Reviewed International Journal of Medicine, Nursing & Public Health

PERCEPTION OF PATIENT SAFETY AMONG THE HEALTHCARE PROFESSIONALS AT THE KAKAMEGA COUNTY REFERRAL HOSPITAL, KENYA

ELIZABETH OSAGA MULUSA — 2024-03-12

One of the global parameters in measuring healthcare quality is patient safety. Patient safety plays a pivotal role in maintaining and promoting patient safety. The World Health Organization has opined that a weak patient safety culture among healthcare workers predisposes patients to adverse events which subsequently increase hospital stay, healthcare costs, patient morbidity, and mortality. Based on existing literature, the biggest challenge in understanding patient safety is how to assess it. Existing studies assess patient safety using different assessment approaches with most studies assessing patient safety using managerial, staff, or policy perspectives. There is, however, a paucity of studies reviewing the interaction of the three modes of safety assessments. Hence, it was imperative to establish the interaction of the three determinants influencing patient safety. Premised on this, this study sought to establish the determinants of patient safety among critical care clinical teams. Findings from this study posit to help inform patient safety in Kenya and act as a baseline to help trigger further research that could inform policy change. The study was conducted at the Kakamega County Referral Hospital in Kenya and did adopt an analytical cross-sectional design. The study included all healthcare providers working closely with the Critical Care Units (CCUs) since these units are the most critical in-patient safety. A self-administered questionnaire was used to collect data from the study participants. Collected data was coded electronically using the Statistical Package for Social Sciences (SPSS) software version 21 before being subjected to analysis. Using the eight (8) sections of the questionnaire, data was first analyzed and reported descriptively as numbers, percentages, means, and standard deviations. Inferential statistics was then run on selected variables to help answer the research questions. After explaining the scope and rationale of the study, the respondents was required to first consent by signing a consent form before being included in the study. Study findings was communicated digitally and physically in print format and made available to the public through the university library and online through the university website and an accredited peer-reviewed journal.

DETERMINANTS OF MORAL DISTRESS AMONG HEALTHCARE PROVIDERS WORKING IN ONCOLOGY DEPARTMENT, KENYATTA NATIONAL HOSPITAL, NAIROBI CITY COUNTY, KENYA

MORINE N. MWENYA — 2024-04-21

Background: This study discusses the prevalence, causes and interrelationships of the causal factors and the coping mechanisms of the HCPs to moral distress in oncology departments.

The purpose of the study: A cross sectional study was conducted, using a proportionate stratified sampling method to take in the study sample representative and information was composed using a structured self- administered questionnaire. Descriptive analysis was done where frequencies and percentages were used to sum up grouped data while mean and standard deviation was used to summarize continuous data. Chi-square and Fischer’s exact test were used to investigate the factors associated with moral distress. Binary logistic regression was used to investigate the determinants of moral distress. Level of significance was investigated at 0.05. Statistical package for social sciences was used for analysis.

Results: The findings showed that, 56.6%(n =82) of the respondents were male. In investigating age group of study participants, 40.7%(n =59) were aged between 41 and 50 years. Marital status showed that 59.3%(n =86) of the participants were married. In investigating moral distress, that 37.9% (n =55) had no moral distress, 49%(n =71) had mild moral distress while 13.1%(n =19) had severe moral distress. The findings showed that participants with degree, (AOR =0.33, 95%CI:0.14 – 0.85, p =0.001), higher diploma, (AOR =0.22, 95%CI:0.10 – 0.49, p <001) and those with master’s level education, (AOR =0.16, 95%CI:0.04 – 0.51, p =0.010) were less likely to experience moral distress as likened to those with diploma level qualification. Those who had ≤2 years duration of experience (AOR =2.50, 95%CI:1.91 – 6.41, p =0.005). Those who were neutral on assertion that patients’ relatives have unrealistic expectations about them (OR =0.24, 95%CI:0.09 – 0.76, p =0.015), Those who agreed with the statement that patients’ relatives have unrealistic expectations about (AOR =3.88, 95%CI:1.05 – 14.35, p =0.042 and those who disagreed with the statement that there is autonomy in decision making (AOR =4.15, 95%CI: 1.16 – 14.81, p =0.028) were determinants of moral distress.

Conclusion and recommendations: The findings have showed that the burden of moral distress is high which warrants the need for healthcare providers to shape focus on their wellbeing. There is need to foster a culture of open communication where healthcare providers feel comfortable discussing moral distress and ethical challenges with colleagues, supervisors, and mentors.

