Mary M. Moleki

Exploring Communication Challenges Between Nurses and Mechanically Ventilated Patients in the Intensive Care Unit: A Structured Review

BACKGROUND Mechanical ventilation is a necessary procedure for patients with a range of illnesses and conditions. Mechanical ventilation affects voice production, leaving patients unable to communicate their needs with nurses and family. The communication difficulty causes distress, frustration, and anger if not attended to. AIMS This structured review sought to identify communication challenges which exist between nurses and mechanically ventilated patients in intensive care units (ICU) and hence explore possible solutions to improve these communication challenges. METHODS A electronic search of MEDLINE, CINAHL, and PsycINFO was conducted to identify relevant literature on nurse-patient communication challenges in the ICU published between January 2005 and December 2014. Studies meeting the inclusion criteria were retrieved in full, reviewed, and study quality assessed. RESULTS Six studies were identified for inclusion in the review. Analysis identified five core influences on communication in the ICU: patients consciousness level, nature of nurse-patient interactions, communication methods, staff skills and perceptions, and the intensive care physical environment. LINKING EVIDENCE TO ACTION An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes.

Community-based maternal and newborn care: A concept analysis

Background Community-based care can serve as a valuable programme in the provision of essential maternal and newborn care, specifically in communities in low-income countries. However, its application in maternal and newborn care is not clearly documented in relation to the rendering of services by skilled birth attendants. Objectives The purpose of the analysis was to clarify the meaning of the concept ‘community-based maternal and newborn care and its relationship to maternal and newborn health’. Method Walker and Avant’s and Rodgers and Knafl’s as well as Chin and Kramer’s approaches to concept analysis were followed to analyse community-based maternal and newborn care. Results The attributes of community-based care in maternal and newborn health include (1) the provision of home- and/or community-level skilled care, (2) linkages of health services and (3) community participation and mobilisation. These attributes are influenced by antecedents as well as consequences. Conclusion The provision of good maternal and newborn care to all clients is a crucial aspect in provision of maternal and newborn services. In order for low-income countries to promote maternal and newborn health, community-based care services are the best option to follow.

Individual determinants associated with utilisation of sexual and reproductive health care services for HIV and AIDS prevention by male adolescents

Background Adolescent sexual and reproductive health is one of the essential health care programmes in the world. However, adolescents still face numerous challenges in the area of sexual and reproductive health, which hinder their utilisation of available Sexual and Reproductive HealthCare Services (SRHCS). Male adolescents face further obstacles in accessing and utilising sexual reproductive health services owing to the influence of social constructions of masculinity, which has a bearing on how they view sexual and reproductive health services and their use. Objectives The aim of this study was to investigate individual determinants associated with utilisation of SRHCS for HIV and AIDS prevention by male adolescents. Method An exploratory, descriptive and contextual qualitative design was used and semi-structured interviews with 20 purposively selected male adolescents aged 18–24 years living in the South African seat of government were conducted. Data were analysed using Tesch’s approach of data analysis. Results Knowledge of existing services was described as a significant individual determinant of utilisation of SRHCS. This was linked to the quality of SRHCS and violation of human rights of male adolescents. Conclusion The study recommends the development of a strategy that will enhance and promote the utilisation of SRHCS by male adolescents.

Perspectives on Patient Safety Education in the Kenyan Preregistration Nursing Curriculum

