A framework for capacity enhancement of Rwandan nurse educators and preceptors facilitating nursing students to learn pediatric pain management.

INTRODUCTION: In low- and middle- income countries like Rwanda, children are most likely to suffer from painful and life-limiting conditions due to various factors predominant in these settings. Adequate pre-licensure pain management training can improve pain relief nursing practices. Educators and nurses in practice have a responsibility to teach the soon-to- be nurses for holistic competent nursing care of children, emphasizing the importance of and addressing child's suffering, yet inconsistencies were reported in what was taught regarding pediatric pain management from a theoretical perspective by nurse educators as compared to their counterparts in clinical settings in Rwanda. DESIGN: This study applied a qualitative approach using group discussions based on nominal group technique (NGT) to develop and validate a conceptual framework supporting the capacity enhancement of nurse educators and preceptors facilitating students' learning about pediatric pain management in Rwanda. METHODS: NGT meetings were conducted with academic nurses (n = 8), nurse clinicians (n = 4), and nursing students (n = 2) during a 2-day workshop to identify strategies, discuss the relevance of each strategy and to agree on key concepts of a framework for improving the ability of nurse educators and preceptors to teach PPM to nursing students. After four weeks another round of NGT meetings were done with nursing faculty (n = 6), academic nurse leaders (n = 3), nurse preceptors (n = 2), clinical nurse leaders (n = 2), a nurse leader from a regulatory body (n = 1), and nursing student (n = 1) to validate the developed framework. FINDINGS: Four main strategies corresponding to the key concepts were mapped in a framework. Participants had a consensual agreement on the importance of the developed framework, they confirmed its completeness and practicality. In addition, participants found that the developed framework is logical, and confirmed that it is applicable for its purpose. CONCLUSION: The developed framework presents an opportunity to respond to the gaps in nursing pain education in the context of limited resources settings such as Rwanda. It can also be applied in nursing practice and nursing research, aligning with the need of improving the quality of care of suffering children. Furthermore, the framework can be adapted and utilized to meet the needs of healthcare professionals other than nurses. CLINICAL RELEVANCE: Strategies are suggested to improve the ability of nurse educators and preceptors in clinical settings to facilitate the acquisition of pediatric pain management competencies by the next generation of nurses. Future Rwandan nurses could then use the competencies acquired to provide optimal health care to children with pain in the best way possible during their practices.

Workplace violence experience among nurses at a selected university teaching hospital in Rwanda.

Introduction: workplace violence is a global problem in the health sector, especially in the hospitals affecting healthcare works´ job satisfaction and performance. Workplace violence (WPV) is present in different forms associated with various factors and the nurses are the most affected. This study aimed to explore WPV among nurses working at a selected University Teaching Hospital in Rwanda. Methods: the research approach used was the quantitative descriptive cross-sectional design. The stratified random sampling was used to recruit 195 participants among 379 nurses. The data were collected using a structured, validated, and self-administered questionnaire that was adapted from the International Labor Organization, International Council of nurses, the World Health Organization, and Public Services International. Descriptive statistics were used for analyzing frequencies and percentages. The Chi-square test was used for evaluating the association between variables. Results: the findings revealed that (58.5%, n=114) of nurses have experienced some types of WPV in the twelve months preceding the study, among them (44.6%, n=108) of nurses were verbally abused. The nurses providing emergency care, the nurses working in the emergency department, and nurses working with vulnerable patients like HIV/AIDS patients were associated with WPV Chi-square (1, n=195), P=<0.001). The psychological problems have been found to be the first consequences of WPV. Conclusion: based on the study findings, it was concluded that the hospital management needs to be aware of WPV, develop and implement appropriate policies and strategies. These will strengthen nurses´ concentration towards them and will result in service delivery improvement.

Exploring factors affecting the facilitation of nursing students to learn paediatric pain management in Rwanda: A descriptive qualitative study.

