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Knowledge, attitude, practice and learning needs of nursing personnel related to domestic violence against women: a facility based cross sectional survey.
International Journal of Community Medicine and Public Health. 2018 Mar; 5(3):996-1003.Background: Domestic violence against women (DVAW) is widely recognized as a public health problem. In India, health sector response to DVAW is suboptimal. Present study aimed to assess the knowledge, attitude, practice and learning needs of nursing personnel regarding women’s health issues related to domestic violence. Methods: This facility based cross sectional study was carried out among 100 nursing personnel from Public sector in Delhi, selected using stratified random sampling. Data were collected using a validated, pretested, structured self reported questionnaire with a few open ended questions. It included knowledge, attitude, practice and learning needs of nursing personnel relevant to DV. Descriptive statistics were used for data analysis using Stata 11.0 (College Station, Texas, USA). Results: Two third of nursing personnel (67%) had moderate knowledge scores and 27% had poor knowledge scores; 19% had favourable attitude scores towards DV; 57% had good practice scores; 44% reported moderate to high need for learning and majority lacked preparedness to manage DV victims. The knowledge was significantly associated with younger age, single, graduate/ Post graduates, B.Sc. Nursing degree holders, working in tertiary hospital, as staff nurse/public health nurse/sister in charge and those with lesser experience, (p<0.05). The attitude was significantly associated with younger age, single, graduate/post graduates, and those with lesser experience, (p<0.05). Conclusions: Nursing personnel had substantial gap in their knowledge, attitude and practice related to DV and a large unmet learning need highlighting the need for relevant pre service and continuing education.
A study to assess the knowledge and practice of nursing staff posted in postnatal ward about immediate care of newborn and breast feeding in selected hospital of Bhopal district, Madhya Pradesh.
International Journal of Community Medicine and Public Health. 2018 Dec; 5(12):5438-5442.Background: High rate of infancy deaths is largely attributed to very high share of neonatal deaths i.e 66% of infant deaths in 2007, in India. It can be largely attained by providing quality care to the newborn immediately after birth and Breast-feeding which is the standard way of feeding all infants. Objectives of the study were to assess the knowledge and practices of nurses regarding Immediate Care of Newborn and assess the knowledge of nurses of postnatal ward regarding Breast feeding. Methods: This was a hospital based cross-sectional study carried out in selected hospital of Bhopal district. 32 nurses involved in the immediate care of the newborn were identified. Data was collected about Immediate Care of Newborn and breast feeding. Analysis was done using MS Excel and EpiInfo-7. Results: 81.3% nurses knew how to prevent the new born from bleeding and 71.9% knew the correct dose of Vit K at birth. 78.1% put delivered baby on to mother’s abdomen, 84.4% dried and covered the baby correctly, 90.6% tied cord correctly and 96.9 weighted the baby. 75% said initiation should be done within first hour of birth. 90.6% said feeding should be done for more than 8 times a day and 87.5% believed hand washing should be done before every feed. 59.4% said Pre-lacteal feeding should not be given, 87.5% adhered to colostrum feeding. Conclusions: Nurses have knowledge about the immediate care of the newborn and breast feeding but there are some lacunas despite the continuous efforts of training. Much still needs to be done.
Journal of Pediatric Nursing. 2018 Sep 10;Add to my documents.
The impact of using nurses to perform postpartum intrauterine device insertions in Kalyani Hospital, India.
International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):33-37.In the postpartum period women are vulnerable to unintended pregnancy, which may lead to legal or illegal abortion and impact on maternal and neonatal morbidity and mortality. Although several postpartum family planning options are available, lack of access to and availability of family planning services and trained staff pose serious challenges. Peripheral centers may not have a doctor; however, they will have nursing staff that can be trained to offer family planning counselling and services. The present study demonstrates how task sharing with nurses to provide postpartum intrauterine device (PPIUD) services worked to give women a convenient and safe contraceptive method. PPIUD insertion provides women the additional advantage of leaving hospital with appropriate long-term contraception after institutional delivery, and also decreases the costs borne by patients and the government. This approach also impacts maternal and newborn health by avoiding unwanted pregnancy.