Patient safety education is recognised as a key ingredient in the development of safety competencies in healthcare professionals. To ensure that patient safety is emphasised in the preregistration education, it is important that it be integrated explicitly in the curriculum. This study aimed at identifying explicit patient safety concepts in the Kenyan nursing curriculum and exploring the perspectives of the nursing faculty members and clinical nurses on the integration of patient safety in the curriculum. A qualitative content analysis was conducted on the relevant curriculum documents from two universities. In-depth, semi-structured interviews were conducted on a purposive sample of 13 staff members of the nursing faculty from the university and 14 clinical nurses from the hospitals where the students undergo clinical instruction. A thematic analysis was carried out on the transcribed interviews from which four themes and subthemes emerged. The curriculum content analysis did not identify any explicit patient safety content but the content was rather implicit within the curriculum as a series of statements and inferences to patient safety. The themes included curriculum issues, student characteristics, a patient safety culture, clinical education issues, and the academic-clinical relationship. To ensure training of a nurse who is competent in patient safety, the concepts must be integrated in the curriculum, the academic and clinical faculties need to be well equipped to teach and assess these concepts, the patient safety culture in clinical placement sites should be conducive to allow for learning about patient safety, and better collaboration between the academic and clinical settings for integration of patient safety in nursing education should be realised.

Analysis of Undergraduate Students’ Perception of the Educational Environment of a Medical School in Zambia Provided a Framework for Strategic Planning

Aim: To propose a strategy for improvement of undergraduate students’ learning environment based on analysis of their perceptions. Methods: Medical, Pharmacy, and Physiotherapy undergraduate students participated in the study. The study used a quantitative descriptive design, based on the Dundee Ready Educational Environment Measure (DREEM) inventory. The University of South Africa and University of Zambia Ethics Committees provided ethical approval. Using stratified random sampling, participants were drawn from the Ridgeway Campus of the University. They responded to a demographic section and the 50 DREEM items. Data analysis included descriptive statistics on demographics, total and subscales DEEM scores, and mean scores on individual items. Cronbach’s alpha and confirmatory Original Research Article Ezeala and Moleki; BJMMR, 21(5): 1-9, 2017; Article no.BJMMR.33545 2 factor analysis provided reliability and validity indices of the dataset. Specific issues derived from individual items’ scores were used to propose a strategy. Results: Total participants were 488 including 239 from Medicine, 135 from Pharmacy, and 74 from Physiotherapy. Response rate was 95.5%. Mean total score was 119.3/200. Scores within subscales of perception of learning, perception of teachers, academic self-perception, perception of atmosphere, and social self-perception were 29.87/48, 26.29/44, 20.96/32, 27.26/48, and 14.86/14, respectively. Four strategic issues emerged from six items with mean scores below 2.0/4.0: lack of adequate social support for stressed students, substandard teaching and mentoring, unpleasant accommodation, and inadequate facilities. Strategic objectives were raised and strategic options recommended from literature. Conclusion: Strategic planning in medical and health professions education should consider learners’ concerns by analysing their learning environments.

Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients

BackgroundPatients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses’ experience of a communication skills training intervention.MethodsA convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis.ResultsSix themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses.ConclusionThe findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training.

Exploring Communication Challenges Between Nurses and Mechanically Ventilated Patients in the Intensive Care Unit: A Structured Review: Communication Between Nurses and Mechanically Ventilated ICU Patients

BACKGROUND Mechanical ventilation is a necessary procedure for patients with a range of illnesses and conditions. Mechanical ventilation affects voice production, leaving patients unable to communicate their needs with nurses and family. The communication difficulty causes distress, frustration, and anger if not attended to. AIMS This structured review sought to identify communication challenges which exist between nurses and mechanically ventilated patients in intensive care units (ICU) and hence explore possible solutions to improve these communication challenges. METHODS A electronic search of MEDLINE, CINAHL, and PsycINFO was conducted to identify relevant literature on nurse-patient communication challenges in the ICU published between January 2005 and December 2014. Studies meeting the inclusion criteria were retrieved in full, reviewed, and study quality assessed. RESULTS Six studies were identified for inclusion in the review. Analysis identified five core influences on communication in the ICU: patients consciousness level, nature of nurse-patient interactions, communication methods, staff skills and perceptions, and the intensive care physical environment. LINKING EVIDENCE TO ACTION An evidence-based and multifactorial communication intervention encompassing staff skills development and training, development of relevant patient materials or devices and collaborations with relevant health professionals like speech and language therapists has the potential to improve nurse-patient communication in the ICU and hence improve patient outcomes.