Oral care practices of nurses on ventilated patients in Kigali Intensive Care Unit

Background: Oral care in the Intensive Care Unit (ICU) is an essential intervention proven to prevent Ventilator Associated Pneumonia (VAP). VAP results in increased morbidity and mortality, with excess hospital stay and cost. Oral care is a critical intervention that controls the accumulation of oral pathogens; however, it is viewed as a comfort measure and not a critical life-saving intervention.Objective: To assess the oral care provided to ICU ventilated patients by nurses at a referral hospital in Kigali.Methods: This cross-sectional design used a convenience sample of 47 nurses at a referral hospital in Kigali. Descriptive statistics were used for data analysis.Results: The majority of nurses (89.4%) used normal saline for comprehensive mouth care on ICU patients. The majority reported they never used a toothbrush (53.2%) toothpaste (63.8%), or Chlorhexidine solution (89.4%), which are the recommendation. One third (34%) do not perform the oral assessment on admission. There is no ICU oral care protocol, and oral hygiene supplies are limited.Conclusion: Oral care is critical care in VAP prevention. ICU nurses reported a low level of oral care practice. We recommend an oral care protocol and in-service training to improve the quality of oral care to ICU ventilated patients.Keywords: Oral care, ICU, nurses, ventilated patients, ventilator-associated pneumoni

Models and theories of care applicable to predicting and improving adherence behaviours among Chronic Kidney Disease (CKD) patients

Introduction: Models which relate to cognitive variables and processes may apply to adherence behaviours in patients with chronic conditions. Management of Chronic  Kidney Disease (CKD) requires incorporation of these models to facilitate the positive adherence behaviours among patients.Aim: This article critiques models and theories of care applicable to predicting and improving adherence behaviours among patients with chronic kidney disease (CKD).Methods: Medline, Ebsco, PubMed, Google Scholar, Cinahl and grey  literature were used to identify the relevant articles from the years  1990-2018. A conclusive search was done using the following key words: Models OR ‘Theories of care AND Prediction [tab]’ AND Improving AND adherence behaviours AND Chronic Kidney DiseaseResults: The search identified 23 articles containing information on models and theories of care applicable to the management of CKD patients. The Common-Sense Model, Orem Self-care and Theory of Planned Behaviour Models were applied in predicting and improving adherence among CKD patients. Other identified possible models in predicting and improving adherence included Tran’s Theoretical Model, the Theory of Reasoned Action, and the Social Cognitive and Health Belief Models.Conclusion: These theories and models provide a baseline assessment regarding predicting and improving adherence in chronic kidney disease patients. However, there is no model or theory which comprehensively explains an understanding of predicting and improving adherence of CKD patients to their management, hence the need to consider the available models/theories to effectively engage CKD patients with their integrated management to promote the highest level of adherent  behaviour._________________________________________________________________________Key words: Models/theories of care, prediction, adherence, Chronic Kidney Disease stages 1 to 5

Perceptions of caregivers regarding engagement with integrated management of chronic kidney disease patients in selected public hospitals of KwaZulu-Natal region, South Africa

Background: Chronic kidney disease (CKD) patients rely on non-professional health care providers, namely caregivers to manage their long-term condition. Despite the growing literature on CKD patients, little is known about the perceptions of caregivers regarding integrated management of CKD. Aim: The aim of the study was to explore the perceptions of caregivers with regard to integrated management of CKD patients. Setting: The study took place in selected public hospitals of KwaZulu-Natal Province, South Africa. Method: A qualitative case study design was used. A purposive sampling method was used to select the study participants. Data were collected through a semi-structured interview schedule developed from the literature. Data were analysed through thematic template approach using Health Belief Model constructs. Results: Hypertension and diabetes mellitus were risk factors that worsen progression of CKD. Unemployment, lifestyle changes and limited social interaction were revealed as negative effects of CKD. Caregivers were aware of consequences of non-engagement with integrated management. The revealed positive benefits of integrated management were mainly physiological and system-related. Barriers to engagement with integrated management were side effects of diet and haemodialysis, hot weather, unemployment, false perception of good health and shortage of kidneys for transplant. Conclusion: Chronic kidney disease patients require caregivers support to help with necessary changes to cope and adapt with integrated management of the disease. These caregivers experience effects of CKD, consequences of non-engagement and barriers to integrated management. Identification of caregivers perceptions offers healthcare workers a better understanding and formulation of strategies that can offer adequate support to this population

Workplace Stressors and Coping Strategies of Intensive Care Unit Nurses at University Teaching Hospitals, in Rwanda

Background Nursing is widely known as a stressful profession but intensive care unit is the most stressful; when nurses fail to cope with workplace, stresses’ complications such as burnout and depression ensue, and this can compromise the quality of nursing care. In Rwanda, there is a limited literature about workplace stress and coping strategies. Research objectives To assess the workplace stress and coping strategies of intensive care unit nurses at University Teaching Hospitals. Methodology This study used a cross-sectional study design, recruited 92 ICU nurses through the census sampling method; ENSS and Brief COPE Inventory, while SPSS was used for data analysis.  Results Eighty percent experienced moderate to high stress, while 19.6% had low stress. Married nurses tend to experience high stress than singles, while those with Bachelors or Master’s degree were less likely to be stressed. Main stressors are care for suffering/dying, or agitated patients; and heavy workload, while main coping strategies were alcohol use, emotion support from friends and religion comfort. Conclusions Nurses experience workplace stress, while workplace stressors are nursing care for suffering/dying or agitated patients and heavy workload. The coping strategies were alcohol use, emotional support and comfort from religion. Rwanda J Med Health Sci 2021;4(1):53-7

Diabetes health education: nurses’ knowledge of essential components at a Rwandan hospital

Background: Diabetes mellitus type 2 (T2DM) is the most prevalent form of diabetes that has continued to increase worldwide over the past decades. The cornerstone of T2DM management is education on self-management. Evidence shows that nurses have insufficient knowledge of the content of T2DM patient education.Objective: To assess nurses’ knowledge of health education content for T2DM patients, and to establish the relationship between their education and knowledge level of T2DM health education.Methods: A descriptive cross-sectional design and total population sampling strategy were used to recruit nursing staff at a medical/surgical unit. Fifty-one nurses at the referral hospital of Rwanda completed the self-administered questionnaire. Descriptive statistics were used for data analysis.Results: Nurses exhibited poor knowledge of diabetes health education. There was no significant relationship between the nurses’ level of education and diabetes health education knowledge (p=0.102).Conclusion: Nurses had good general knowledge of diabetes, though a low level of knowledge of diabetes health education in this low-resource setting. Hospitals equipped with a T2DM protocol and appropriate staff training would likely improve the nurses’ knowledge and patient care outcomes.Keywords: Type 2 diabetes mellitus, nurses, knowledge, patients’ self management educatio

Perceived effects of burnout on patients and its management among nurses in the Intensive Care Unit and Emergency Department of a Rwandan University Teaching Hospital

Background: The level of burnout among nurses working in the Intensive Care Unit (ICU) and Emergency Department (ED) is high, which adversely affects health and work-related outcomes for both nurses and patients. Little is known about burnout among ICU and ED nurses in Rwanda.Objective: To explore the perceived effects of burnout among nurses and its management at a referral hospital in Rwanda.Methods: A qualitative study design was carried out using focus groups. A purposive sample of six ICU and six ED nurses were recruited from the referral hospital in the capital city of Kigali. The discussions were audio-recorded in Kinyarwanda, transcribed verbatim into English and analysed inductively using thematic analysis.Results: Burnout among the 12 nurses was high and the five main themes namely, high burnout, the Variability of care, Incomplete care, Erratic care and Improving situation to prevent burnout.Conclusion: The results of this study indicated that burnout is high between the ICU and ED study population and nurses need to be taken care of too. A good working environment addressing adequate staffing, specialty training, operational materials, and social activities are needed to improve unit functioning, and patient satisfaction and safety.Keywords: Burnout, nurses, Intensive Care Unit, emergency department, patient car

Organ donation and transplantation within the Zulu culture

M.Cur. (Intensive General Nursing)Knowledge and technological advancement in the field of transplantation has increased the demand for organ donation. However, the supply of organs does not meet this demand, especially, among the black communities. Literature reviewed associate this imbalance with the few sources of organs, the technique of organ retrieval, discrepancies in the allocation of organs and sociocultural factors. The aim of this study was to investigate the extent to which the Zulu cultural norms and social structural dimensions influence an individual's decision to donate an organ or to undergo a transplantation, based on the theoretical assumptions of Leininger and Chrisman. A qualitative approach using an ethno- nursing method was selected, semi-structured interviews were conducted with the transplant co-ordinator representing the professional sector, the religious leaders and traditional healers representing the folk sector and the general public representing the popular sector of the health care system. The respondents were extracted from both the urban and rural settings. The conclusions arrived at were that there is lack of knowledge among the Zulu speaking people on organ donation and transplantation, related mainly to misconceptions associated with their life patterns, beliefs about death, burial and life hereafter, values and social structural dimensions. The recommendations with regard to the promotion of organ donation and transplantation among the Zulu speaking people were made based on culture sensitive and culture congruent principles, namely: • Cultural care preservative or maintenance such as ancestor worship, extended families etc. • Cultural care accommodation or negotiation such as their knowledge of anatomy and physiology of the human body especially the transplantable organs and their fear to discuss death, etc. • Cultural care repatterning and restructuring such as culture sensitive educational campaigns to dispel the fears and correct misconceptions

Barriers to management of Chronic Kidney Disease (CKD) CKD in a renal clinic in KwaZulu-Natal Province, South Africa – A qualitative study

Background: The progression of Chronic Kidney Disease (CKD) and existence of comorbid conditions makes management of CKD complicated, leading to unforeseen challenges for patients and healthcare professionals. Moreover, studies exploring the barriers to management of CKD from the perspectives of healthcare workers involved in direct care or patients receiving such care are limited. Purpose of the study: The purpose of this study was to explore the barriers to management of CKD in a Renal Clinic in KwaZulu-Natal Province, South Africa. Methods: A qualitative research approach was used, and a descriptive exploratory design employed. The sample size was thirteen, with seven CKD patients and six healthcare providers, as determined by data saturation. A purposive sampling strategy was used to select study participants. Semi-structured interviews with open-ended questions were utilised to collect the data. Credibility, transferability, confirmability and dependability were used to evaluate the trustworthiness of the qualitative data collected. Data was analysed using a thematic framework approach. Ethical rights were observed, and informed consent and participant authorisation were sought. Results: The side-effects of treatment, longevity of haemodialysis procedure, gastrointestinal problems, a false sense of good health, depression, lack of employment opportunities, limited in-service training, inclement weather condition, cultural and religious practices as well as uncertainties about obtaining a kidney transplant were highlighted as barriers to the management of CKD from the perspectives of both CKD patients and healthcare workers. Conclusion: Despite the measures of state hospitals to provide CKD management, barriers to management of CKD still exist amongst the CKD population. Hence, there is need to develop specific tailored interventions to reduce such obstacles thus promoting effective management of CKD patients. Keywords: Barriers, Management, Chronic Kidney Disease, Healthcare workers, Patient

Perceptions of healthcare professionals regarding self-management by kidney transplant recipients in South Africa: A qualitative study

Background: Kidney transplant is the recommended treatment for patients with end-stage renal disease. Healthcare professionals involved in kidney transplant management are the main stakeholders in facilitating quality evidence-based care to improve overall kidney transplant self-management, ultimately improving long-term durability of the transplanted kidney. Purpose: The purpose of the study was to explore perceptions of healthcare professionals regarding self-management by kidney transplant recipients in South Africa. Methodology: Purposive sampling was used to select study participants. Data were collected through semi-structured interviews developed from an in-depth reading of appropriate literature. A qualitative design was used. A sample size of 20 was determined by data saturation. Data were analyzed through the use of a thematic template. Results: Perceptions of healthcare professionals regarding kidney transplant self-management were categorized in terms of benefits, barriers and consequences. The identified benefits included independence, procreation, improved quality of life, and decreased physical, financial and social burden. The perceived barriers included negative attitudes, lack of support, non-adherence, lack of education and insight on kidney transplant self-management. Perceived consequences of poor self-management included, financial burden, increased workload and low staff morale. Success of kidney transplant self-management is largely attributed to the healthcare professionals. Conclusion: Understanding the perceptions of healthcare professionals regarding kidney transplant self-management may assist in developing in-service training programmes to remove barriers and to alter negative perceptions of healthcare professionals. This may enable them to improve their facilitation of self-management by kidney transplant recipients. Keywords: Kidney transplant recipient, Kidney transplant self-management, Perceptions, Healthcare professional