Nurse educators and nurse preceptors play a fundamental role in facilitating nursing students' acquisition and utilization of professional competencies. Previous studies about key elements for teaching and learning about pain in nursing education programs include students' personal characteristics and previous experiences; educators' knowledge, skills, and beliefs; learners' exposure to leaders in pain education; and curricular pain content and delivery approaches. These studies were mainly carried out in developed countries, with a context of educational and health care systems different from those of developing countries. The current study explores academics', clinical nurse preceptors', and nursing students' perceptions about factors influencing the facilitation of nursing students' competency for paediatric pain management in Rwanda. A qualitative descriptive exploratory design was used in this study that utilized in-depth interviews with six nurse educators and eight nurse preceptors, and focus group discussions with nineteen senior year nursing students. The study setting included five sites: two academic institutions and three clinical settings. Narratives from participants were transcribed verbatim and analysed using thematic analysis. The analysis yielded six themes describing factors that affected the facilitation of students' learning about paediatric pain management. The themes included student motivation, facilitators' attributes, collaboration between academics and clinicians, nurses' limited autonomy for decision-making regarding PPM practices, shortage of human and material resources, and educational qualification. Knowing these factors is essential as it provides an opportunity to design targeted interventions aimed to enhance the capacity of nurse educators and clinical nurse preceptors involved in teaching nursing students about paediatric pain management.

Teaching and learning during COVID-19 crisis: faculty preparedness and factors influencing the use of E-learning platform at the College of Medicine and Health Sciences, University of Rwanda

Background Towards the beginning of 2020, the COVID-19 pandemic spread worldwide and caused many schools to close. Many educational institutions transitioned from traditional face-to-face or blended to a total e-learning approach. The University of Rwanda rapidly shifted from a blended teaching and learning approach to a total e-learning approach. Thus,this study assessed the faculty preparedness and the factors influencing the use of e-learningplatforms at the College of Medicine and Health Sciences. Methods The study used a cross-sectional design. A web self-administered questionnaire was used to collect data from 450 CMHS faculty from June to July 2020, with a response rate of 34.4% (n=155). SPSS was used to describe nominal variables with frequencies and percentages. Similarly, continuous variables were analyzed by calculating median and interquartile ranges. The Chi-Square and Man-Whitney tests were also computed using SPSS. Results The majority of participants (93.7%) started using the e-learning approach, and 92.4% attended e-learning training. The top motivator for e-learning use was a personal interest in technology use (93.3%) and the leading barrier to using e-learning was the concern about access to students (77.1%). Conclusion This study found that faculty preparedness was significantly associated with e-learning use. The leading motivator and barriers were a personal interest in technology use and concern about access to students, respectively.

A cross-sectional study of the prevalence and factors associated with symptoms of perinatal depression and anxiety in Rwanda.

BACKGROUND: Perinatal depression and anxiety are increasingly recognized as important public health issues in low and middle-income countries such as Rwanda and may have negative consequences for both mothers and their infants. Maternal mental health may be particularly challenged in Rwanda because of the prevalence of risk factors such as poverty, low education levels, negative life events and marital problems. However, there are limited data about perinatal depression and anxiety symptoms in Rwanda. This study thus aimed to explore the prevalence of symptoms of perinatal depression and anxiety in Rwanda, and factors associated with them. METHODS: A sample of 165 women in the perinatal period (second and third trimester of pregnancy, up to 1 year postnatal) were interviewed individually over 1 month in October 2013. Women were interviewed at 5 of 14 health centres in the Eastern Province or the affiliated district hospital. Participants answered socio-demographic questions and scales measuring symptoms of perinatal depression (EPDS: Edinburgh Postnatal Depression Scale) and anxiety (SAS: Zung Self-rating Anxiety Scale). RESULTS: Among women in the antenatal period (N = 85), 37.6% had symptoms indicating possible depression (EPDS ≥10) and 28.2% had symptoms associated with clinical levels of anxiety (SAS > 45). Among women within the postnatal period (N = 77), 63.6% had symptoms of possible depression, whereas 48,1% had symptoms of probable anxiety. Logistic regression showed that symptoms of postnatal depression were higher for respondents who had four or more living children relative to those having their first child (Odds Ratio: 0.07, C.I. = 0.01-0.42), and for those with a poor relationship with their partner (Odds Ratio: .09, C.I. =0.03-0.25). Any lifetime exposure to stressful events was the only predictor of symptoms of postnatal anxiety (Odds Ratio = 0.20, C.I. = 0.09-0.44). CONCLUSIONS: Symptoms of postnatal depression and anxiety were prevalent in this Rwandan sample and most strongly predicted by interpersonal and social factors, suggesting that social interventions may be a successful strategy to protect against maternal mental health problems in the Rwandan context.

Return for prenatal care and childbirth services among Nigerian women using primary health care facilities.