Promoting respectful maternity care in rural Tanzania: nurses' experiences of the "Health Workers for Change" program.
BMC Health Services Research. 2018 Aug 22; 18(1):658.BACKGROUND: Disrespectful and abusive care of women during their pregnancies has been shown to be a barrier for women accessing health care services for antenatal care and delivery. As part of an implementation research study to improve women's access to health care services in Rorya District, Mara, Tanzania, we conducted a pilot study training reproductive health care nurses to be more sensitive to women's needs based on the "Health Workers for Change" curriculum. METHODS: Six series of workshops were held with a total of 60 reproductive health care nurses working at the hospitals, health centres and dispensaries in the district. The participants provided comments on a survey and participated in focus groups at the conclusion of the workshop series. These qualitative data were analyzed for common themes. RESULTS: The participants appreciated the training and reflected on the poor quality of health care services they were providing, recognizing their attitudes towards their women patients were problematic. They emphasized the need for future training to include more staff and to sustain positive changes. Finally, they made several suggestions for improving women's experiences in the future. CONCLUSIONS: The qualitative findings demonstrate the success of the workshops in assisting the health care providers to become aware of their negative attitudes towards women. Future research should examine the impact of the workshops both on sustaining attitudinal changes of the providers and on the experiences of pregnant women receiving health care services.
MCN. American Journal of Maternal/Child Nursing. 2018 Jul/Aug; 43(4):213-217.BACKGROUND AND PURPOSE: Reproductive coercion involves behavior that interferes with the individual's unique ability to make decisions about their reproductive health. The concept was first recognized in 2010. Reproductive coercion is intended to maintain power and control in a relationship by someone past, present, or future wishing to be involved in an intimate or dating relationship with an adult or adolescent. Three forms of coercion have been identified: contraceptive sabotage, pregnancy pressure, and control of pregnancy outcomes. METHODS: A search for scientific literature was conducted examining studies involving reproductive coercion as well as evidence-based interventions that could be used by nurses in the clinic setting. CONCLUSIONS: Prevalence of reproductive coercion is estimated to range from 8% to 16%. There is a high association between intimate partner violence (IPV), sexually transmitted infections (STIs), and unintended pregnancy. Adolescents are at greater risk for reproductive coercion than older women. IMPLICATIONS FOR PRACTICE: There are interventions we can incorporate into our clinical practices to screen and assess women for reproductive coercion. Women experiencing reproductive coercion are at risk for unintended pregnancy, STIs, IPV, and forced pregnancy outcomes.
Maternal and child factors associated with neonatal jaundice influencing the outcome of phototherapy in Karimnagar district.
MRIMS Journal of Health Sciences. 2017 Oct-Dec; 5(4):136-140.Background: Health care settings are reported to be the most significant contexts for stigma and discrimination of HIV/AIDS in India, which may lead to severe social consequences and also hampers the treatment and diagnosis contributing to further spread. Objective: The study was planned to study the stigma against PLWHA (People living with HIV/AIDS) among in-service nurses of a private hospital. Methodology: A hospital based cross-sectional survey was conducted among all the nursing personnel, willing to participate in the study of a private hospital in south Karnataka, India. The study was conducted for a period of 3 months using a pre-tested and predesigned tool to measure HIV related stigma and discrimination in health facilities and the data collected was analyzed using SPSS 16.0 Results: About the attitudes of PLWHA, majority (68.6%) reported that, people living with HIV/AIDS do not care if they infect other people. When enquired about the perception of rights of PLWHA and the care provided to them, majority agreed that respective families has the right to know about the HIV/AIDS status (95.71%); women with HIV/AIDS status should not get pregnant if they already have children (92.86%); should be sterilized without their willingness (72.86%) and majority of them were not worried to touch PLWHA clothing and taking their temperature (p=0.014). Most (35%) of the nurses observed other Health care providers giving HIV treatment conditional on use of family planning Conclusion: High level of stigma against PLWHA exists among HCPs and such may lead to prejudicial actions accompanied by discriminatory behavior.
Utilisation of the partogram among nurses and midwives in selected health facilities in the Eastern Province of Rwanda.
