Petra Brysiewicz

The Lived Experience of Genocide Rape Survivors in Rwanda

PURPOSEnThe purpose of this study was to explore the lived experience of women who were raped during the 1994 genocide in Rwanda.nnnMETHODSnA phenomenological approach was used and this study was carried out in Rwanda in three different locations. The 7 participants took part in three semi-structured, individual interviews which were audiotaped.nnnRESULTSnParticipants reported many themes unique to Rwandan women survivors of genocide. These themes included violation by perceived inferiors, loss of dignity and respect, loss of identity, social isolation, loss of hope for the future (i.e., HIV/AIDS), the ongoing torture of rape babies, and developing a sense of community.nnnCONCLUSIONSnRwandan women survivors of the 1994 genocide have lived through unimaginable suffering. Limited information is available regarding the experiences of these rape survivors and this information could create awareness and some understanding of what these women endured.nnnCLINICAL RELEVANCEnThis study can help nurses to understand the sequelae of war and rape and thus have needed information which can be used to offer assistance to women in these circumstances.

The Consequence of Caring Too Much: Compassion Fatigue and the Trauma Nurse

Working in the trauma unit can be considered “chaotic and hectic.” The continuous influx of patients, overcrowding, resource constraints, high acuity of patients, common holdups in waiting for inpatient beds, bearing the brunt of patients’ and visitors’ anxieties and concerns, coupled with few skilled nursing staff increase the stresses placed on a nurse. The trauma unit nurse must be able to recognize and prioritize emergencies, perform rapid assessments, initiate treatments, and competently execute a variety of resuscitation techniques. In addition, the nurse is exposed to numerous traumatic events and witnesses the suffering of others, often on a daily basis. This increased stress can cause “psychological and emotional problems for the trauma unit nurse” which can ultimately lead to compassion fatigue. An added factor is, in the trauma unit, the nurse frequently does not take time for self-care, instead putting their patients’ needs before their own and increasing their vulnerability to emotional distress and subsequent compassion fatigue.

Emergency nursing in South Africa.

The role of the emergency nurse in South Africa is a challenging one due to a variety of reasons. This article describes the healthcare system of South Africa with particular attention to the emergency medical system as well as the reason why most emergency clients present to the emergency departments. The actual experience of working as an emergency nurse in South Africa is highlighted.

A Description of the Forensic Nursing Role in Emergency Departments in Durban, South Africa

INTRODUCTIONnSouth Africa has unenviable rates of violent crime and low rates of conviction and prosecution. Contributing to this is the poor collection of medical evidence by health workers.nnnMETHODSnA quantitative exploratory descriptive survey using a questionnaire was carried out with nurses, either registered or enrolled with the South African Nursing Council, who had a minimum of 6 months experience in the Emergency Department. The Emergency Departments of two provincial (state) and two private hospitals, as well as two comprehensive care clinics (state) were used.nnnRESULTSnThe findings revealed that most of the forensic tasks to be performed by the Emergency Department nurses were rated as never or seldom done and this was due to a lack of training and knowledge in the field of forensic nursing. The respondents did however indicate that forensic nursing was very important to their daily activities in the Emergency Departments.nnnDISCUSSIONnEmergency nurses in South Africa are facing new challenges in acquiring the skills to effectively care for crime victims. It is becoming extremely important for these nurses to correctly manage the forensic evidence, as failure to do so can have far reaching legal consequences.

Injury surveillance in a central hospital in Kigali, Rwanda.

INTRODUCTIONnThis paper will describe the injury profile of patients admitted over a 9-month period to the emergency department of the Central Hospital (CHUK) in Kigali, Rwanda.nnnMETHODSnA quantitative, retrospective descriptive survey was conducted with the purpose of identifying the injury profile of the patients admitted to CHUK during the first 9 months of 2005. Haddons Matrix was the conceptual framework used to guide this study. After consultation with the research supervisor, the doctors and nurses working in the emergency department at CHUK, the researcher developed a checklist which was used to collect information from the selected patients files. This checklist comprised of 4 sections: demographic data, circumstance of injury, category of injury and outcome, and trauma score calculation.nnnRESULTSnThis study found a high proportion of injury, especially in the urban setting that involved young males aged between 16-30 years. Blunt injury was the most common mechanism of injury, with the leading causes of injury being road traffic collisions. This study also highlighted the limitations in the record keeping of the patients admitted to the emergency department.nnnDISCUSSIONnThe researcher carried out this study in an attempt to compile an injury profile of patients admitted to CHUK ED in Kigali, Rwanda. The results illustrated that road traffic collisions are the major cause of injuries and young males are the most typical victim. This study also highlighted the limitations in the record keeping of the patients admitted to the emergency department and suggest important implications for the ED nurses working in Rwanda.

Emergency nursing experience in Malawi

Malawi has a population of 13 million with the vast majority of its people living in the rural areas. Government health facilities are the main providers of health care services in the country with a few private facilities charging for their services. Emergency medical care in Malawi is offered in all health care delivery areas, however the quality offered and its accessibility is compromised especially in rural areas. Every health care professional receives a component of emergency training during their generic programme although there are very limited specialized emergency professionals. Working as a nurse in the emergency department in Malawi is a challenging experience due to these various difficulties.

