Antoinette Barton-Gooden

The lived experiences of adolescents with sickle cell disease in Kingston, Jamaica.

Aim To explore the lived experiences of adolescents with sickle cell disease, in Kingston, Jamaica. Method A descriptive qualitative design was used for this research. In-depth interviews were conducted with six adolescents with sickle cell disease at a Sickle Cell Unit operated by the University of the West Indies. Interviews were audiotaped, transcribed, and thematically analyzed. Results The majority of the adolescents demonstrated a positive self-concept. They reported strong family, school, and peer support which made them feel accepted. All were actively engaged in social activities such as parties, but had challenges participating in sporting activities. Various coping strategies were utilized to address challenges of the disease including praying, watching television, and surfing the Internet. Conclusion Sickle cell disease can be very challenging for the adolescent, but with positive self-concept and increased social support, especially from family and peers, these adolescents were able to effectively cope with their condition and live productive lives.

Physical Restraint Usage at a Teaching Hospital A Pilot Study

This mixed method study examines the prevalence of restraint usage; perception of nurses and doctors about the practice and whether they were trained to apply physical restraints. The physical restraint prevalence tools were used to observe 172 adult patients and conduct 47 chart audits in the medical-surgical wards and a psychiatric unit in November 2011. Focus group discussions with nurses and doctors were conducted. Quantitative data were analyzed using the SPSS and focus group discussions thematically analyzed. The prevalence of physical restraints between the medical-surgical wards was 75%. Nurses and medical doctors were not formally trained to apply restraint, and had learnt from peer observation. They expressed sadness, guilt, and fear when restraints are used and identified that inadequate institutional support existed. Restraint usage was high, and nurses and doctors experienced moral dilemma when they perceived that lack of formal training and inadequate institutional support may contribute to patient injury.

Contraceptive usage among Jamaican women with sickle cell disease

BACKGROUND The usage of contraceptive methods in young women with sickle cell disease (SCD) and the factors affecting usage are unknown. STUDY DESIGN Young women (N=132) with SCD attending the Sickle Cell Unit were interviewed regarding their contraceptive usage. SPSS version 12 was used for data analysis. RESULTS Sixty-four (48%) of women with SCD were using a contraceptive method. The more commonly used methods were condoms (n=25, 39%) and depot medroxyprogesterone acetate (DMPA) (n=18, 28%). Of the nonusers, 52% were not sexually active. The reasons for nonusage in sexually active women included the desire to become pregnant (17), belief that they were unable to get pregnant (11) and health concerns (7). A majority had been informed about contraceptive methods by a trained professional. Sixty-seven percent agreed with at least one of the common Jamaican myths regarding contraceptive usage. CONCLUSIONS This study demonstrates that 92% of these women with SCD were using contraceptive methods or had reason not to do so. Subjects had been educated about contraceptive methods and appeared to be uninfluenced by local myths regarding contraceptive usage.

Attitudes of patients towards being cared for by male nurses in a Jamaican hospital

AIM To determine the attitudes of patients towards male nurses in a Jamaican hospital. BACKGROUND More males in nursing will help to address the nursing shortage and provide diversity in the profession. Patient attitudes towards male nurses will influence recruitment and retention. METHODS A cross-sectional study was used. Data were collected using a self-administered questionnaire and an attitudinal measuring scale. RESULTS Seventy-three patients responded (response rate 91%). Male nurses were perceived negatively by 51% of respondents. However, only 10% had a negative perception of the care they received from male nurses. More males (80%) than females (54%) had a negative attitude towards receiving an enema from a male nurse. CONCLUSIONS Patients generally had a negative attitude towards male nurses but had a positive view if they were cared for by a male nurse. These traits can be used as the basis of changing the gender balance of nurses in Jamaica.

Utility of paediatric quality of life and revised illness perception questionnaires in adolescents with sickle cell disease

ABSTRACT Quality of life (QOL) and illness perceptions are important considerations when managing adolescents with sickle cell disease (SCD). This study aims to assess the psychometric properties of the SCD-specific paediatric quality of life (PedsQL™-SCD) and the revised illness perception questionnaires (IPQ-R) in Jamaican adolescents with SCD. One hundred and fifty Jamaican adolescents (M: 74, F: 76; mean age 16.1 ± 1.9 years, range: 13–19 years) completed the IPQ-R, PedsQL™-SCD (teen and parent forms) and a knowledge questionnaire. Socio-demographic and clinical data were also collected and the latter were used to create a severity index. Instruments’ structure, feasibility, reliability and construct validity were assessed. The Cronbach’s alpha for the 24-item knowledge questionnaire was 0.85; IPQ-R domains from 0.56 to 0.79 (except ‘treatment control’: 0.34); PedsQL teen-form domains from 0.70 to 0.93 and PedsQL parent-form domains from 0.72 to 0.95. All scales and subscales had low floor effects but some teen subscales yielded high ceiling effects. The SCD-specific scale and subscales showed high sensitivity as they varied significantly by severity of illness. Factor analysis of causal items on IPQ-R yielded a three-factor structure, explaining a total variance of 52.1%. The factors could be labelled as ‘psychological’, ‘physical’ and ‘innate/behavioural risk factors’. The teen QOL scores had significant negative correlations with the severity score (r: −0.46, p-value <0.001); IPQ identity domain (r: −0.42, p-value <0.001); IPQ consequences subscale (r: −0.36, p-value <0.001); IPQ cyclical timeline subscale (r: −0.31, p-value <0.001) and IPQ emotional representation subscale (r: −0.29, p-value <0.01). The severity index also had significant correlation with the QOL parent form (r: −0.44, p-value <0.001); IPQ identity domain (r: 0.43, p-value <0.01) and IPQ consequences domain (r: 0.35, p-value <0.001). In conclusion, both the IPQ-R and PedsQL™-SCD demonstrate robust psychometric properties in adolescents with SCD. Continuing longitudinal study will provide further assessment of the instruments such as ‘responsiveness to change’.

