ABSTRACT
Exercising autonomy allows nurses to demonstrate their knowledge and skills. However, more information is needed about the critical care nurses' perceptions of their professional autonomy in rural areas. Objective: To explore the perceptions, facilitators and barriers to professional autonomy among critical care nurses in rural Kenya. Methods: The hermeneutic phenomenological study design was used in this study. Data were collected in a critical care unit using a semi-structured interview guide. A sample of 10 participants were recruited. The study was conducted in Nyeri County Referral Hospital. Results: Three themes emerged from the study on the nurses' experiences of professional autonomy, perceptions of autonomy, facilitators of autonomy, and barriers to autonomy. Conclusion: Autonomy undeniably plays a pivotal role in defining the professional status of the nursing profession. Perceptions, facilitators and barriers to professional autonomy form the background of the current professional status. Nurses, therefore, exercise autonomy effectively when it aligns with patient care needs and when a conducive environment supports it.
Subject(s)
Humans , Professional Autonomy , Critical Care Nursing , Nurses , Nursing , Qualitative Research , Patient CareABSTRACT
Diabetes Mellitus (DM) is a chronic metabolic disease with various complications throughout its course. The presence of emotional burden in diabetes disease, which is referred to as diabetes-related distress (DRD) is common among such patients and may affect their response to treatment. Objectives: To assess the relationship of diabetes-related distress and glycaemic control among patients with Type 2 Diabetes mellitus. Methods: This hospital-based cross-sectional study was conducted at the Family Medicine Department of LASUTH, Ikeja, Lagos. A total of 317 patients with Type 2 Diabetes mellitus were systematically recruited. The data were collected over a four-month period. Important clinical information including clinical characteristics and diabetes-related distress using the diabetes distress scale (DDS-17) was collected. Glycosylated haemoglobin (HbA1c) was also assessed. Results: The degrees of DRD were as follows: 54.9% (None/little), 40.1% (moderate) and 5.0% (severe). The mean HbA1c estimate for all participants was 7.83±1.8%. Among the 317 study participants, 67.2% had poor glycaemic control while 32.8% had good glycaemic control. There was a statistically significant association between DRD and glycaemic control (p< 0.001). Likewise, the various domains of DRD had statistically significant associations with glycaemic control with the exception of physician-related domain. Participants with better glycaemic control reported lower levels of DRD than participants with poorer glycaemic control. Conclusion: There is a high level of diabetes-related distress patients with diabetes mellitus. Good glycaemic control is important in improving or preventing DRD. Therefore, T2DM patients should be screened for DRD during their treatment.
Subject(s)
Humans , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Patient Care , Blood Glucose , Cross-Sectional Studies , Polyendocrinopathies, Autoimmune , Noncommunicable Diseases , Chronic Disease IndicatorsABSTRACT
BACKGROUND: Assessing quality by considering input, process and output level quality variables is important to ensure improved quality services. Designing and execution of an effective quality management system are aimed for the purpose of quality improvement, error reduction and associated risks. Therefore, this review is designed to assess the value of accreditation on the performance of healthcare institutions in ensuring quality improvement interventions. Moreover, this review presents important concepts of accreditation and the aspects of quality. METHODS: Published articles were downloaded using EndNote® application software program from PubMed (NML) database, Web of Sciences (TS) and Google Scholar. From a total of 883 downloaded full-text published materials, only 28 journals and 1 report issued from 2010 to 2017 were used for the development of this review. RESULT: The overall quality of healthcare services in developing countries was error-prone and suffered from limitations. These could be associated with wrong interventions and increased risks. Accreditation schemes have been implemented to provide quality care and ensure safety. CONCLUSION: Evaluation feedback induces interventions aimed at quality improvement and ensures better management systems, good process design, wise resource utilization, meeting patients' need and increased satisfaction. Hence, stakeholders must be engaged in the provision of improve quality patient care and reduce associated risks. Hence, giving special quality improvement attention helps to improve quality healthcare services
