and challenges observed.Results: Students were able to translate theoretical knowledge gained in class to clinical practice. Although the hospitals provided good learning opportunities in relation to the number of patients attended to and the various surgical treatments provided, the existing infrastructures, and care delivery systems, still need improvement.Conclusions: Hospital structure and processes helped the students to achieve their clinical learning objectives. Fostering strong collaboration of Universities, Hospitals and Ministry of Health will promote specialization in the emerging field of perioperative nursing in Rwanda.Keywords: clinical experiences, masters program students training, perioperative nursing, referral hospita

Medication interruptions and associated factors among nurses working in pediatric unit at a selected referral hospital in Rwanda

Introduction: Interruptions have been proven to cause medication administration errors in pediatric settings. Therefore, this study assessed the medication interruptions and associated factors among nurses in a pediatric unit at a selected referral hospital in Rwanda. Methods: A descriptive observational study was conducted among 59 nurses using a developed observational checklist. Data were entered into SPSS, version 26. Descriptive and inferential statistics were used to analyze the data. The IRB of the University of Rwanda approved the study. Results: Among the 414 medication administrations observed, 149 (36%) had interruptions. The main source of interruption was technical problem (14.5%) with interruption from direct care (12%) as the main reason. The factors associated with interruption occurrence were shift of the day, time of medication round, duration and phase of medication administration and nurse perception (p = 0.001), age (p=0.046), educational level (p = 0.044) and professional experience (p = 0.031). Conclusion: The existence of medication interruptions is evident with associated factors predominantly being demographics and technical. Therefore, the authors recommended that an in-service training program for nurses regarding medication administration errors. The hospital leadership should address the technical problems including availing the required materials for medication administration.   French title: Interruptions médicamenteuses et facteurs associés chez les infirmières travaillant dans l'unité pédiatrique d'un hôpital de référence sélectionné au Rwanda Introduction : Il a été prouvé que les interruptions provoquent des erreurs d'administration de médicaments en milieu pédiatrique. Par conséquent, cette étude a évalué les interruptions de médication et les facteurs associés chez les infirmières d'une unité de pédiatrie d'un hôpital de référence sélectionné au Rwanda. Méthode de l'étude : Une étude observationnelle descriptive a été menée auprès de 59 infirmières à l'aide d'une liste de contrôle d'observation élaborée. Les données ont été saisies dans SPSS, 26. Des statistiques descriptives et inférentielles ont été utilisées pour analyser les données. L'IRB de l'Université du Rwanda a approuvé l'étude. Résultats de l'étude : Parmi les 414 administrations de médicaments observées, 149 (36 %) ont subi des interruptions. La principale source d'interruption était un problème technique (14,5 %) avec l'interruption des soins directs (12 %) comme principale raison. Les facteurs associés à l'occurrence d'interruption étaient décalage de la journée, heure de la tournée de médicaments, durée et phase d'administration des médicaments et perception de l'infirmière (p = 0,001), âge (p=0,046), niveau d'éducation (p = 0,044) et expérience professionnelle (p = 0,031). Conclusion : L'existence d'interruptions de médication est évidente avec des facteurs associés principalement démographiques et techniques. Par conséquent, les auteurs recommandent un programme de formation continue pour les infirmières concernant les erreurs d'administration de médicaments. La direction de l'hôpital devrait résoudre les problèmes techniques, notamment en mettant à disposition les matériaux requis pour l'administration des médicaments

Pharmacovigilance: Awareness and Practice of Nurses and Midwives in Monitoring and Reporting Adverse Drug Reactions in a Selected University Teaching Hospital, Rwanda

BackgroundAdverse drug reactions result in thousands of deaths, disabilities, and other serious outcomes. Nurses and midwives administer drugs, monitor both therapeutic and adverse drug reactions, and are on the front line of safety reporting. This study aimed to assess awareness of nurses and midwives about pharmacovigilance and their practice in monitoring and reporting adverse drug reactions at the University Teaching Hospital of Kigali .MethodsWe conducted a cross-sectional study on 147 randomly selected nurses and midwives. Self-administered questionnaires were used to collect data. We analyzed data using SPSS version 22 computer software for descriptive and inferential statistics.ResultsConcerning the awareness of nurses and midwives, 88% had heard about pharmacovigilance, and 22.3% were aware of Rwanda Food and Drug Authority. Nearly two-thirds (62.3%) reported inadequate practice in monitoring adverse drug reactions. Their practice was associated with having heard about pharmacovigilance (p=0.004) and knowing the hospital’s adverse drug reactions reporting system (p=0.005). Concerning practice in reporting adverse drug reactions, 66.2% had observed adverse drug reactions, and 18.2% filled out adverse event notification forms.ConclusionFew nurses and midwives were aware of the pharmacovigilance system in Rwanda, and many of them reported inadequate practices toward monitoring and reporting adverse drug reactions .Rwanda J Med Health Sci 2022;5(2):233-24

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways