Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
1,960
result(s) for
"Adam, Mary"
Sort by:
Patient death and nurses’ coping strategies: Perception of nurses at a tertiary referral hospital in Kenya
In healthcare facilities, patient deaths are a common occurrence, exposing nurses to diverse behavioral and emotional reactions, particularly within the context of resource constraints in Kenyan healthcare settings. This study aimed to investigate the experiences of nurses at AIC Kijabe Hospital in Kenya regarding patient death and their coping strategies. The focus group discussions sought to understand factors influencing nurses’ reactions to death, assessing the adequacy of their basic training in preparing them for coping, exploring the determinants of their coping strategy choices, and gathering recommendations for enhancing coping mechanisms. Employing qualitative research, six focus group discussions were conducted with 50 nurses from various hospital departments, including the emergency department, medical and surgical wards, intensive care unit, and maternity ward. After data collection, the information was transcribed verbatim and analyzed using a thematic analysis approach with inductive coding. Two researchers independently coded the data. A code was an identifying term for a specific part with emphasis on the aspect being investigated. Subsequently, the research team met to compare the codes and reached a consensus on the best interpretation of the data codes. The coding was then categorized into themes and Subthemes. The study findings revealed four overarching themes: individual process, institutional process, work team relationships, and educational gaps. In the individual process, nurses disclosed factors influencing their reactions to and feelings about death, encompassing Stress injuries, views of life (pessimism or optimism), cultural background, religious beliefs, and self-drive/self-management. Nurses expressed immediate emotional responses to the word “death” and conveyed the emotional toll of losing patients. The institutional process delved into how the hospital assisted nurses in coping with patient deaths, revealing a lack of support or guidance in selecting coping mechanisms. Nurses advocated for psychological support, support groups, and counseling sessions. Work relationships and educational gaps were also featured, with nurses emphasizing the deficiency in training on the emotional and psychological aspects of coping with death. They advocated for enhancements in educational preparation to better equip nurses for the emotional challenges intrinsic to their profession.
Journal Article
American wild
American Wild: it can kill you, or exhilarate you. It's always there, a character in its own right in the great unfolding narrative of American writing. This issue of Granta is dedicated to stories of the wild, from MELINDA MOUSTAKIS on gutting fish in Alaska to CLAIRE VAYE WATKINS on a lost child in a dystopian California. Also: ANTHONY DOERR on a family of pioneers in Idaho, ADAM NICOLSON on tracking wolves in New Mexico and DAVID TREUER on cage fighting and his Ojibwe heritage.
BOOK
Eliciting women’s preferences for place of child birth at a peri-urban setting in Nairobi, Kenya: A discrete choice experiment
Maternal and newborn mortality rates are high in peri-urban areas in cities in Kenya, yet little is known about what drives women's decisions on where to deliver. This study aimed at understanding women's preferences on place of childbirth and how sociodemographic factors shape these preferences.
This study used a Discrete Choice Experiment (DCE) to quantify the relative importance of attributes on women's choice of place of childbirth within a peri-urban setting in Nairobi, Kenya. Participants were women aged 18-49 years, who had delivered at six health facilities. The DCE consisted of six attributes: cleanliness, availability of medical equipment and drug supplies, attitude of healthcare worker, cost of delivery services, the quality of clinical services, distance and an opt-out alternative. Each woman received eight questions. A conditional logit model established the relative strength of preferences. A mixed logit model was used to assess how women's preferences for selected attributes changed based on their sociodemographic characteristics.
411 women participated in the Discrete Choice Experiment, a response rate of 97.6% and completed 20,080 choice tasks. Health facility cleanliness was found to have the strongest association with choice of health facility (β = 1.488 p<0.001) followed respectively by medical equipment and supplies availability (β = 1.435 p<0.001). The opt-out alternative (β = 1.424 p<0.001) came third. The attitude of the health care workers (β = 1.347, p<0.001), quality of clinical services (β = 0.385, p<0.001), distance (β = 0.339, p<0.001) and cost (β = 0.0002 p<0.001) were ranked 4th to 7th respectively. Women who were younger and were the main income earners having a stronger preference for clean health facilities. Older married women had stronger preference for availability of medical equipment and kind healthcare workers.
Women preferred both technical and process indicators of quality of care. DCE's can lead to the development of person-centered strategies that take into account the preferences of women to improve maternal and newborn health outcomes.
Journal Article
Understanding intra- and interprofessional team and teamwork processes by exploring facility-based neonatal care in kenyan hospitals
Background
Within intensive care settings such as neonatal intensive care units, effective intra- and interprofessional teamwork has been linked to a significant reduction of errors and overall improvement in the quality of care. In Kenya, previous studies suggest that coordination of care among healthcare teams providing newborn care is poor. Initiatives aimed at improving intra- and interprofessional teamwork in healthcare settings largely draw on studies conducted in high-income countries, with those from resource-constrained low and middle countries, particularly in the context of newborn care lacking. In this study, we explored the nature of intra- and interprofessional teamwork among health care providers in newborn units (NBUs) of three hospitals in Kenya, and the professional and contextual dynamics that shaped their interactions.
Methods
This exploratory qualitative study was conducted in three hospitals in Nairobi and Muranga Counties in Kenya. We adopted an ethnographic approach, utilizing both in-depth interviews (17) and non-participant observation of routine care provision in NBUs (250 observation hours). The study participants included: nurses, nursing students, doctors, and trainee doctors. All the data were thematically coded in NVIVO 12.
Results
The nature of intra- and interprofessional teamwork among healthcare providers in the study newborn units is primarily shaped by broader contextual factors and varying institutional contexts. As a result, several team types emerged, loosely categorized as the ‘core’ team which involves providers physically present in the unit most times during the work shift; the emergency team and the temporary ad-hoc teams which involved the ‘core’ team, support staff students and mothers. The emergence of these team types influenced relationships among providers. Overall, institutionalized routines and rituals shaped team relations and overall functioning.
Conclusions
Poor coordination and the sub-optimal nature of intra-and interprofessional teamwork in NBUs are attributed to broader contextual challenges that include low staff to patient ratios and institutionalized routines and rituals that influenced team norming, relationships, and team leadership. Therefore, mechanisms to improve coordination and collaboration among healthcare teams in these settings need to consider contextual dynamics including institutional cultures while also targeting improvement of team-level processes including leadership development and widening spaces for more interaction and better communication.
Journal Article
Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya
Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance.
The study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women's children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas.
Mean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%.
The delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.
Journal Article
Medical Error Reporting among healthcare workers in a Kenyan tertiary level hospital: a knowledge, attitude, and practice study
Background
Medical Error Reporting (MER) enables organizations to characterize safety events, learn from them, and mitigate their recurrence in the future. However, Medical Error Reporting is inconsistently practiced by healthcare workers. This study aimed to assess the knowledge, practice, and attitude towards MER at the Kenyatta National Hospital (KNH), a tertiary care teaching and referral hospital in Kenya that serves Kenya and the East and Central African regions.
Methods
This cross-sectional study was conducted among healthcare workers at KNH between February and July 2022. Out of a calculated sample size of 384, a total of 390 participants were recruited, and 372 were included in the final analysis. Stratified convenience sampling was used to ensure representation across clinical cadres (nurses, doctors, and others) and hospital divisions (medicine, surgery, pharmacy, and others). Participants were recruited via email, departmental WhatsApp groups, or during meetings. Data were collected using a pre-tested, self-administered questionnaire (online and paper-based).
Results
Of the 372 participants, most were nurses 62.3%, followed by doctors (30.3%) and other staff (7.4%). Awareness of the MER tool was reported by 259 (71.2%). A total of 247 (68.6%) had encountered a medical error in the past two years, and among them, 138 (55.9%) had used the MER form, submitting a total of 758 reports. Nearly half of the respondents (49.2%) expressed a positive attitude toward medical error reporting (MER), which was significantly associated with reporting behaviour, particularly among respondents in the Surgery division (χ² = 11.78,
p
= 0.003). Most participants, 245 (74.2%), correctly defined patient safety. MER use was significantly associated with cadre; nurses reported more than doctors (χ² = 25.1, df = 2,
p
< 0.001).
Conclusion
Medical error reporting remains underutilized at KNH, especially among doctors. As the first study to document MER form use at the institution, it highlights gaps in awareness and attitude. Enhancing uptake will require addressing fear of victimization, strengthening supportive reporting cultures, and raising awareness across all healthcare worker cadres.
Journal Article
Outpatient management of urinary tract infections by medical officers in Nairobi, Kenya: lack of benefit from audit and feedback on adherence to treatment guidelines
Introduction
Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specific diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical officers in the region.
Methods
Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical officer specifically assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical officer from each of the 16 clinics was recruited from each clinic was recruited with eight each randomized to control vs. feedback groups. Both groups were given a multimodal educational session including locally adapted UTI guidelines and emphasis on problems identified in the baseline assessment Each record was scored using a scoring system that was developed for the study according to adequacy of history, physical examination, clinical diagnosis matching recorded data, diagnostic workup and treatment. Three audits were done for both groups; baseline (audit 1), post-CME (audit 2), and a final audit, which was after feedback for the feedback group (audit 3). The primary analysis assessed overall guideline adherence in the feedback group versus the CME only group.