Subject(s)
Accreditation , Developing Countries , Ethiopia , Patient Care , Quality of Health CareABSTRACT
Background: The introduction of image-guided biopsy has revolutionized the quality of patient care by avoiding open and complications associated with it and the use anesthesia. Even though Ethiopian radiological training dates back to more than two decades, interventional radiology is a very recent introduction. This study reports the safety and significance of image guided biopsy on patient care.Patients and methods: This study was a prospective study carried out to assess the impact and safety of doing image-guided biopsy in a tertiary care teaching Hospital in Addis Ababa, Ethiopia.Results: A total of 117 patients, their age ranging from 3 to 80years and a mean age of 41 were evaluated; 6.8% of them were children below the age of 10. Around two-thirds of the cases had intra-abdominal indications for biopsy followed by mediastinal pathologies. Ultrasound was used as a guide in about 85% of the cases. Except for one case that developed massive hemoptysis following fine needle aspiration of a middle mediastinal mass and treated conservatively, there was no major complication. A few minor complications, like mild pain and minor hemorrhage, required only close observation.Conclusion: On the whole, our study indicates that image-guide biopsy improves the existing medical care.Moreover, institutions particularly those providing training in radiology should promote the establishment of interventional radiology for better patient diagnosis and improved planning of subsequent treatment
Subject(s)
Image-Guided Biopsy/methods , Patient Care , SafetyABSTRACT
Introduction : L'initiation tardive du Traitement Anti-Rétroviral (TAR) est fréquente dans les pays à ressources limitées, où la plupart des individus ne connaissent pas leur statut sérologique jusqu'à ce qu'ils soient symptomatiques.Matériel et méthodes : Il s'est agi d'une étude transversale et analytique, qui s'est déroulée du 1er janvier 2016 au 31 décembre 2016 dans le service de médecine générale du Centre Hospitalier Régional (CHR) de Sokodé, le service de référence dans la prise en charge de l'infection à VIH dans la région centrale du Togo.Résultats : Cent-neuf patients dont 15 enfants (13,8%) ont été inclus dans la file active du service de médecine générale du CHR de Sokodé par l'initiation du TAR. La moyenne d'âge des patients était de 32,38 ans [1-59 ans] avec une prédominance féminine (67,9%). La majorité des patients était classée aux stades III (60 cas ; 55%) et au stade IV (11 cas ; 10,1%). Les manifestations cliniques ou affections opportunistes étaient dominées par la diarrhée chronique (15 cas), la fièvre prolongée inexpliquée (12 cas) et la candidose oropharyngée (12 cas). Le taux moyen des CD4 des patients était de 328,54 cellules/mm3 [0-2216 cellules/mm3] et la co-infection VIH-VHB a été retrouvée dans 13,8% (n = 15). L'association Ténofovir (TDF) - Lamivudine (3TC) - Efavirenz (EFV) (87,2% ; n = 95) a été la plus prescrite pour l'initiation du TAR.Conclusion : Le profil des patients infectés par le VIH à l'initiation du TAR à Sokodé est caractérisé par un stade avancé de l'infection à VIH
Subject(s)
Chelation Therapy , Cytotoxicity, Immunologic , Patient Care , Sickness Impact Profile , TogoABSTRACT
Introduction :Without uniform recognition of Emergency Medicine as a specialty in developing sub-Saharan African countries; data are limited on the epidemiology of emergency care needs. The purposes of this study were to quantify the burden of disease presenting as medical or surgical emergencies and describe the patient population at a small community medical centre in the Republic of Tanzania. Methods : An observational study was conducted from March to June 2011 at the University of Arusha (UOA) Medical Centre in Arusha; Tanzania. All consenting patients presenting with acute illness or injury were eligible for inclusion in the study. A standardized form was used to record demographic information; chief complaint; diagnosis/diagnoses; procedure(s); treatment(s); and disposition. Results : Data were collected on 719 patients; with a mean age of 21.8 years (range neonate to 83 years). Fever (19.5); respiratory (17.5); and gastrointestinal complaints (15.0) were the top three chief complaints; 94.9 of chief complaints were atraumatic. The top three diagnoses included respiratory infection (22.1); malaria (21.4); and skin or soft tissue infection (7.9). Forty-three percent of patients required no procedures or tests; and 42 required only one procedure or test. Of treatments administered; 67.6 were analgesics; 51.3 were cough medications; and 47.6 were antipyretics. Ninety-seven percent of patients were discharged home after their visits. Discussion: Respiratory infections; malaria; and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha; Tanzania; highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma; burns; and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis; most treatments administered were inexpensive; and most patients were discharged home; suggesting that providing acute care in this setting could be accomplished with limited resources
Subject(s)
Community Health Centers , Emergency Medicine , Patient Care/epidemiology , TanzaniaABSTRACT
Background: Nurses are faced daily with a variety of ethical issues which could be as a result of budget cuts; target setting; the shortage of nurses and expertise. Objectives: The objectives of the study were to identify ethical issues related to patient care; to describe ethical issues related to patient diversity; rights and human dignity. To describe ethical issues related to caring in nursing and to the workplace environment.Method: A quantitative explorative descriptive research design was applied. A stratified sample of (n = 142/5) was drawn from all nurses and caregivers (N = 2990) working in a selected group of eight private hospitals. Self-administered questionnaires were used to collect the data. Statistical tests were applied to determine statistical relationships between variables.Results: Results included (95) of respondents provided safe and committed care to their patients; (99) loved to care for their patients and (93) believed in the Nurses' Pledge of Service. Fifty percent (50) of the respondents indicated verbal abuse from patients and only (59) experienced openness and transparency in the work environment. Analysis further identified that the caregivers did not respect the noble tradition of the profession and experienced the most verbal abuse. Conclusion: This study has identified ethical issues which may give rise to conflict within the workplace environment if not adequately addressed by management. The study further showed that the use of caregivers not regulated in nursing practice may pose as a threat to the safety of the patient
Subject(s)
Ethics , Hospitals , Nursing , Patient Care , Personhood , WorkplaceABSTRACT
La haute incidence des AVC en Afrique et leur gravite en termes de mortalite est bien documentee. Mais les modalites actuelles de leur prise en charge restent a evaluer. L'objectif de ce travail etait d'analyser les modalites de prise en charge et l'offre de soins pour les AVC; au Mali. Il s'agissait d'une enquete de sante publique aupres des prescripteurs exercant dans des structures impliquees dans la prise en charge AVC dans 7 des 8 regions existantes et du district de Bamako. Un questionnaire a ete adresse a tous les intervenants potentiels recenses de ces territoires; tandis que les plateaux techniques et les personnels ont ete systematiquement recenses. Au cours de ce travail 149 prescripteurs sollicites ont repondu au questionnaire (90). Il s'agissait de 68 medecins generalistes; 12 medecins specialistes; 69 internes. Sur le plan de la logistique; la presque totalite de ce plateau technique et du personnel se trouvent sur une aire geographique qui represente moins de 10du territoire national et n'abrite que 14 de la population. Ces donnees temoignent de l'insuffisance et de l'inegale repartition des ressources allouees a la prise en charge des AVC
Subject(s)
Disease Management , Patient Care , StrokeABSTRACT
Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet; suboptimal adherence to ART and retention in care of patients still persists and; by many accounts; is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa.Method: In this qualitative study; semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa.Results: The results of the interviews were categorised according to poverty-related; institution-related and social barriers to clinic attendance and pill-taking; which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work; transport expenses; long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity; stigma and discrimination.Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors; such as a healthcare-enabling environment; might play an important role in influencing healthcare-promoting behaviour among patients
Subject(s)
Anti-Retroviral Agents , Medication Adherence , Patient Care , Poverty , Social Discrimination , StereotypingABSTRACT
