Masters of Nursing Science

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https://hdl.handle.net/20.500.11951/1044

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The Effects of Integrating a Pain Assessment Scale on the Surgical Ward Nurse’s Knowledge, Attitude, and Practice Regarding Post-Operative Pain Management in Mengo Hospital Kampala, Uganda.
(Uganda Christian University, 2023-09-08) Betty Nabiwande Musisi
Abstract Background Post operative pain remains one of the greatest concerns for patients following surgery. Pain is an unpleasant sensory and emotional experience accompanied by actual and potential tissue damage. Failure to promptly assess and manage pain may upshot into postoperative complications like hypertension, depression, lengthened hospital stays, and overall patients’ poor health outcomes. Objective The purpose of this study was to describe the effect of integrating the pain assessment scale on the nurse’s knowledge, attitude, and practice toward post-operative pain management in the surgical ward in Mengo hospital, Kampala. Methods At the surgical wards (obstetrics/gynecology & other general surgical procedures), nurses participated in a descriptive quantitative cross-sectional, quasi-experimental study. A total of 60 nurses participated in the study by applying the educational intervention of integrating the PAS into postoperative pain management using a 4-point Likert scale. The practice was observed using a checklist. Data were analyzed using SPSS version 20. A chi-square test was done, and significantly associated factors were acknowledged. Results In the pretest and posttest, the mean total knowledge scores about post-operative pain treatment were (M= 62.83, SD= 9.583), t = -59, P=0.01, respectively. The results raise concerns about the respondents' intolerable lack of understanding regarding how to manage patients' post-operative pain. Conclusion Nurses’ low level of knowledge, unacceptable attitude, and practice were acknowledged. Nursing curricula both at Under-Graduate and master’s should be undertaken to ensure relevant, appropriate information equips nurses to effectively manage pain.
A Criterion - Based Audit of Postnatal services Given to Mothers and Newborns Within 24 Hours of Birth in the General Hospital in Western Uganda
(Uganda Christian University, 2023-09-12) AGNES AGWANG
Abstract Background: Postnatal care is a key global intervention and a major safe motherhood initiative recommended for reducing maternal and neonatal mortality globally. Criterion-based audit helps measure the quality of postnatal care reliably and checks adherence to World Health Organization criteria and standards. This study assessed the quality of postnatal care services offered to mothers and their babies within 24 hours using a baseline Criterion-based audit at the general hospital. Methods: Mixed methods used on a facility Criterion-based audit with descriptive cross-sectional and explorative study design. Study population comprised of quarterly recorded and reviewed maternal postnatal files. A questionnaire and key informant interview guide were used. A systematic sampling technique was used for selecting files while key informants were selected purposively. Data was analyzed using SPSS version 20. Qualitative data was transcribed using related concepts to form themes and sub themes. Results: 248 files reviewed. Assessment of the mothers and their babies within one hour after birth almost met the WHO standards in all the parameters except after birth pains and incision site for cesarean mothers. Within 6 hours, assessments fell far below the WHO criteria and standards, including records of potentially life-threatening conditions and information shared upon discharge. No mental health information was shared upon discharge. Immediate care of the newborn almost met the WHO criteria and standards except for stimulation of the baby, use of ambu bag and mask, and use of resuscitation drugs. Six hours and subsequently the standards were not met (head circumference, temperature, bladder and bowel function, color of the eyes, cord checked and skin color), including records of potentially life-threatening conditions. Information on discharge was shared except delayed bath and continuity of prescribed treatment. Factors associated with quality of postnatal care included lack of guidelines, understaffing, inadequate sundries and equipment. Conclusion and recommendations: Assessment of the mothers and their babies after six hours of birth did not meet the WHO criteria and standards. Criterion-Based Audit of postnatal services in this study revealed that attention was given in improving the quality of postnatal care than it did before through, adopting WHO guidelines for postnatal care, improving the staffing levels and their general welfare. Criterion-based Audits can be used in other maternity departments like antenatal clinic and labour ward to assess quality of care.
Effect of an Orientation Activity on the Perception and Attitude on First Year Direct Bachelors Nursing Students towards the Nursing Profession, A Study Done in Four Universities in Central Uganda.
(Uganda Christian University, 2023-09-15) AISA NAKAWUNDE
Background and Objective: The roles that nurses play in health care are numerous but not well known to the public nor to the students who join nursing. The students instead join with various misperceptions of the profession and they have limited awareness of the different opportunities in nursing. Without any intervention to correct the misperceptions, the students’ attitude towards their chosen nursing course remains questionable and this can affect their performance in school and the quality of nurses they make after school. Orientation programs have been proven to clear misperceptions and promote a positive attitude towards nursing, but their effect has not been studied in Uganda. The purpose of this study was therefore, to determine how an orientation activity affects the perception and attitude of first year nursing students towards the Nursing profession. Method: It was a descriptive quantitative study with a pre-post interventional design (quasi experimental). It was carried out in four universities in central Uganda and 64 students participated. Pre-test data was collected, followed by a one-hour orientation presentation about nursing professionalism, roles and specialties among others in each institution. Then, Post- data was collected two weeks later using self-administered questionnaires. Data was analyzed using stata version 16, and descriptive statistics included: mean, standard deviation, and frequencies. The relationship between variables was examined using a paired T-test with a P value of < 0.05 to measure significance. Results: Students had favorable perceptions in some aspects before the presentation, for example like; the need of knowledge and skills to practice(M=2.1, SD=.9), professional autonomy(M=2.1, SD=.9), gender(M=2.1, SD=.9), nurses’ contribution to research(M=2.1, SD=.9), etc. However, their ideas about nursing were found to be limited and unfavorable in some other aspects before the presentation for example on: nurses pay (M=2.1, SD=.9), marriage (M=2.8, SD=.9), advanced roles (M=2.9, SD= .8), males make good nurses (M=3, SD=.9). Following the presentation, students became more aware of the roles and opportunities in nursing like professionalism, advanced roles, marriage and specialties. Therefore, the presentation had a significant effect on the students perception as shown by the paired T-test (Pr(|T| > |t|)= 0.033 & Pr(T > t)= 0.016 > 0.05) at 5% level. Although some aspects of attitude obtained favorable mean scores, students had an unfavorable score on their comfort in attending to the hygiene needs of others (M=2.7, SD: .9) and this was one of the lowest mean scores before and after the presentation. There was little but no change in their attitude except increment in their intention to remain in nursing following the presentation. Conclusion: These findings reveal that students have some favorable perception of nursing at the beginning of the course. However, their ideas are limited and unfavorable in some other aspects of nursing. Also, unfavorable attitude towards nursing was noted before and after the presentation in very important profession aspects. An orientation activity can improve students’ perceptions and attitude towards nursing, but more effort is needed to change the students’ attitude towards caring for the hygiene needs of others. Educators should pick interest in knowing the students’ perception at the beginning of their course and create intentional positive professional experiences to correct any misperception and influence students’ attitude towards nursing.
The Effect of Intergrating the Pain Assessment Scale to the Nurses Knowledge,Attitude,and Practice Towards Post Operative Pain Management on the Surgical Wards
(Uganda Christian University, 2023-09-19) Betty Nabiwande Musisi
Describe the Knowledge and Attitude on the Use of International Guidelines for Management of Patients with Heart Failure Among Nurses at the Uganda Heart Institute, Mulago Hospital.
(2024-03-25) Atifa Munanda
Background and aim: Heart failure is a raising public health issue globally. In Uganda HF affects more than 15 % Ugandans annually, and results to increased hospital length of stay, frequent re-hospitalizations, increase hospital costs and premature deaths among those affected. The aim of study is to describe the knowledge and attitude on the use of international guidelines for managing HF among nurses at the Uganda Heart Institute. Methods: The study employed descriptive cross-Sectional study design of quantitative approach of data collection. The research was conducted on 72 nurses who have worked for more than six months in Uganda heart institute. The questionnaire consisted of 30 questions that assessed knowledge and attitude of nurses on the use of international guidelines. The study questionnaire was conducted on the month of June 2023 to July 2023. Results: A total of 72 nurses participated in this study. Average age was 36.7 years with minimum age 27 and maximum age 58 years. 67% of the respondents were below 40 years. Overall, 46.9% of the respondents had good knowledge about management of heart failure using international guidelines. Among the 72 respondents 48(66.7%) had positive attitude towards heart failure management (M = 3.8, SD= 3.3), male had nearly equal attitude compared to female (70.0% vs. 68.7%), participants who had an experience of more than 20 years had a better attitude compared to all categories of experience. Discussions and conclusion: participants had a good knowledge compared to the results from other studies. The knowledge was associated with knowledge years of experience and some forms of specialization. The results showed good attitude which was similar to other studies. Increasing awareness on the use of international guidelines might further improve knowledge.
