Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.

INTRODUCTION: Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients' suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes. AIM: This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. METHOD: In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0. RESULTS: The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing. CONCLUSION: Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood Pressure in Ghanaians with Hypertension.

BACKGROUND: In sub-Saharan Africa, the prevalence of hypertension has assumed epidemic levels and currently accounts for numerous complications such as stroke, heart failure, and kidney damage. Management of hypertension involves both drug and nonpharmacological approaches. Self-monitoring of blood pressure is an important nonpharmacological approach that facilitates early detection of deteriorating blood pressures and complications. AIMS: We determined the practice and sociodemographic factors influencing self-monitoring of blood pressure among Ghanaians with hypertension. METHODS: In a cross-sectional design, we recruited four hundred and forty-seven (447) Ghanaians with hypertension receiving care at the hypertensive Outpatient Department (OPD) Clinics of the Medical Department at the Korle-Bu Teaching Hospital (KBTH). The respondents were sampled using a simple random sampling technique of balloting without replacement. A structured questionnaire was used to gather data on the practice of self-monitoring of blood pressure and sociodemographic factors influencing self-monitoring in the respondents. We also measured some anthropometric and haemodynamic indices of the respondents. The data was entered in Microsoft Excel 2010 and exported into SPSS 21.0 to aid with the data analysis. A chi-square test and Student's t-test analysis were done to determine the relationship between the practice of self-monitioring and other sociodemographic variables. Data analayses were conducted at a significant level (alpha 0.05) and power of 95% confidence. Thus, p < 0.05 was considered statistically significant. RESULTS: The practice of self-monitoring of blood pressure was 25.3% with more female respondents claiming to practice self-monitoring as compared to their male counterparts (28.6% vs. 20.7%). Awareness of self-monitoring of blood pressure was associated with increased practice of self-monitoring of blood pressure. Health workers (46.8%), colleague patients (39.8%), relatives/spouses (6.7%), and the media (6.7%) were identified as the sources of information about self-monitoring of blood pressure. Awareness of self-monitoring, level of education, valid health insurance, occupation, income levels, and marital status had a significant relationship with self-monitoring of blood pressure among the respondents. Thus, respondents with higher education, awareness of self-monitoring, valid health insurance, formal employment, and higher income were likely to monitor their blood pressure. CONCLUSION: Several sociodemographic factors influence the practice of self-monitoring of blood pressure in Ghanaians with hypertension. Thus, targeted hypertension education and social-cognitive interventions should focus on these sociodemographic factors so as to improve self-monitoring of blood pressure in order to reduce the complications of hypertension.