Examining nursing practices for management of sepsis in low income countries: the case of Uganda

Examining nursing practice guidelines to improve quality of care for patients with sepsis in low income countries is required. A large amount of information about best practice standards in sepsis management is available for healthcare professionals; however, implementation and adherence to practice guidelines recommended by the Surviving Sepsis Campaign remains low in low income countries. A formal scope of practice for nursing and midwifery as a professional guideline is absent and national clinical guideline for Uganda remains unclear regarding the specific management of sepsis. Inadequate documentation of patient care in Uganda makes sepsis cases difficult to be early detected. Research evidence regarding sepsis management remains scarce in Uganda. Adopting SSC guidelines without appropriate adaptation for the local context contributes problems, especially in LICs where necessary resources are limited

Health workers’ documentation process as a prerequisite to the integration of patient care at a Regional Referral Hospital in Uganda

Background: Integrated patient care is necessary for better care outcomes. Documentation enhances the integration of care; however, in the Ugandan setting, documentation of care is poor (e.g., omissions and incomplete records) and integration of patient care is not visible. This study presents a review of patient health records that was undertaken to understand documentation of care at a regional referral hospital in Eastern Uganda. This information will help in developing a documentation model to facilitate the integration of patient care in Uganda. Methodology: This retrospective review involved 513 patient health records from the medical-surgical, pediatric, and obstetric/gynecological departments of Jinja Regional Referral Hospital. Data were collected using checklists. Stratified sampling was used to capture variations in ward unit records and identify a fair representation of each department. Data were analyzed with descriptive and inferential statistics. All analyses were performed with SPSS version 22. Results: On average, the study hospital attended to 1000 patients per day and discharged 100 patients per ward unit per month. Our record review showed that documentation by both nurses and doctors was incomplete, and care was fragmented. However, doctors documented care more often than nurses, although the integration of patient care was not evident in doctors’ documentation. Conclusion: To establish integrated patient care, documentation must meet standards set by relevant professional bodies. The findings of this study will inform the development of a feasible documentation model to facilitate the integration of patient care in Uganda

Experiences of mothers and significant others in accessing comprehensive healthcare in the first 1000 days of life post-conception during COVID-19 in rural Uganda

Background: COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy mayhave been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and born newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance. This study explored the experiences of mothers and their significant others of comprehensive care in the first 1000 days of life post-conception during the COVID-19 pandemic in Bunghokho-Mutoto sub-county, Mbale District, Uganda. Methods: A qualitative exploratory descriptive design was used with data collected in semi-structured interviews. Mothers (pregnant or with a child under 2 years) and their significant others were purposively recruited for this study. The sample size (N = 14) was determined by data saturation. Data. were analysed using thematic analysis. Results: One theme emerged “Increasing barriers to healthcare”, which encompassed six sub-themes: accessing healthcare, distressing situations, living in fear, making forced choices, navigating the gatekeepers, and ‘coping with increased poverty. Conclusion: This study found that the COVID-19 pandemic increased barriers to accessing healthcare services in the region. Participants’ narratives emphasised the lack of access to expert care and the shortage of skilled health workers, especially midwives

A study of culture confirmed cases of extrapulmonary tuberculosis in a tertiary care hospital from Western Maharashtra, India

Background: The proportion of cases of extrapulmonary tuberculosis (EPTB) has increased in India in recent years. Since the disease can affect virtually all organs, has an atypical clinical presentation, the clinical samples for laboratory diagnosis are sometimes difficult to procure, the confirmation of diagnosis is often delayed. With this background, the present study was undertaken to identify the culture confirmed cases of EPTB from clinically suspected cases, to identify the patient related factors associated with the disease and common sites of involvement in these patients.Methods: The study comprised of 143 patients clinically suspected to have EPTB. Relevant clinical samples were collected from these patients according to the anatomical site involved. Confirmation of diagnosis was done by mycobacterial culture using Lowenstein Jensen (L-J) medium.Results: Out of 143 specimens, 42 (29.37%) were culture positive for mycobacteria (culture confirmed cases). Higher proportion of EPTB was found in females (36.92%) than males (23.08%). Maximum patients of EPTB belonged to the age group of 21-40 years (22 cases out of 57, 38.60%). Out of the 17 HIV positive patients, 6 (35.29%) were culture positive for mycobacteria. Maximum culture positivity was found with pus samples from bone and joint (44.12%) followed by lymph nodes (42.42%).  Conclusion: It was found that female sex, younger age (below 40 years) and HIV infection were found to be commonly associated with extrapulmonary tuberculosis. While many studies report TB lymphadenitis as the most common form of EPTB, in our study bone and joint was found to be the commonest site involved in the disease followed by lymph node. Since EPTB has become more common than previously and is difficult to diagnose, it is important to have greater clinical suspicion for the disease and to take appropriate laboratory help for its confirmation.