PALLIATIVE CARE NEEDS OF PATIENTS ON MAINTENANCE HEMODIALYSIS AT THIKA LEVEL 5 HOSPITAL, KIAMBU COUNTY, KENYA

STEPHEN N. GITHUKU — 2024-04-28

Globally, a huge gap exists between the required and the available renal palliative care services. The gap is particularly worse in low-and-medium income countries despite having the highest percentage of patients requiring palliative care. Maintenance hemodialysis patients contribute a sizable percentage of the global renal patient population in need of palliative care. Successful provision of adequate palliative care services requires a holistic understanding of the patients’ needs. The purpose of this study was to explore the palliative care needs of patients on maintenance hemodialysis at Thika Level 5 Hospital. A qualitative descriptive design was used to explore the palliative care needs of the patients at the institution. Purposive sampling was used to recruit participants. Data collection was conducted for a period of one month at the hospital’s renal unit. A total of twelve maintenance hemodialysis patients participated in the study. Audiotaped semi-structured interviews were used to conduct data collection. Thematic analysis was used to analyze the data. The study findings showed that maintenance hemodialysis patients have many palliative care needs. The needs regard to physical, psychological and social aspects. Distressing physical symptoms were identified as the primary physical needs where fatigue, skin changes and fluctuations in appetite were reported as the most prominent symptoms. Difficult thoughts related to uncertainty about the future, caregiver burden, inability to get more children, stress and worry as well negative self-image were reported as the psychological needs experienced by the patients. Interruption of social roles, abandonment by friends and financial burden on the family were revealed as the social needs of the patients. To deal with their illness and treatment related challenges, the patients primarily utilized spiritual coping where prayers were reported to be the most utilized coping method. Lack of knowledge on palliative care and fear of being judged were identified as patient related barriers to meeting palliative care needs of the patients. Understanding the palliative care needs of maintenance hemodialysis patients has important implications on practice and policy making. Findings could be used in developing renal palliative care services provision policies and protocols to use as a guide in the identification and provision of palliative care to maintenance hemodialysis patients. Also, nephrology nurses and other renal care team healthcare professionals could use the findings to develop strategies of addressing patient related barriers to meeting palliative care needs. For research, studies could be done to evaluate the influence and perspective of healthcare providers in the provision of palliative care to maintenance hemodialysis.

KENYA MEDICAL TRAINING COLLEGE INVOLVEMENT IN THE ACHIEVEMENT OF UNIVERSAL HEALTH COVERAGE

CATHERINE ALING’A O. LESASUIYAN — 2024-06-30

Universal Health Coverage (UHC) is a fundamental goal for many countries globally, including Kenya. To realize the government's UHC agenda, it is imperative to strengthen the healthcare workforce. Kenya Medical Training College (KMTC) plays a crucial role in this endeavor as a leading institution for competent health professionals training. This paper presented a strategic framework for involving KMTC in driving and achieving the government's UHC agenda through comprehensive strategies, curriculum implementation, expanding infrastructure, fostering research and consultancy and promoting active community engagement.

UTILIZATION OF REFLECTIVE PRACTICE BY NURSES WORKING IN THE CRITICAL CARE UNITS AT A LEVEL SIX HOSPITAL IN KENYA

LILLIAN NYANDUKO SAMOITA — 2024-08-13

This study aimed to investigate the Utilization of Reflective practice among nurses in the critical care units (CCUs) at Kenyatta National Hospital (KNH). The specific objectives of the study were determining the practice of reflection, the perception towards utilization of reflective practice, the relationship between nurse characteristics, and facility associated factors and utilization of reflective practice. A cross sectional quantitative study was conducted with 154 sampled respondents. A structured self-administered questionnaire was used for data collection. Statistical Package for Social Sciences (SPSS) version 25.0 was utilized for data analysis, incorporating Logistic regression and Chi-square tests to evaluate relationships. Formal training in reflective practice was strongly associated with increased utilization, as those who received training had a utilization rate of (92.6%), while those without training had a utilization rate of (47%). Nurses who indicated that their nursing practice had been altered by engaging in reflection demonstrated a greater utilization rate (68.2%) in comparison to those who did not report any such modification. Majority (88.2%) of the respondents reported they did not have a designated space for reflective practice, (76.3%) lacked supportive institutional policies, (80.8%) missed opportunities for training, and (68.7%) experienced workload related obstacles. The study underscores the importance of promoting formal training in reflective practice, establishing supportive institutional policies, and providing dedicated spaces for reflection among CCN.

UTILIZATION OF RESEARCH FOR EVIDENCE BASED PRACTICE AMONG NURSES IN THE MAIN CRITICAL CARE UNIT, KENYATTA NATIONAL HOSPITAL, NAIROBI COUNTY

MARY AUMA JUMA — 2024-10-01

This study was carried out to determine the utilization of research for evidence-based practice among nurses in the main critical care unit, Kenyatta National Hospital, Nairobi County. A quantitative cross-sectional study design was used to determine level of utilization of research among nurses in main CCU, relationship between research utilization and nurse characteristics and to determine the facilitators and barriers to research utilization among nurses in main CCU at KNH. Convenience sampling technique was used to select participants because of the different shifts and workload. A sample size of 82 nurses was used and a self-administered questionnaire. Data was coded into electronic form using statistical package for social science (SPSS) version 28.0. Analysis of data was done using both descriptive and inferential statistics. Level of significance was evaluated at p<0.05. The findings showed that, 35.4% (n =29) of the respondents had utilized the findings of the studies they read from the websites. Age (>40 years) (AOR =6.11, 95%CI:4.38 – 17.11, p<0.001), MScN educational qualification (AOR=5.55, 95%CI:1.86 – 19.22, p=0.025), trained in computer packages (AOR=9.81, 95%CI:2.26 – 25.11, p =0.012) and high level of awareness on research (AOR=14.75, 95%CI:1.88 – 55.46, p=0.010) were significantly associated with utilization of research for evidence-based practice. 50% (n =41) of the respondents disagreed that nurses have access to research evidence, 68.3% (n =56) of the respondents disagreed with the statement that nurses have enough training on research while 64.6% (n =53) were unsure on whether research agents are needed to spearhead research utilization. Major barriers to research utilization were 78% (n =64) of the respondents cited lack of resources, 64.6% (n =53) cited resistance to change and 54.9% (n =45) stated that negative attitude among care providers were major barriers to research utilization. The findings showed that the practice of research utilization in nursing is poor hence the need for multi-disciplinary integration to help improve the level of awareness as well as improve overall understanding of nurses on the importance of research in clinical practice.