Aim: The study assessed the return for prenatal care and childbirth services among Nigerian women using primary health care facilities. Design: A descriptive cross-sectional approach was employed for the study. Methods: A total of 730 participants randomly recruited systematically from 21 purposively selected primary health care facilities in Ibadan, Nigeria were studied. A questionnaire and a checklist were used for data collection. The collection of data spanned three months (April to June, 2014). The data were analysed descriptively and inferentially while the results were presented in frequency tables. Results: The women's mean age was 28 ± 5.3 years. Out of the 730 women studied, 92.6% received prenatal care. The mean difference between the number of prenatal care registration and the number of childbirths was 76.5. Poor environmental hygiene of facilities, statistically significant cost of services and non-availability of 24-hr service were implicated for dissatisfaction with care received by the women and consequent poor return rate for childbirth.

Utilisation of the partogram among nurses and midwives in selected health facilities in the Eastern Province of Rwanda.

BACKGROUND: Maternal mortality continues to be a global burden, with more than 200 million women becoming pregnant each year and a large number dying as a result of complications of pregnancy or childbirth. The World Health Organisation has recommended use of the partogram to monitor labour and delivery in order to improve healthcare and reduce maternal and foetal mortality rates. OBJECTIVE: This study described factors affecting utilisation of the partogram among nurses and midwives in selected health facilities of Rwanda. METHOD: A descriptive quantitative and cross-sectional research design was used. The population comprised 131 nurses and midwives providing obstetric care in 15 health institutions (1 hospital and 14 health centres). Data collection was through a self-administered questionnaire, and a pre-test of the data collection instrument was carried out to enhance validity and reliability. The Statistical Package for Social Sciences (version 21) was used to capture and analyse data. Ethical clearance was obtained from the University of the Western Cape (Republic of South Africa) and from the Institutional Review Board of Kigali Health Institute (Rwanda). Patricia Benner's model of nursing practice was used to guide the study. RESULTS: It was found that 36.6% of nurses and midwives did not receive any in-service training on how to manage women in labour. Despite fair knowledge of the partogram among nurses and midwives in this study, only 41.22% reported having used the partogram properly, while 58.78% reported not having done so. CONCLUSION: Nurses' and midwives' years of professional experience and training in managing pregnant women in labour were found to be predictors of the likelihood of proper use of the partogram. In-service training of obstetric caregivers in the Eastern Province of Rwanda is recommended to improve use of the partogram while managing women in labour.

Challenges in Neonatal Nursing Clinical Teaching to Nurse-Midwife Technicians in Malawi.

BACKGROUND: Practice-based learning is important in clinical teaching of nursing and midwifery as students develop the necessary competencies and confidence aligned by the outcomes of their learning programs. However, in Malawi, research shows that clinical teaching in neonatal nursing has not been given adequate consideration. This article reports on challenges faced by educators and students in clinical teaching and learning in neonatal nursing for nurse-midwife technicians. METHOD: An explorative qualitative study was conducted. Data were collected through 23 focus group discussions with 140 students and 31 clinical teachers from eight nursing colleges. Audiorecorded data were transcribed verbatim and analyzed using Hennink's content analysis stages. RESULTS: Challenges faced by clinical teachers and students were short duration and variation in clinical placements, lack of emphasis in clinical teaching, and lack of skills among clinical staff. CONCLUSION: Nursing training institutions should maximize student learning opportunities in neonatal nursing practice by creating more practice-based learning opportunities that meet the students' needs. [J Nurs Educ. 2017;56(4):215-221.].

Utilization of the partogram among nurses and midwives in selected health facilities in the Eastern Province of Rwanda

Background: Maternal mortality continues to be a global burden, with more than 200 million women becoming pregnant each year and a large number dying as a result of complications of pregnancy or childbirth. The World Health Organisation has recommended use of the partogram to monitor labour and delivery in order to improve healthcare and reduce maternal and foetal mortality rates.Objective: This study described factors affecting utilisation of the partogram among nurses and midwives in selected health facilities of Rwanda.Method: A descriptive quantitative and cross-sectional research design was used. The population comprised 131 nurses and midwives providing obstetric care in 15 health institutions (1 hospital and 14 health centres). Data collection was through a self-administered questionnaire, and a pre-test of the data collection instrument was carried out to enhance validity and reliability. The Statistical Package for Social Sciences (version 21) was used to capture and analyse data. Ethical clearance was obtained from the University of the Western Cape (Republic of South Africa) and from the Institutional Review Board of Kigali Health Institute (Rwanda). Patricia Benner's model of nursing practice was used to guide the study.Results: It was found that 36.6% of nurses and midwives did not receive any in-service training on how to manage women in labour. Despite fair knowledge of the partogram among nurses and midwives in this study, only 41.22% reported having used the partogram properly, while 58.78% reported not having done so.Conclusion: Nurses' and midwives' years of professional experience and training in managing pregnant women in labour were found to be predictors of the likelihood of proper use of the partogram. In-service training of obstetric caregivers in the Eastern Province of Rwanda is recommended to improve use of the partogram while managing women in labour

Cracking the nut of service-learning in nursing at a higher educational institution.