Background: Evaluation of drug use and patient care practice is a very vital aspect of patient care. It also measures the quality of care provided by health practitioners for patients. Data from this study is very essential in healthcare management and planning. Objectives: To assess drug use and patient care practices at the outpatient section of a referral hospital in Yenagoa; south-south; Nigeria; using WHO drug use indictors. Methods: The study was conducted at Federal Medical Centre; Yenagoa; Bayelsa State. A total of 2450 prescriptions from the outpatient pharmacy were selected by systematic sampling and retrospectively studied. A prospective study of the patient care practices and health facility indicators; which include consultation and dispensing times; revenue time; Patient's knowledge of their medications and availability of key essential drugs; was also undertaken. Data collected was analyzed using WHO guideline for assessment of drug use in healthy facilities. Results: The average number of drugs prescribed per encounter was 3.4; Percentage of encounters with at least an antibiotic prescribed was 35.5. Injections were prescribed in 22of encounters. 62of drugs were prescribed by generic name while 87of drugs prescribed were from the essential drug list. The mean consultation and dispensing times were 11.5 and 3.5 minutes respectively. Two out of every three patients interviewed knew both the names and the duration of their medications while four out of every five knew the correct dosage of their medications. Conclusion: Many of the prescribing and patient care indicators assessed were found to be inappropriate and need to be improved upon. . There was high tendency of poly- pharmacy and over prescription of antibiotics. The patients' knowledge of vital aspects of medication management was found to be inadequate. The overall picture of drug use suggests that the indicators at this facility are not yet at the optimal level
Subject(s)
Drug Utilization , Guideline , Health Facilities , Patient Care , Pharmaceutical Preparations , Referral and ConsultationSubject(s)
Cardiovascular Diseases , Chronic Disease , Health Education , Palliative Care , Patient CareABSTRACT
There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to develop a comprehensive assessment of the health services capacity to provide tuberculosis (TB) and human immunodeficiency virus (HIV) care but also to enhance patient empowerment; social network and community support. A cross-sectional study was conducted from 1 to 31 of August 2007 in 3 districts of Burkina Faso. We used a step-by-step model and the assessment of chronic illness care (ACIC) scale to assess capacities of 24 first line health centres (FLHC) and 3 district hospitals (DH) for providing TB and HIV/AIDS care. Data for the step-by-step model were extracted from medical records of 75 TB and 66 HIV patients. The ACIC scale was completed by health professionals; 6 medical doctors and 18 nurses; working at the DH level and at the FLHC level; respectively. The biological test for confirmation was free of charge for all the TB patients but only for 10.6(7/66) HIV cases. Up to the time of the survey; 5 TB (6.6) and 18 HIV+ patients (27.3) have been hospitalised for care at least once; 64 TB (85.3) had been declared cured and 38 HIV (54.5) were under antiretroviral treatment. Health care process organisation for TB and HIV care had distinct areas of weaknesses. From a maximum ACIC score of 11; the overall score for TB care ranged between 1.9 and 4.9 with a median of 3.7 and for HIV care between 2.1 and 6.7 with a median of 4.1. This study provides an illustration of assessing the HIV and TB care combining data from the routine information system and from the chronic illness care assessment tool; to encompass both disease control and patient health perspective. It provides to health managers arguments for clear conclusions and sufficient data for action
Subject(s)
Acquired Immunodeficiency Syndrome/therapy , Patient Care , Rural Health , Tuberculosis/therapy , WorkforceABSTRACT
Chronic wounds afflict millions worldwide; incurring significant health care costs and chronic suffering. Clinicians are often unsure about treatment; resulting in poor outcomes. Objective. To determine the scope of knowledge possessed by fifth-year medical students; general practitioners (GPs) and surgical registrars; concerning chronic wound management. Design. Cross-sectional study.Methods. Deans of eight South African medical schools received letters requesting information regarding time devoted to wound-care training. Knowledge-based questionnaires were distributed to final-year students at two universities; surgical registrars at four universities and GPs attending refresher courses. Results. Four medical schools replied; of whom only two offered formal teaching. 162 medical students; 45 GPs and 47 surgical registrars completed questionnaires. The overall median (25th - 75th percentiles) knowledge scores for registrars; GPs and students were 65(55 - 70); 55(45 - 65) and 45(35 - 50) respectively. Whereas the scores of registrars and GPs did not differ; the student scores were significantly less. Only 32of registrars and 18of GPs attained scores of 70or more. 96considered training to be inadequate. Interest in wound care was only mild to moderate; with more GPs than registrars requesting literature. Conclusions. Very little; if any; training on chronic wounds is offered in South Africa. The levels of knowledge cannot be considered adequate for successful treatment; nor for teaching to undergraduates. This preliminary study cannot reflect the attitudes and knowledge throughout the country. However; it is clear that there is a need for improved education about these conditions that have huge clinical and economic consequences