Knowledge and Attitudes of Select Ugandan Nurses towards Documentation of Patient Care

Ideally through documentation, nurses track changes in a patient’s condition, make decisions about needs, and ensure continuity of care. However, nursing documentation has often not met these objectives. In Uganda, the systematic nursing specific approach is not reflected in documentation of nursing care. A mixed methods intervention study was conducted to determine knowledge and attitudes of nurses towards documentation, including an evaluation of nurses’ response to a designed nursing documentation form. Forty participants were selected through convenience sampling from six wards of a Ugandan health institution. The study intervention involved teaching nurses the importance of documentation and using of the trial documentation tool. Pre and post testing and open-ended questionnaires were used in data collection. On both pre and post-tests, most participants strongly agreed that nursing notes were meaningful and necessary for legal protection, as well as a nursing priority. Most participants strongly disagreed that there was familiarity with policies on nursing documentation, and that an uninterrupted environment for care documentation existed. Although participants’ knowledge about documentation improved by 20% following the intervention, there was no significant change in attitudes toward documentation. Participants consistently reflected on documentation as an important practice, but highlighted contextual constraints limiting implementation and quality of documentation. The study findings have implications for pre and post-service training, documentation policies, and organizational supports for nursing documentation

Unit Knowledge and Practice of Emergency Nursing Interventions at a Tertiary Public Cardiac Health Center in Uganda

Background: Research suggests that many of the millions of deaths and long-term disabilities resulting from acute cardiovascular events and other emergency conditions are preventable if effective emergency care services were readily available. Effective emergency care requires trained and competent staff, including registered nurses. Most educational pathways do not adequately prepare nurses to deliver sensitive health care services for those with acute illness and injury. This includes Uganda, where few capacity-building initiatives have targeted emergency nursing care delivery, leading to knowledge and practice gaps. Purpose: This study aimed to assess emergency nursing knowledge and clinical practice at a tertiary public cardiac health facility in Uganda. Method: This was a single-center, descriptive cross-sectional survey of a convenience sample of nurses working in the emergency department. Results: A total of 49 emergency care nurses completed the survey (response rate of 81.6%). Among the participants, 75.5% were females, 65.3% had a bachelor\u27s degree, 28.6% had Basic Life Support training, and 12.2% were certified in Advanced Cardiac Life Support. Additionally, 75% of the respondents had low proficiency in assessing critically ill patients, 100% could not perform safety checks, 50% could not maintain patent airways or complete patient handover, and only 50% could connect a patient to a defibrillator. Conclusion: We report that the most significant gap in nurse-provided emergency care is the application of practical skills. Capacity-building initiatives are required to improve the knowledge and practice of nurses in emergency care delivery

The Nursing Documentation Dilemma in Uganda: Neglected but Necessary. A Case Study at Mulago National Referral Hospital

In Uganda, nursing documentation still remains a challenge, in most of the government hospitals and some private hospitals, it remains at a manual (non-technology driven) level and omissions have been observed. Nurses continue to capture standard elements in their documentation. A mixed methods intervention study was conducted to determine knowledge and attitudes of nurses towards documentation, including an evaluation of nurses’ response to a designed nursing documentation form. Forty participants were selected through convenience sampling from six wards of a Ugandan health institution. The study intervention involved teaching nurses the importance of documentation and using of the trial documentation tool. Pre- and post-testing and open-ended questionnaires were used in data collection. The results from the close-ended questions were presented in the previous publication; the responses from the open-ended questions would then be presented. The open-ended questions regarding comments about the nursing documentation process and suggestions about the process of implementing the nursing documentation system in the ward units were considered. All participants were provided the opportunity to provide personal comments, reflections, or stories of their experiences with documentation in patient care. A thematic analysis approach was used during data analysis. The results showed that the participants had positive attitude towards documentation of patient care, but they had constraints limiting them to document, they reflected issues concerning the perceived pressure from the administrations and support to document. The study findings have implication that there is need for organizational support and to have multisite studies and extension of the documentation tool

Microwave Synthesis, Characterization, and Photoluminescence Properties of Nanocrystalline Zirconia

We report synthesis of ZrO2 nanoparticles (NPs) using microwave assisted chemical method at 80°C temperature. Synthesized ZrO2 NPs were calcinated at 400°C under air atmosphere and characterized using FTIR, XRD, SEM, TEM, BET, and EDS for their formation, structure, morphology, size, and elemental composition. XRD results revealed the formation of mixed phase monoclinic and tetragonal ZrO2 phases having crystallite size of the order 8.8 nm from most intense XRD peak as obtained using Scherrer formula. Electron microscope analysis shows that the NPs were less than 10 nm and highly uniform in size having spherical morphology. BET surface area of ZrO2 NPs was found to be 65.85 m2/g with corresponding particle size of 16 nm. The band gap of synthesized NPs was found to be 2.49 eV and PL spectra of ZrO2 synthesized NPs showed strong peak at 414 nm, which corresponds to near band edge emission (UV emission) and a relatively weak peak at 475 and 562 nm

Experimental Investigation of Heat Transfer in Double Pipe Heat Exchanger Using Cerium Oxide Nano fluid

Heat exchanger is a very important device in every modern industry. In this research work, the thermal performance analysis of a pipe in pipe heat exchanger is performed by varying the composition of nanofluid used, which is a mixture of Cerium Oxide (CeO2) and water. An experimental analysis will be performed on pipe in pipe heat exchanger by varying volume concentration (2%, 3%, 4%) of nanoparticles in nanofluid at different flow rates (7, 8, 9 litres/min) of nanofluid flow. Experimental results such as heat transfer rates, overall heat transfer coefficient, Reynolds number, Nusselt number and heat exchanger effectiveness will be calculated to analyse the performance of heat exchanger. The objective of this research work is to check the use of Nano fluids to improve the heat exchanger’s performances and at what percentage of Nanoparticle-coolant mixture, the performance of pipe in pipe heat exchanger will obtain maximum heat exchange rate