BACKGROUND: The readiness of academics to engage in the service-learning (SL) institutionalisation process is not accentuated in research on SL institutionalisation in South Africa. The argument has been advanced that SL scholarship and willingness of key stakeholders are crucial for SL institutionalisation at the academic programme level. AIM: The research focus of the study being reported here was on readiness of respondents to embed SL in the curricula of the nursing programme. METHOD: This study used a quantitative, exploratory and descriptive design. A self-administered structured questionnaire was used to collect data from a stratified sample comprising 34 respondents. The data were analysed for descriptive statistics using SPSS 19. RESULTS: The demographic profile of the respondents indicated that 31 (66%) were between 31 and 50 years old; 36 (75.16%) had a minimum of 10 years' nursing experience; 19 (39.6%) had a master's degree, two (4.2%) had a doctorate; and 29 (60.4%) had been employed by the school for a maximum of five years. The results indicated that the nurse educators were in need of SL capacity-building because 9 (18.8%) had limited or no knowledge of SL and 24 (50%) confused SL with other forms of community engagement activities. However, only 15 (33%) of the clinical supervisors and 13 (27%) of the lecturers indicated a willingness to participate in such a programme. CONCLUSION: The school was not ready to embed SL in the academic programme because of a lack of SL scholarship and willingness to remediate the identified theory-practice gaps.

Factors contributing to incivility amongst students at a South African nursing school.

BACKGROUND: This study determined the experiences of nurse educators of the factors contributing to the uncivil classroom behaviours of nursing students at a South African school of nursing. OBJECTIVE: To describe what nurse educators consider to be factors contributing to incivility among nursing students in a South African nursing school. METHOD: A qualitative descriptive design was used. Eleven nurse educators were purposively sampled for their experiences on the factors contributing to incivility. Individual face-to-face interviews were conducted until data saturation. RESULTS: The data analysed indicated that the educators had varying but often similar perspectives on which factors contribute to incivility among nursing students. The three themes that emerged from the data were academic, psycho-pathological and social factors.The themes were discussed on the basis of their reported impact on classroom behaviour and the implications for the teaching and learning environment. CONCLUSION: Conclusions were made that an educational screening system to identify committed students before admission into nursing education should be explored; that a support system should be explored for nurse educators to deal with incidents of uncivil behaviour, perhaps within policy frameworks in the nursing institution; that emotional support should be provided for students who may be experiencing difficulties adjusting to the rigours of post-secondary education; and that a forum should be set up for nurse educators to compare notes and share ideas on what works best in reducing the incidence of uncivil behaviours in the classroom setting.

Validation of the integration of HIV and AIDS related nursing competencies into the undergraduate nursing curriculum in South Africa.

BACKGROUND: Being in its fourth decade, HIV remains an epidemic that requires combined efforts for the global fight. The strategies planned and implemented in the fight against HIV include reversing and halting the spread of HIV, increasing health care access, and strengthening the health care system. South Africa has made the fight one of its top priorities, and has developed plans to increase the role of nurses in the management of HIV, demonstrating its willingness, commitment and progress in the fight against HIV. OBJECTIVE: This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into the four-year Bachelor of Nursing programme at a university in South Africa. METHODS: This study adopted a constructivist paradigm, using a qualitative approach, applyingthe design step of the process model of curriculum development, to validate the inte gration of the mapped HIV and AIDS related nursing competencies into the undergraduate nursing curriculum. RESULTS: For each competency, outcomes were developed for each year. Participants confirmed completeness of outcomes and appropriateness of the mapping of the HIV and AIDS related outcomes into the nursing curriculum, as well as the feasibility and practicability of the integration. CONCLUSION: Required resources for integration of HIV and AIDS related nursing competencies, such as human resources and nurse educators' continued personal development were identified, as well as barriers to integration, and measures to eliminate them were discussed. The importance of integration of HIV and AIDS nursing competencies into the curriculum was reiterated.

An ethnographic exploration of postoperative pain experiences among Ghanaian surgical patients.