Subject(s)
Cross-Sectional Studies , General Practitioners , Knowledge , Patient Care , South Africa , Students, Medical , Wounds and InjuriesABSTRACT
Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with `at risk' feet (ARF) to those with `normal/not at risk' feet (NARF) and so assess whether the education effort by the clinic is effective. Methods. Patients attending the clinic completed an interviewer-assisted questionnaire with 11 questions concerning foot care knowledge. A knowledge score for each patient was calculated. Results. Possible scores ranged from 4 to 11 (maximum 11). The mean score for the ARF group was 8.9 (standard deviation (SD) 1.4) (range 4 - 11) compared with 8.9 (SD 1.4) for the NARF group (range 5 - 11) (p0.05). The most substantial difference between the two groups was that the ARF group gave 20more correct answers than the NARF group with regard to frequency of foot inspection (daily) (p=0.025). Conclusions. Both groups of patients had a reasonable knowledge regarding foot care. The patients at risk were more aware of the need for daily foot inspection
Subject(s)
Diabetes Complications , Foot Diseases , Patient CareABSTRACT
Le Centre Hospitalier et Universitaire de Brazzaville (C.H.U-B), est l'une des grandes structures sanitaires en République du Congo. Dans ce centre hospitalier, on constate une présence massive des gardes malades, qui interpelle plus d'un observateur au point de s'interroger sur leur nécessité. Celle-ci serait elle l'expression de la solidarité ou du dysfonctionnement des services sous tutelle du C.H.U-B? Pour vérifier nos hypothèses, nous nous sommes parvenus au résultat selon lequel, cette présence des gardes malades dans ce centre hospitalier résulte de la conjonction de ces deux (02) facteurs, c'est à dire la solidarité mécanique et le dysfonctionnement du C.H.U-B. À cela s'ajoute l'inadéquation entre les nouvelles attentes des malades et l'état actuel des structures de ce centre.
The Brazzaville Hospital and University Center (C.H.U-B) is one of the largest health facilities in the Republic of Congo. In this hospital, there is a massive presence of sick keepers, which challenges more than one observer to question the reason of their existence. Would this be the expression of the solidarity or the dysfunction of the services under the supervision of the C.H.U-B? To verify our hypotheses, we arrived at the result according to which, this presence of the sick keepers in this hospital center results from the conjunction of these two (02) factors, that is to say the mechanical solidarity and the dysfunction of the CHU-B. Added to this is the mismatch between the new expectations of the patients and the current state of the structures of this center.
Subject(s)
Humans , Female , Professional-Family Relations , Social Environment , Continuity of Patient Care , Custodial Care , Academic Medical Centers , Patient Care , Inpatients , Sociology, MedicalABSTRACT
A semi-structured questionnaire study of 326 randomly selected pregnant women referred for ultrasound examination at the ultrasound Laboratory of University of Nigeria Teaching Hospital (UNTH); Enugu was undertaken. The main objectives of this survey included assessment of women's perception and satisfaction with obstetric ultrasound service at UNTH; Enugu and to reflect on our practice. Questions were asked about gestational age; reasons for the scan; information provided before and during the scan; the women's expectations when attending for the scan; their waiting time; their opinion regarding the scan service and suggestions to improve services. Results showed that majority of the patients (66; N = 215) were not given adequate in formation required to make a knowledgeable decision about their scan. Large number of the women (67.5; N = 220) waited for a long time (1-4 hours) before their scan. About half of the respondents (53; N = 173) were satisfied with the way the result of the scan was communicated to them. Results suggest that full implementation of informed consent; reduced waiting time; better communication; explanation and counseling of scan findings to patients would improve the quality of our obstetric ultrasound service