Curationis. 2017 Aug 3; 40(1):e1-e9.BACKGROUND: Maternal mortality continues to be a global burden, with more than 200 million women becoming pregnant each year and a large number dying as a result of complications of pregnancy or childbirth. The World Health Organisation has recommended use of the partogram to monitor labour and delivery in order to improve healthcare and reduce maternal and foetal mortality rates. OBJECTIVE: This study described factors affecting utilisation of the partogram among nurses and midwives in selected health facilities of Rwanda. METHOD: A descriptive quantitative and cross-sectional research design was used. The population comprised 131 nurses and midwives providing obstetric care in 15 health institutions (1 hospital and 14 health centres). Data collection was through a self-administered questionnaire, and a pre-test of the data collection instrument was carried out to enhance validity and reliability. The Statistical Package for Social Sciences (version 21) was used to capture and analyse data. Ethical clearance was obtained from the University of the Western Cape (Republic of South Africa) and from the Institutional Review Board of Kigali Health Institute (Rwanda). Patricia Benner's model of nursing practice was used to guide the study. RESULTS: It was found that 36.6% of nurses and midwives did not receive any in-service training on how to manage women in labour. Despite fair knowledge of the partogram among nurses and midwives in this study, only 41.22% reported having used the partogram properly, while 58.78% reported not having done so. CONCLUSION: Nurses' and midwives' years of professional experience and training in managing pregnant women in labour were found to be predictors of the likelihood of proper use of the partogram. In-service training of obstetric caregivers in the Eastern Province of Rwanda is recommended to improve use of the partogram while managing women in labour.
NASN School Nurse. 2018 Sep; 33(5):284-287.Nationally, many adolescents remain at risk for unintended pregnancies and sexually transmitted infections. School nurses can be leaders and change agents in their schools. This article shares the journey of a school nurse in Maine, who used evidence-based data to develop support from administration and key stakeholders to successfully advocate for a needed policy change. That support and advocacy led to a new "Safer Sex" policy.
Evaluation of the clinical protocol quality for family planning services of people living with HIV/AIDS. Avaliacao da qualidade de protocolo clinico para atendimento em planejamento familiar de pessoas vivendo com HIV/AIDS.
Revista da Escola de Enfermagem da U S P. 2018; 52:e03335.OBJECTIVE: To evaluate the quality of a clinical protocol for family planning care for people living with HIV/AIDS. METHOD: An evaluative study based on the six domains of the Appraisal of Guidelines for Research & Evaluation II and on Pearson's Coefficient of Variation. RESULTS: The protocol reached between 88.8% and 100.0% quality in the domains of the Appraisal of Guidelines for Research & Evaluation II and 93.3% in the overall evaluation. The obtained Pearson's coefficient of variation was between zero and 18.6. Considering that a minimum percentage of 70.0% was adopted for the quality attributed by the evaluators, quality has been achieved for all domains of the Appraisal of Guidelines for Research & Evaluation II. As a coefficient for all domains was less than 25%, we can infer that the scores attributed by the evaluators were linear or homogeneous, meaning high agreement between them. CONCLUSION: The protocol was evaluated as a quality instrument, recommended for use by health professionals who deal with family planning for people living with HIV/AIDS.
Effect of Deploying Trained Community Based Reproductive Health Nurses (CORN) on Long-Acting Reversible Contraception (LARC) Use in Rural Ethiopia: A Cluster Randomized Community Trial.
Studies In Family Planning. 2018 Jun; 49(2):115-126.To investigate the effect of innovative means to distribute LARC on contraceptive use, we implemented a three arm, parallel groups, cluster randomized community trial design. The intervention consisted of placing trained community-based reproductive health nurses (CORN) within health centers or health posts. The nurses provided counseling to encourage women to use LARC and distributed all contraceptive methods. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where the new service providers were deployed, health post or health center. We calculated difference-in-difference (DID) estimates to assess program impacts on LARC use. After nine months of intervention, the use of LARC methods increased significantly by 72.3 percent, while the use of short acting methods declined by 19.6 percent. The proportion of women using LARC methods increased by 45.9 percent and 45.7 percent in the health post and health center based intervention arms, respectively. Compared to the control group, the DID estimates indicate that the use of LARC methods increased by 11.3 and 12.3 percentage points in the health post and health center based intervention arms. Given the low use of LARC methods in similar settings, deployment of contextually trained nurses at the grassroots level could substantially increase utilization of these methods.
Training in youth-friendly service provision improves nurses' competency level in the Great Lakes Region.
International Journal of Public Health. 2018 Jul; 63(6):753-763.OBJECTIVES: This survey investigates whether relevant training and availability of guidelines improve self-reported competencies of nurses in the provision of youth-friendly sexual and reproductive health services in South-Kivu Province in the Democratic Republic of the Congo, Burundi, and Rwanda. METHODS: A quantitative baseline survey was conducted among nurses in randomly selected health facilities. Nurses providing youth-friendly sexual and reproductive health services were asked to self-rate their competencies with regards to technical knowledge, clinical, and communication skills. In South-Kivu, Burundi, and Rwanda, 135, 131, and 99 nurses were interviewed, respectively. RESULTS: Overall differences of service and guideline availability and self-rated competencies can be observed between the three countries. In two countries, more than one in five nurses considered themselves to be only somewhat or not confident to counsel young people. Nurses from Rwanda showed the highest level of competencies followed by Burundi and South-Kivu. Lack of training in youth-friendly health services or family planning showed significant associations with reporting feeling somehow or not competent. CONCLUSIONS: The lack of training, supervision, and guidelines expressed by the nurses is of great concern. Competency-based training in youth-friendly health services is an important approach in improving nurses' competency level.
Intention to undergo HIV testing and associated factors among women in one high-HIV prevalence city.
International Journal of Nursing Practice. 2017 Jun; 23(3)OBJECTIVE: The objective of this study is to understand the rate of intention to undergo HIV testing and associated factors among women in a city with high HIV prevalence. METHODS: A cross-sectional study was conducted among 293 women HIV/AIDS patients who were newly examined with HIV infection and aged >/=18 years from September to December 2012. Multivariate logistic regression analyses were used to identify the factors associated with intention to undergo HIV testing. RESULTS: The rate of intention to undergo HIV testing was 12.3%. Nearly 90% of participants had no intention of getting HIV tested, and the main reasons were "Never thought I would be HIV-infected" (78.2%) and "I did not feel sick, and it was impossible to be HIV-infected" (19.8%). The awareness rate of HIV knowledge was 67.8%, and 34.1% had casual heterosexual partners. Those who had casual heterosexual partners or had better HIV knowledge were more likely to have intention of getting HIV tested. CONCLUSION: The rate of intention to undergo HIV testing among women is low. AIDS health education programmess and public information campaigns should be initiated to improve knowledge about HIV and the risk of HIV infection, to encourage women to take HIV testing more promptly. It is also vital to take measures to reduce stigma against AIDS patients. (c) 2017 John Wiley & Sons Australia, Ltd.
Improving the utilization of health services among high-risk pregnant women through community health nurse assistance.
Enfermeria Clinica. 2018 Feb; 28 Suppl 1:217-221.OBJECTIVE: The objective of this study was to identify the impact of implementing community health nurse assistance for high-risk pregnant women on utilization of health services. METHOD: The study was quasi experimental with a control group design. The sample included high-risk pregnant women in 10 community health centers in Indonesia who were selected by consecutive sampling. The total sample included 66 women in both the intervention and the control groups. The high-risk pregnant women in the intervention group received nurses' assistance during the third trimester and until giving birth. Before and after the intervention, the knowledge, attitudes, and behavior of the women were measured. RESULTS: The average scores for the knowledge, attitudes, and behavior of women in the intervention group increased. Differences were found in health care utilization between the two groups. All women in the intervention group received antenatal care during the third trimester more than once and were assisted by skilled health personnel during childbirth, while in the control group 10.6% of respondents were assisted by a paraji shaman (traditional birth attendant). All women in the intervention group accepted family planning, and the contraceptive choice varied. CONCLUSIONS: The assistance of community health nurses improves the knowledge, attitudes, and behavior of high-risk pregnant women and positively impacts the rate of health care utilization. Copyright (c) 2018 Elsevier Espana, S.L.U. All rights reserved.