Effect of the Educational Intervention on the Attitude and Practice of Finalist Student Nurses Towards the Care of the Hospitalised Elderly in Uganda
(2024-04-09) Margaret A. Wandabwa
Background to the study: Ugandan hospitals like most countries worldwide have a challenge with caring for elderly patients yet elderly population is increasing. Most of the patients admitted to hospitals are the elderly, (65 years and above) and majority are admitted with chronic conditions and are at high risk for functional decline (Brauwer, Corrette, Boland, Verschuren, & Hoore, 2017). Seventeen percent of those admitted while independently mobile end up either requiring assistance to walk on discharge or with detrimental effects of hospitalization (Inderpal, 2016). Many of these patients are discharged with activities of daily living function worse than the baseline function indicating lack of attendance to activities of daily living (Edemekong, Bomgaars, Sukumaran, & Levy, 2020). Nurses are reported to have negative attitude towards care of the elderly and therefore not correctly providing care to this category of patients. Objectives: The study aimed at determining the effect of the educational intervention on the attitude and practice of the finalist student nurses towards care of the hospitalised elderly in Uganda and compared their attitude and practice towards the care of the elderly with the basic information. Methodology A quansi experimental design, using pretest and posttest single group method was used to determine the attitude and practice of the finalist student nurses towards care of the elderly in relation to activities of daily living. A sample size of seventy participants was selected through simple random sampling. The intervention involved training the finalist student nurses in the use of the Katz tool for assessing activities of daily living. Quantitative data was collected using self-administered questionnaires before and after the intervention. Data was analyzed in SPSS package Version 26.0 at both descriptive and inferential levels. Results All the selected participants participated. They had some information on the care of the elderly 42 (60%) and most of them received it from the clinical area. All had ever nursed elderly patients. The attitude towards care of the elderly in relation to activities of daily living improved from negative to positive for most participants. They were positive that it was vital to correctly assess the patient’s ADLS to determine the functional status and identify areas for intervention. They appreciated the Katz tool as a useful tool for the assessment. After the intervention there was a significant change in the attitude towards the care of the elderly from 2.37 to 5.11 with p <0.001. They strongly agreed that nurses must have positive attitude to be able to provide correct care to these patients. They appreciated the Katz tool as a useful tool for assessing the pts ADLS. Conclusions and recommendations The study results revealed that care of the elderly is a very important area of nursing care and that it requires positive attitude and skills for quality of care. The participants had some information on the care of the elderly which most of them acquired from the clinical area. They realised the importance of positive attitude towards care of the elderly and that negative attitude affects care provision and patient recovery. The study recommends that nurse leaders and policymakers address care of the elderly as a specialty and to formalize training of nurses in the care of the elderly. They should advocate training of care providers emphasizing on positive attitude for them to be able to provide quality care to elderly. They should device effective ways of providing quality care like developing tools that can guide care providers to identify areas of care.
Effect of Clinical Coaching on the Health Workers’ Knowledge, Attitudes, and Practice Towards the Use of the Patient Health Questionnare-9 Tool in HIV Care at Atiak HCIV in Amuru District, Northern Uganda
(2024-04-10) Douglas Tonny Otim
Abstract Background: Worldwide depression is a concern, especially in people living with HIV. In low- and middle-income countries, its identification continues to be difficult in lower-level healthcare facilities. Specific assessment tools for depression such as Patient Health Questionnare-9 (PHQ-9) are accessible tools that can be implemented to support and improve detection in clinical settings. Health workers in lower-level facilities are not trained to use the PHQ-9 tool, and yet they are in a better position to screen and improve depression detection. Addressing healthcare workers' knowledge, attitudes, and practices using a clinical coaching strategy can increase the efficacy of the PHQ-9 tool. This study aimed to analyze the effect of clinical coaching on the knowledge, attitude, and practices of health workers towards the use of the PHQ-9 assessment tool in an HCIV in Northern Uganda. Method: A one-group pretest-posttest cross-sectional study that employed consecutive sampling was used among 34 health workers. A 5-hour clinical coaching interventions were implemented, and a structured self-administered questionnaire was used to collect data pre- and post-interventions. Descriptive statistics and the significance of the observed difference were assessed with SPSS version 22. Result: There was a significant difference before (M=70.8, SD=3.3) and after (M=90.6, SD=2.6) the coaching intervention on knowledge, t(33) =11.4, p= <0.001, a significant improvement in the scores for before (M= 3.32, SD=0.42) and after (M=3.58, SD=0.31) clinical coaching intervention in attitude; t(9) = -4.77, p = 0.001, and a significant improvement in the optimal practice scores from the baseline (58.8%) and after clinical coaching intervention (85.3%), p = 0.023. Conclusion: Generally there was a noticeable improvement in the knowledge, attitude, and practices of health workers regarding the use of the PHQ-9 tool after clinical coaching intervention. Keywords: Knowledge, attitude, practices, clinical coaching, PHQ-9, and depression screening.