BACKGROUND: The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain. PURPOSE: This study focused on patients' experiences of postoperative pain (POP) and factors that affect POP. DESIGN: The study employed qualitative ethnographic principles. METHOD: Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana. FINDINGS: Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing. IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE: Health professionals need to understand the sociocultural effects of pain in order to give effective care. CONCLUSION: The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.

Validation of the Integration of HIV and AIDS Related Nursing Competencies into the Undergraduate Nursing Curriculum in South Africa

Background: Being in its fourth decade; HIV remains an epidemic that requires combined efforts for the global fight. The strategies planned and implemented in the fight against HIV include reversing and halting the spread of HIV; increasing health care access; and strengthening the health care system. South Africa has made the fight one of its top priorities; and has developed plans to increase the role of nurses in the management of HIV; demonstrating its willingness; commitment and progress in the fight against HIV.Objective: This article presents the validation process conducted to confirm the integration and mapping of the HIV and AIDS related nursing competencies into the four-year Bachelor of Nursing programme at a university in South Africa.Methods: This study adopted a constructivist paradigm; using a qualitative approach; applyingthe design step of the process model of curriculum development; to validate the inte gration of the mapped HIV and AIDS related nursing competencies into the undergraduate nursing curriculum.Results: For each competency; outcomes were developed for each year. Participants confirmed completeness of outcomes and appropriateness of the mapping of the HIV and AIDS related outcomes into the nursing curriculum; as well as the feasibility and practicability of the integration.Conclusion: Required resources for integration of HIV and AIDS related nursing competencies; such as human resources and nurse educators' continued personal development were identified; as well as barriers to integration; and measures to eliminate them were discussed. The importance of integration of HIV and AIDS nursing competencies into the curriculum was reiterated

Patients' experiences of being nursed by student nurses at a teaching hospital.

BACKGROUND: Teaching hospitals are medical institutes at which most nursing education institutions provide their students with practical nursing experience. Although the focus of care is the patient, attention is sometimes focused more on the nursing students rather than on the patients who are undergoing care at the hands of both the nursing professionals and students. However, proper nursing care should also take into account the experiences of patients during the care process in the health facility. OBJECTIVES: The study had three objectives: to describe the experiences of patients nursed by student nurses in a teaching hospital in the Western Cape; to identify patterns in the experiences of patients receiving patient care from student nurses; and to analyse aspects of the experiences that may need further attention for the training of student nurses. METHOD: A descriptive phenomenological approach was used to explore the experiences of patients nursed by student nurses. Participant selection took place purposively from different wards of the identified teaching hospital, and thematic saturation was achieved at 10 participants. The data were collected through in-depth interviews and analysed using thematic content analysis. RESULTS: Three main themes were discovered after data analysis: methods of identification of student nurses by patients; positive perceptions of student nurses by patients; and negative perceptions of student nurses by patients. CONCLUSION: The findings will inform the clinical supervisors and educational institutions of aspects of the nursing training of student nurses that need improvement and those that require enforcement. 

The Ghanaian surgical nurse and postoperative pain management: a clinical ethnographic insight.

Nurses form an indispensable part of the clinical team that manages postoperative pain (POP). Within a particular clinical context, nurses perceive and respond to pain based on specific factors. This study aimed at illuminating the perceptions and responses of Ghanaian surgical nurses regarding their patients' POP. It also identified the factors that influenced nurses' pain responses. A focused ethnography was used, and data were collected through individual interviews. Sampling was performed purposively to include junior, senior, day, and night nurses who cared for surgical patients. Concurrent data analysis was performed and data were saturated with 12 individual interviews. The findings indicated that nurses perceived POP as an individual phenomenon, and nurses responded to patients' pain by administering analgesics and by using nonpharmacologic measures. Factors that influenced the nurses' response were individual factors, such as commitment, discretion, fear of addiction, and organizational factors, such as organizational laxity and challenges of teamwork. The study recommended that nurses should be educated, supported, and encouraged to ensure pain relief after surgery and that they should see pain relief as a priority postoperative care to avert the negative repercussions of poorly managed POP.

Determinants of nurses' knowledge gap on pain management in Ghana.