Violent death and the South African emergency nurse

A violent death is the sudden and unexpected loss of life due to a violent means, and in South Africa, violent death due to interpersonal violence appears to be a huge problem with the majority of these clients being young adults in the prime of their life (Trauma Rev. 5(1) (1997) 1).The objective of the study was to explore the influence that the confrontation of violent death of their clients had on the emergency nurses daily personal and professional lives. The participants described a number of physical and emotional ways in which their lives had been affected.

A model for dealing with sudden death.

The purpose of this study was to attempt to provide health professionals working in emergency departments with guidelines to use in order to ensure the therapeutic management of the dead or dying client, the suddenly bereaved families, and fellow colleagues (health professionals). A 4-year action research study was undertaken involving semistructured interviews with health professionals (doctors and nurses) working in selected Level I emergency departments, suddenly bereaved families belonging to a local bereavement support group, and mortuary staff in KwaZulu-Natal, South Africa. Further analysis of the categories and themes that emerged from the interviews informed the development of the Dealing with Sudden Death Model, a family information pamphlet, a preparation checklist, and an incident evaluation checklist.

Case review: Ejection from a motor vehicle

At 08:20 h on a Friday morning, a 51-year-old male, of Asian descent, accompanied by pre-hospital staff, was brought into a level-one Emergency Department in KwaZulu-Natal, South Africa. The patient had been travelling on his way to work when his car skidded and had a frontal impact collision. The unrestrained driver, of a sedan type car, was ejected from his vehicle. When the pre-hospital services arrived on the scene, they found the patient lying in the road. The patient sustained an avulsion injury to the left frontal region of his skull and possible cervical spine injuries. He temporarily lost consciousness at the scene of the collision for approximately 20 min. Medical history revealed that the patient was a known diabetic on oral hypoglycaemics. As the man had lost consciousness at the scene, and was experiencing retro-grade amnesia on regaining consciousness, he was not able to furnish details on the injury occurrence. In addition to this, bystanders provided very little information regarding the collision, and there had been no other person in the vehicle with the patient. On reconstruction of the events that had possibly transpired, the man had been travelling northbound on a busy national road on his way to work. Due to the force involved in his injury, and the subsequent ejection from his vehicle, he may have been travelling over the speed limit (120 km/h or 75 miles/h). The man slammed on the brakes, possibly due to traffic congestion at that time of the morning, or to avoid hitting an object in the road, and his wheels locked. As it had been raining heavily for a few days, the road was saturated with pools of water, resulting in the car ‘‘aquaplaning’’ and skidding, still at a considerable rate, until the car impacted with another vehicle. On impact with the other vehicle (head-on frontal impact), the driver was ejected through the windscreen out of his vehicle, with his head as the lead point forming a ‘‘human missile.’’ As the man had been unrestrained, his left frontal region impacted with the windscreen, shattering the windscreen completely and resulting in an open complex depressed fracture of the left frontal region, and a degloving injury to his scalp and face. On admission to the Emergency Department the patient was fully assessed, with vital signs appearing normal, and his Glasgow Coma Scale was recorded at 15/15 with pupils equal and reacting to light. He had a pressure bandage to his head and on close inspection, once the dressings had been removed, the pre-hospital staff ascertained that moderate blood loss had occurred and had been arrested. The patient had sustained an open complex depressed skull fracture to the left frontal region of approximately 10 cm in length, and approximately 10–15 cm in width. The skull had been completely avulsed, with dural laceration and pneumocephalus. A degloving injury was noted from the skull fracture extending down to the upper orbital ring and to the left zygomatic arch. He had also sustained a laceration to his right arm, which needed suturing and debridement in theatre. Accident and Emergency Nursing (2003) 11, 18–21 a 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0965-2302(02)00141-8

Integrative Review of Facility Interventions to Manage Compassion Fatigue in Oncology Nurses

PROBLEM IDENTIFICATIONnOncology nurses are regularly exposed to high-stress situations that may lead to compassion fatigue, and many institutions have implemented interventions to reduce burnout in nurses, but knowledge on the feasiblity, effectiveness, and nurses experience of interventions is lacking.u2029.nnnLITERATURE SEARCHnElectronic search of literature published from 1992-2015 was performed to evaluate in-facility interventions to manage compassion fatigue in oncology nurses. Databases used included CINAHL®, PubMed, Web of Science, Google Scholar, and PsycINFO®. u2029.nnnDATA EVALUATIONnThe goal was to evaluate the effectiveness, feasibility, and nurses experience of interventions to manage compassion fatigue. The study designs, methods, and limitations were independently screened by the authors. u2029.nnnSYNTHESISnOf 164 studies, 31 met eligibility criteria. u2029.nnnCONCLUSIONSnThe majority of the studies were conducted in Western countries, which suggests the need for additional research in other settings to determine effective interventions that address compassion fatigue and stress cross-culturally. Quantitative and qualitative studies failed to gain high scores in terms of quality. Limited conclusions can be drawn from small studies that report on outcomes with many confounding variables, such as turnover rate or general health of nurses, from a single institution. u2029.nnnIMPLICATIONS FOR RESEARCHnLack of empirical precision in evaluating the effectiveness, feasibility, and nurses experiences of interventions indicates a need for future, more rigorously designed experimental studies. Because of the global increase in the number of patients being diagnosed and living with cancer, oncology nurses should be able to recognize and manage compassion fatigue.