Effect of an Education Intervention Based on Utilization of an Individualized Rapid Assessment Tool on Knowledge, Attitude and Practice of Healthcare workers Regarding Medical Waste Management: A Quasi-Experimental Study at Selected Health Center III’s in Mukono District.
(Uganda Christian University, 2024-04-30) Irene Nakamatte
Background/Purpose: At least 5 million people including nurses, doctors, and laboratory workers are diagnosed with hepatitis and human immune virus, the vast majority of these occurring in low-income countries. The spread of these infections to healthcare workers can be prevented through proper medical waste management such as segregation of medical waste and disposal in color-coded bins. This study determined the effect of an education intervention based on the utilization of an Individualized Rapid Assessment Tool (IRAT) on the knowledge, attitude and practice of healthcare workers regarding medical waste management at selected Health Center III’s in Mukono district. The study was guided by the Health Belief Model. Methodology: A quasi experimental study design with quantitative items was used. A total of 36 healthcare workers participated in the study; these were selected by consecutive sampling approach. Results: Utilizing the IRAT significantly improved the healthcare workers’ knowledge (t= 8.40, P=.001), attitude (t (20) = 7.422, P=.001) and practice (t (5) = 7.9, P=.001) of medical waste management. Conclusions: An education intervention based on utilization of IRAT is highly effective in improving the knowledge, attitude and practice of healthcare workers regarding medical waste management. Recommendations: Health facility leaders should organize regular trainings using the IRAT aiming at improving healthcare workers knowledge, attitude and practice. Key terms: Individualized rapid assessment tool, healthcare workers, knowledge of medical waste management, attitude on medical waste management, practice of medical waste management.
Effect of Implementing Chemotherapy Administration SOPs on Nurse’s Knowledge and Attitude at Uganda Cancer Institute
(Uganda Christian University, 2024-05-08) Misk Kemigisha
Background/Purpose: The worldwide increase in cancer cases has led to an escalated use of chemotherapy treatment. Administering chemotherapy is a complex and high-risk process that requires a multidisciplinary approach and a high level of competency. At the study unit, nurses lack specialized training in oncology and typically learn on the job, with no structured training or monitoring of the use of standard operating procedures (SOPs) for chemotherapy administration (CA). Therefore, their competency in administering chemotherapy was currently unknown. This study aimed at assessing the impact of implementing chemotherapy administration SOPs on nurses’ knowledge and attitude towards safe chemotherapy administration. Methods: A single group pretest-posttest quasi experimental design was conducted to assess the effectiveness of implementing chemotherapy administration standard operating procedures (SOPs) on nurses' knowledge and attitude. A semi-structured questionnaire containing demographic data and questions about nurse's knowledge and attitude of chemotherapy administration SOPs was used at pre and posttest implementation. Participants were chosen by convenience. Knowledge questions were scored as one for correct answers and zero for incorrect ones, while attitude questions were rated on a 5-point Likert scale. Results: The results indicated that most participants understood the use of personal protective equipment (PPE) in handling of antineoplastic drugs (ANPDs) (98.6%) and the adverse effects of ANPDs exposure (94.4%). Although 80.6% of participants observed safety precautions, 48.6% did not. Most participants did not engage in conversations with patients before chemotherapy administration to assess their understanding. While reasonable steps were taken to minimize hazardous exposure, 43.1% of participants mentioned work overload. The participants' attitude toward paying attention to precautionary measures did not change significantly after training, with time constraints being cited as a reason for the lack of attitude change. Recommendation: The study recommended that the Uganda Cancer Institute and the Ministry of Health should develop institutionalized chemotherapy administration guidelines and support the implementation of educational training programs for nurses. It also suggested the establishment of an orientation program for newly employed nurses and in-service refresher courses for staff in chemotherapy administration safety. Additionally, the study recommended further research to assess nurses' chemotherapy administration practices.