Results
The overall scores in both groups showed significant improvement after the CME in comparison to baseline and for each group, the scores in most domains also improved. However, audit 3 showed persistence of the gains attained after the CME but no additional benefit from the feedback. Some deficiencies that persisted throughout the study included lack of workup of possible STI and excess use of non-UTI laboratory tests such as CBC, stool culture and
H. pylori
Ag. After the CME, the use of nitrofurantoin rose from only 4% to 8% and cephalosporin use increased from 49 to 67%, accompanied by a drop in quinolone use.
Conclusion
The CME led to modest improvements in patient care in the categories of history taking, treatment and investigations, but feedback had no additional effect. Future studies should consider an enforcement element or a more intensive feedback approach.
Journal Article
Exploring healthcare workers’ perceptions on the use of morbidity and mortality audits as an avenue for learning and care improvement in Kenyan hospitals’ newborn units
Background
In many sub-Saharan African countries, including Kenya, the use of mortality and morbidity audits in maternal and perinatal/neonatal care as an avenue for learning and improving care delivery is sub-optimal due to structural, organizational, and human barriers. While attempts to address these barriers have been reported, lots of emphasis has been paid to addressing the role of tangible inputs (e.g., availing guidelines and training staff in the success of mortality and morbidity audits), while process-related factors (i.e., the role of the people, their experiences, relationships, and motivations) remain inadequately explored. We examined the processes of neonatal audits, their potential in promoting learning from gaps in care and improving care delivery, with a deliberate focus on process-related factors that generally influence mortality and morbidity (M&M) audits.
Methods
This was an exploratory qualitative study, conducted in three hospitals, in Nairobi and Muranga counties. We employed a mix of in-depth interviews (17) and observation of 12 mortality and morbidity audit meetings. Our study participants included: nurses, doctors, trainee clinicians (i.e., junior doctors on internships), and nursing students involved in providing newborn care. These data were coded using NVivo12 employing a thematic content analysis approach.
Results
Perceived shortcomings in the conduct of M&M audits such as unclear structure was reported to have contributed to its sub-optimal nature in promoting learning. These shortcomings, in addition to hierarchy and power dynamics, poor implementation of audit recommendations, and negative experiences, (e.g., blame) also demotivated health workers from attendance and participation in audits. Despite these, positive outcomes linked to audit recommendations, such as revision of care protocols, were reported. Overall, leadership and a blame-free culture enabled positive changes and promoted learning from audit-identified modifiable factors.
Conclusion
Our findings indicate that M&M audits provide a space for meaningful discussions, which may lead to learning and improvement in care delivery processes. However, a lack of participation, lack of observed positive outcomes, and negative experiences may reduce their usefulness. An enabling environment characterized by minimized effects of hierarchy and positive use of power and a blame-free culture may promote active participation, enhancing positive relationships and interactions thus promoting team learning.
Journal Article
Preparedness, resilience and unmet needs of informal caregivers of advanced cancer patients in a Regional Mission Hospital in Kenya: Qualitative Study
Background
Cancer is the third highest cause of death in Kenya. Eighty percent of cancer cases arrive at advanced stages, when there is nothing that can be done to cure them, and palliative care is the best alternative. Although the majority of end-of-life care in Kenya is provided at home, little is known about the caregivers’ preparedness, resilience and continued unmet needs. The goal of this qualitative study was to explore caregivers’ perceived preparedness, resilience and continued unmet needs in their caregiving role to patients with advanced stages of cancer.
Methods
A purposive sampling method was used to identify and recruit twelve informal, home-based caregivers of patients with advanced cancer from Kijabe Palliative Clinic data base. Interviews were conducted in patients' homes. The data was analyzed using interpretive phenomenological analysis approach. Ethical considerations were observed. Participants were kept anonymous and confidentiality.
Results
Competing tasks, lack of preparedness in handling end-of-life care for patients in advanced stages of cancer were the main concerns. Continued unmet needs and financial stresses, and vulnerability for female caregivers all contributed to increased caregiver burden in this study. Caregivers were however determined and resilient amidst challenges that faced them, they exhibited hope against hopelessness. Some caregivers were vulnerable and faced potential for abuse following anticipated loss of their family member exacerbated psychosocial stress and needs
Conclusion
Informal caregivers had common unmet needs related to caring for their advanced cancer patients. Whilst family caregivers had huge caregiver burden, insurmountable practical challenges related to role overload and competing tasks, they remained resilient though unprepared in giving end of life care.
Recommendations
Caregivers should also be examined, prepared, and supported during clinic reviews. More research is needed on the use of telephones for caregiver follow-up, the impact of introducing caregiver-targeted screening tools on caregiver quality of life and their impact on enhancing caregiver well-being in order to prepare & support them adequately for the caregiving role.
Journal Article