Creative Nursing. 2018 Apr 1; 24(1):142-145.Teenage pregnancy is a significant social issue in the United States, resulting in increased levels of poverty. Most public health family planning efforts have traditionally focused on teaching teens the how-to of contraception, with little focus on teaching the why-to. During my time as a nurse practitioner in a public health department family planning clinic, I developed a method to open discussions with patients about the possibilities of a future that includes delayed childbearing. My experience with this strategy taught me that hope may indeed be the most powerful contraceptive of all.
International Nursing Review. 2016 Sep; 63(3):422-8.AIM: To describe Jordanian nurses' roles and practices in screening for intimate partner violence. BACKGROUND: Intimate partner violence is a recognized global health problem with a prevalence of 37% for the Eastern Mediterranean region. Jordanian nurses screening for intimate partner violence is as low as 10.8%. Nurses have encountered institutional and personal barriers hindering their screening practice. METHOD: A descriptive phenomenological design was used for this study. A purposive sample of 12 male and female Jordanian nurses working at a university hospital in Jordan participated. Participants were interviewed in 2014 using a semi-structured, face-to-face interview. Steps of Colaizzi's phenomenological method were used to analyse the qualitative data. FINDINGS: Four themes were derived from the data: (1) screening practices and roles for suspected IPV cases, (2) advantages for screening and disadvantages for not screening for intimate partner violence, (3) factors hindering screening practice and (4) feelings towards screening and not screening for intimate partner violence. CONCLUSION: Increasing Jordanian nurses' awareness of the need for intimate partner violence screening in this sample was needed. Professional education and training may facilitate the adoption of intimate partner violence screening practices. A key barrier to intimate partner violence screening is Jordanian nurses' personal beliefs. Overcoming these personal beliefs will necessitate a multi-faceted approach starting with schools of nursing and bridging into healthcare settings. IMPLICATION FOR NURSING AND HEALTH POLICY: Healthcare professionals including nursing and policy makers at health institutions should enforce screening policies and protocols for all receipt of care at first contact. In addition, an emphasis on modelling culturally congruent approaches to develop the trusting nurse-patient relationships and process for screening patients for intimate partner violence. (c) 2016 International Council of Nurses.
Bulletin of the World Health Organization. 2017 May 1; 95(5):353-361.OBJECTIVE: To develop a novel measure to characterize human immunodeficiency virus (HIV) programme quality at health facilities in Kenya and explore its associations with patient- and facility-level characteristics. METHODS: We developed a composite indicator to measure quality of HIV care, comprising: assessment of eligibility for antiretroviral therapy (ART); initiation of ART; and retention on ART or in care, if ineligible for ART, for 12 months. We applied the comprehensive retention indicator to routinely collected clinical data from 13 331 patients enrolled in HIV care and treatment at 63 health facilities in the Eastern and Nyanza regions of Kenya from 1 January 2014 to 31 March 2016. We explored the association between facility- and patient-level characteristics and the primary outcome: appropriate staging and management of HIV, and retention in care over 12 months. FINDINGS: Of the enrolled patients, 8404 (63%) achieved comprehensive retention 12 months after enrolment in care. In univariate analyses, patients at facilities where nurses delivered HIV treatment services (including eligibility assessment, initiation and follow up of ART) had significantly higher comprehensive retention rates at 12 months. In multivariate analyses, after adjusting for both facility- and patient-level characteristics, patients at facilities where nurses initiated ART had significantly higher comprehensive retention in care at 12 months (relative risk, RR: 1.22; 95% confidence interval, CI: 1.00-1.48). CONCLUSION: Nurse-led HIV services were significantly associated with quality of care, confirming the central role of nurses in the achievement of global health goals, and the need for further investment in nursing education, training and mentoring.
Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015.
Nursing Open. 2018 Apr; 5(2):131-138.Aim: Postpartum depression is a mood disorder that commonly affects women during the early postpartum period. The objective of this study was to analyse the association of postpartum depression with drugs (including contraceptive devices and implants) with spontaneously reported adverse events reported in the US Food and Drug Administration Adverse Event Reporting System database. Design: Retrospective study. Method: Reports of postpartum depression events between 2004-2015 were analysed with a reporting odds ratio (ROR) algorithm. The Medical Dictionary for Regulatory Activities was used to identify postpartum depression. Results: The reporting odds ratios (95% confidence intervals, CI) of levonorgestrel (an intrauterine device with progestogen), etonogestrel (a hormonal contraceptive implant), sertraline and drospirenone (an oral contraceptive) were 12.5 (8.7-18.0), 14.0 (8.5-22.8), 12.2 (6.5-23.1) and 5.4 (2.7-10.9) respectively. Among the drugs in the US Food and Drug Administration Adverse Event Reporting System database, the use of contraceptives or an intrauterine device with progestogen might convey risk for postpartum depression.
Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study.
BMC Pediatrics. 2017 Jul 11; 17(1):161.BACKGROUND: Neonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience. METHOD: Semi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14. RESULTS: Analysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience. CONCLUSIONS: Qualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam.
Ciencia and Saude Coletiva. 2017 May; 22(5):1673-1682.This article aims to estimate the prevalence and analyze the factors associated with cross-nursing. A cross-sectional study was conducted in 2013 with interviews with a representative sample of mothers of infants less than one-year-old (n' = 695) attended in nine primary health units in Rio de Janeiro, Brazil. Sociodemographic characteristics were studied; pregnancy, childbirth and primary care assistance; maternal habits and baby features. Adjusted prevalence ratios (PR) were obtained by Poisson Regression, retaining variables associated with the outcome in the final model (p = 0.05). Cross-nursing was practiced by 29.4% of the mothers. Most practitioner mothers were relatives or friends. The following variables were directly associated with cross-nursing: being an adolescent mother (PR' = 1.595), smoking (PR' = 1.396), alcohol consumption (PR' = 1.613), inappropriate baby feeding habits (PR' = 1.371) and infant's age in months (PR' = 1.066). Maternal formal employment was inversely associated with the practice (PR' = 0.579). Cross-nursing has a relevant prevalence among mothers assisted by primary health care units in Rio de Janeiro City. This issue should be addressed, especially among the most vulnerable groups, due to the association with adolescence and with unhealthy habits.
Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study.
JMIR Research Protocols. 2018 Mar 2; 7(3):e67.BACKGROUND: As part of its Family Planning 2020 commitment, the Nigerian government is aiming for a contraceptive prevalence rate of 36% by 2018, and in 2014, approved a policy to allow community health extension workers (CHEWs), in addition to doctors, nurses, and midwives, to provide contraceptive subdermal implants. There is a lack of rigorous evidence on the safety of long-acting reversible contraceptive provision, such as implants, among lower cadres of health providers. OBJECTIVE: This study aimed to compare implant provision by CHEWs versus nurses and midwives up to 14 days post insertion. METHODS: The quasi-experimental, noninferiority study will take place in public sector facilities in Kaduna and Ondo States. In each state, we will select 60 facilities, and from these, we will select a total of 30 nurses and midwives and 30 CHEWs to participate. Selected providers will be trained to provide implant services. Once trained, providers will recruit a minimum of 8125 women aged between 18 and 49 years who request and are eligible for an implant, following comprehensive family planning counseling. During implant insertion, providers will record data about the process and any adverse events, and 14 days post insertion, providers will ask 4410 clients about adverse events arising from the implant. Supervisors will observe 792 implant insertions to assess service provision quality and ask clients about their satisfaction with the procedure. We will conclude noninferiority if the CI for the difference in the proportion of adverse events between CHEWs and nurses and midwives on the day of insertion or 14 days post insertion lies to the right of -2%. RESULTS: In September and October 2015, we trained 60 CHEWs and a total of 60 nurses and midwives from 12 local government areas (LGAs) in Kaduna and 23 LGAs in Ondo. Recruitment took place between November 2015 and December 2016. Data analysis is being finalized, and results are expected in March 2018. CONCLUSIONS: The strength of this study is having a standard care (nurse and midwife provision) group with which CHEW provision can be compared. The intervention builds on existing training and supervision procedures, which increases the sustainability and scalability of CHEW implant provision. Important limitations include the lack of randomization due to nurses and midwives in Nigeria working in separate types of health care facilities compared with CHEWs, and that providers self-assess their own practices. It is unfeasible to observe all procedures independently, and observation may change practice. Although providers will be trained to conduct implant removals, the study time will be too short to reach the sample size required to make noninferiority comparisons for removals. TRIAL REGISTRATION: ClinicalTrials.gov NCT03088722; https://clinicaltrials.gov/ct2/show/NCT03088722 (Archived by WebCite at http://www.webcitation.org/6xIHImWvu).