Factors Associated With Physical Activity Participation Among Students of Uganda Christian University, Mukono
(Uganda Christian University, 2024-05-30) Edson Monday
Background: Physical activity is integral to the overall health and well-being of university students. Understanding the factors that influence their participation in physical activity is crucial for fostering a healthy and active student community. This study aims to identify facilitators and barriers to engaging in physical activity among students at Uganda Christian University (UCU). Methods: A descriptive cross-sectional research design, employing a quantitative research approach, was utilized to collect data through questionnaires. The study involved 207 respondents, students at UCU, selected through consecutive sampling. The questionnaires were designed to capture perceptions of preventive health benefits, venue accessibility, and safety, social advantages, as well as barriers like time constraints, fatigue, and inconvenient schedules for exercise facilities. Results: Key facilitators for physical activity at UCU include students' perceptions of preventive health benefits, accessibility and safety of venues, and social advantages associated with physical engagement 94.7% (Mean = 3.44; SD = 0.643. Conversely, identified barriers encompass time constraints, fatigue, and inconvenient schedules for exercise facilities. Discussion: The findings suggest that students at UCU are motivated to engage in physical activity when they perceive preventive health benefits, accessible and safe venues, and social advantages. However, challenges arise due to time constraints, fatigue, and inconvenient schedules for exercise facilities. Comparisons with existing literature and discussions on the practical implications of these findings are essential for a comprehensive understanding. Conclusion: To address these challenges, there is a pressing need to implement flexible exercise facility scheduling, expand and maintain exercise facilities, and foster peer-led activity groups. Recognizing these facilitators and barriers provides a foundation for tailored interventions to promote physical activity among students at UCU. Keywords: Physical activity, preventive health benefits, time constraints, students, Uganda Christian University.
The Effect of Education Package on Caregivers' Knowledge, and Practices Towards Caring for Adolescents Living With HIV: A Case Study of a Health Center IV in Mid-western Uganda
(Uganda Christian University, 2024-10-04) Deus Mugaga
Background: Human Immunodeficiency Virus (HIV) is the virus that causes AIDS, which is the most advanced stage of HIV infection. Globally, an estimated 37.9 million people are currently living with HIV, of these, 36.2 million were adults and 1.7 million were adolescents, about 1.5 million (89 %) live in sub-Saharan Africa. In Uganda, an estimated 1.4 million people were living with HIV in 2018, about 9% were adolescents aged, and an estimated 1.6% Ugandans died of AIDS-related illnesses. Adolescents on ART need support in order to ensure the high level of adherence is achieved to maximize the benefits of the therapy. The support and guidance from their caregivers are crucial in improving their adherence on ART. However, caregivers‟ intent support to adolescents is a major challenge due to lack of adequate knowledge about the ever-changing drugs used in the treatment of HIV. This study therefore, was to find out the effect of an interventional education package to the caregivers on their knowledge about ART and their practices towards ART adherence among adolescents. Methods: A sample of 98 caregivers were adopted for the study. Data collection was done before and after the education, intervention package slated for one month and this was done by use of an administered questionnaire that was translated into Runyoro. The data was finally analysed using descriptive and inferential statistics with the help of the statistical package for Social Sciences (SPSS). Results: Analysis revealed that active drug level influenced adherence to ART among adolescents, caregivers' supportive of the adolescent on ART improved their adherence, and knowledge affects the way the caregiver enforces the dosages towards the adolescents, and enables them to plan effectively and empowers their ability to supervise their adolescents on ART. Conclusion: Knowledge is a very fundamental factor among caregivers, education package enriches the caregivers' commitment to practices towards enhancing adolescent's adherence on ART, and the caregivers‟ knowledge has a significant relationship with their commitment when it comes to caring for adolescents on ART.

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