There are concerns about adequacy of nurses' knowledge and skill in effective pain management since effective pain management promotes early recovery after surgery. This study explores factors that accounted for Ghanaian nurses' inadequate knowledge of postoperative pain management using a focused ethnographic design for data collection at a tertiary teaching hospital in Ghana. Fourteen nurses designated as key informants with different backgrounds as nurse educators and leaders were purposively sampled to participate. Data were collected through in-depth individual interviews; all interviews were conducted in English, audio-taped and transcribed verbatim. The study revealed that nurses' inadequate pain management knowledge might have resulted from curriculum gaps during training; inadequate clinical supervision, study days, and workshops for practising nurses; lack of funding for organising regular workshops; and, negative attitudes of nurses whereby new information learned at workshops was not readily applied in clinical practice. It was concluded that nursing curricula at all levels of training in Ghana should incorporate credit-bearing courses on pain management, and appropriate pain management education programmes should be instituted for practising nurses. Regular monitoring and evaluation of the impact of such education programs is required.

An insight into the preoperative experiences of Ghanaian general surgical patients.

The unknown outcome of surgery has always been a source of anxiety for patients and their relatives. However, the experiences of Ghanaian surgical patients have not been adequately explored. This study sought to have an in-depth exploration of the preoperative experiences of Ghanaian general surgical patients to inform effective preoperative care. The study employed an ethnographic design and was conducted at two hospitals in Accra. Thirteen general surgical patients were purposively recruited and interviewed. Data analysis occurred concurrently and themes that emerged included reaction to impending surgery with subthemes of inappropriate disclosure, fear of death, readiness for surgery, and effect of waiting in the theatre. Also, the theme information gap had subthemes of preoperative care, expectations at the theatre, and undue delays. The study emphasized the need for health professionals to provide effective education to the public and patients, on surgery and its effects, to curb negative perceptions about surgery.

Adolescent clients' perceptions of maternity care in KwaZulu-Natal, South Africa.

BACKGROUND: Adolescent pregnancy continues to pose a challenge in both the developed and developing countries across the globe. Adolescent maternity clients (AMCs) have special needs and it is imperative to ensure that maternity services are able to respond appropriately to their needs. OBJECTIVE OR QUESTION: The purpose of this study was to explore adolescent maternity clients' perceptions of maternity care and to identify important characteristics of an adolescent-friendly maternity service. METHOD: A qualitative approach was used and a total of 18 adolescent maternity clients, between 15 and 19 years of age, were purposively recruited from antenatal and postnatal services. Data were collected through individual and group interviews. FINDINGS OR DISCUSSION: Findings fell into 3 categories: AMC-health care provider (HCP) interaction; health care system; and health education. Participants wanted HCPs to be caring and supportive. Additionally HCPs should use appropriate interaction and body language to make adolescent clients feel respected and comfortable within the health care setting. Participants expected clinic waiting times to be decreased and measures to make the waiting rooms comfortable be put in place. AMCs also expressed the importance of having extra support during labour and birth. Health education was perceived as essential to their preparation for childbirth and parenting, with them having a role in peer education. CONCLUSION: The relationship between the HCP and AMC is essential to ensuring an optimal outcome for mother and baby. Careful consideration needs to be given to how the health care facility and system are set up in order to ensure that the AMC is comfortable within this context.

A 2-decade appraisal of African nursing scholarship: 1986-2006.

PURPOSE: This paper is a description of a study about articles published about nursing in Africa from 1986 to 2006. METHODS: An exhaustive database search of articles written by nurses or articles related to nursing in Africa was done. Access to the database was mainly via EBSCO (http://www.ebsco.com), which allowed searching seven electronic databases. These are major databases useful for finding and accessing articles in academic journals, repositories, and archives. Data were recorded on computer spreadsheets and analyzed using frequencies and percentages. FINDINGS: A total of 1,860 indexed research studies were categorized and analysed for themes, content, source of publication, location, subject, scientific or nonscientific methods, nursing or non-nursing research, clinical or nonclinical nursing. A progressive increase of publications was noted. Regional variations were observed in the number of publications over the years with most from Southern Africa (67.3%) compared to West Africa (5.2%) and East Africa (3.3%). Common themes were nursing education (11.9%) HIV/AIDS (11.9%), community health care (16.1%), and professional nursing issues (10.3%). Single authorship (90.7%) outnumbered multiple authorship (9.3%), though research-based (50.5%) and nonresearch-based articles (49.5%) were almost evenly distributed. CONCLUSIONS AND RECOMMENDATIONS: More emphasis will be required for research concerning clinical studies; and collaborations--particularly multinational and across regions of Africa--should be developed. Efforts should be intensified to continue to build research capacity among nurses. CLINICAL RELEVANCE: Emphasis on African-based clinical studies which directly relate to patient care and culture can advance evidence-based practice in nursing with particular reference to African settings.