Gender influences on the health of adolescents with sickle cell disease

ABSTRACT The current study examines gender effects on disease knowledge and quality of life in adolescents with sickle cell disease (SCD) in Jamaica. We report the baseline results on 76 girls and 74 boys with mean age (16.9 ± 1.8 vs. 16.2 ±2.0 years), recruited in a larger intervention study. Girls had higher knowledge scores (15.3 ± 4.2 vs. 13.3 ± 4.2 p=.004), poorer overall QOL scores (70.1 ± 19.6 vs. 77.2 ± 17.8 p=0.02) but similar severity scores to boys. Girls also had significantly lower scores on many QOL domain scores: Pain occurrences over the course the past month (Pain and Hurt:77.49 ± 23.3 vs. 85.37 ± 17.13); concerns about seeking health services for pain (Worry1:63.73 ± 26.21 vs. 75.33 ± 24.62); confidence in self-management & treatment effects (Treatment: 72.25 ± 23.6 vs. 80.73 ± 18.90) and SCD disclosure & empathy from others (Communication II: 47.44 ± 1.02 vs. 61.71 ± 29.41). Knowledge was positively predicted by age, higher education, greater household possessions and was higher in girls; whereas QOL was lower in girls and those with greater disease severity and higher with higher education. In conclusion, there is a significant gender differential in disease knowledge and QOL among adolescents with SCD. Interventions will need to address the lower QOL in girls and lower disease knowledge among boys.

Disease Knowledge, Illness Perceptions, and Quality of Life in Adolescents With Sickle Cell Disease: Is There a Link?

Disease knowledge, illness perceptions, and quality of life (QOL) were examined in 150 adolescents (mean age = 16.1 years, SD = 1.9; 49.3% males) with sickle cell disease (SCD). Females had higher knowledge (P = .004), lower QOL (P = .02), and perceived their illness to be more unpredictable (P = .03). Those with more severe disease perceived their illness to be unpredictable with worse outcomes. Those with higher knowledge scores perceived their illness to be chronic, made more sense of their illness, and perceived greater personal and treatment control. Final hierarchical regression model showed that secondary education as compared to primary education level (P < .001) was positively correlated whereas disease severity (P < .001), perceived unpredictability (P = .024), and negative emotions (P < .001) were negatively correlated with QOL. Health practitioners should assess adolescents’ illness perceptions and encouraging continuing schooling and addressing emotional/psychological problems could improve their QOL.

Registered Nurses’ Use of Physical Restraints on the Medical Floor in a Jamaican Hospital

Objectives: To explore registered nurses use of physical restraints on the medical floor of an acute care hospital in Kingston, Jamaica Methods: This descriptive cross-sectional study included 90 registered nurses working on the medical floor. Data collection utilized a 17-item self – administered adapted version of the Perceptions of Restraint Use Questionnaire (PRUQ). Data were analyzed using the Statistical Package for Social Sciences SPSS® version 20 for Windows®. Results: The response rate was 85.7% f (N=90). Participants were female (97%) and ages ranged between 20-29 years (60%). The majority (88%) had baccalaureate degree (88%) and 40% of this number had worked as a registered nurse for less than two years. Registered nurses reported using physical restraints to reduce the likelihood of patients either falling out of bed (4.41±0.95), breakage of sutures (4.26±0.88) or pulling out intravenous line (4.14±0.79) out of a maximum score of 5. Nurses indicated that the time of day influenced physical restraint usage with the night shift accounting for 71.1%. Confused patients were more likely to be restrained (78.9%). The majority (76.7%) of study participants were knowledgeable of the institution’s physical restraint policy but (83% reportedly received no training in its application. Conclusion: Nurses on the medical wards utilized physical restraints to ensure patient safety and facilitate treatment continuation. Patient characteristics, lack of training and institutional support were contributing factors to physical restraint usage. When institutional support is inadequate, nurses’ intention to prevent patient harm and meet professional obligation might contribute to the reliance on the use of physical restraint.