Exposure to routine availability of immediate postpartum LARC: effect on attitudes and practices of labor and delivery and postpartum nurses.
Contraception. 2018 May; 97(5):411-414.OBJECTIVES: Nurses play an integral role in intrapartum and postpartum patient education. This exploratory study aims to assess the attitudes, knowledge, and practices of labor and delivery and postpartum nurses regarding contraception and evaluate for changes in these measures 1 year after an institutional initiative allowing routine availability of immediate postpartum long-acting reversible contraception (LARC). STUDY DESIGN: In 2014, Montefiore Medical Center began to routinely offer comprehensive immediate postpartum contraception. The initiative included education and feedback sessions for labor and delivery and postpartum nurses on contraception, including immediate postpartum initiation of LARC. Nurses completed anonymous surveys at the beginning of the initiative (n=59) and at 1 year (n=56). We compared baseline and 1 year survey results of contraceptive knowledge, attitudes and practices using chi(2) test, Fisher's Exact Test, or t test as appropriate. RESULTS: Nurses who stated they counseled patients on contraception "always" or "most of the time" increased from 27/59 (46%) to 40/56 (71%) (p=.005). The number of nurses who would recommend the intrauterine device and implant for postpartum contraception increased from 1/59 (2%) to 18/56 (32%) (p<.0001). Attitudes towards injectable contraception and breastfeeding remained negative; 27/59 nurses (46%) at baseline and 34/56 (61%) at 1 year agreed with the statement "DMPA [depot medroxyprogesterone acetate] has a negative effect on breastfeeding." CONCLUSIONS: Experience working in a location with routine access to immediate postpartum contraception is associated with increased awareness among nurses of postpartum contraceptive options, especially LARC, and increased contraceptive counseling. Concerns about the impact of hormonal contraception on breastfeeding, specifically DMPA, are persistent and prevalent. IMPLICATIONS: Labor and delivery and postpartum nurses' knowledge regarding immediate postpartum contraception, particularly LARC methods, may change with exposure to routine access to these methods. This exposure may also impact nurses' practices of providing patient counseling on what methods are appropriate for postpartum women. Copyright (c) 2018 Elsevier Inc. All rights reserved.
Understanding of emergency contraception among nursing staff in a tertiary care hospital of Andaman and Nicobar Islands, India.
Journal of Basic and Clinical Reproductive Sciences. 2017 Jan-Jun; 6(1):133-136.Context: Emergency contraception (EC) offers women a last chance to prevent pregnancy after unprotected intercourse. Nursing personnel are both service providers and health educators to the community and their understanding can influence the contraceptive behaviour. Aim: To find out the understanding of emergency contraception among nursing personnel. Settings and design: Descriptive cross-sectional study. Material and methods: A predesigned questionnaire was used to collect the responses of nurses regarding their understanding of Emergency Contraception. Statistical analysis used: Mean & Percentages. Results: Eighty (80%) of the respondents had heard about EC. Majority (88.75%) responded in favour of Levonorgestrel. Most (76.25%) opined incorrectly that EC pills are abortifacient. All the participants showed positive attitude towards EC. However, only three participants came out to be EC users. Conclusion: Nurses with a complete knowledge and positive attitude towards EC can act as effective counsellors to the public to create awareness, improve their understanding and change their attitude towards EC.
Challenges in the prevention of HIV among Thai homosexual males in the era of diversity and freedom of culture.
Australian Nursing and Midwifery Journal. 2016 Nov; 24(5):41.Undeniably, Thai society has changed dramatically, the way of life, values, beliefs and practices have shifted from what they were previously. Exposure to western culture, values and lifestyles are responsible for changes in the way of life of Thai people and their society.
Nursing Ethics. 2016 Aug; 23(5):576-86.BACKGROUND: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses' follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party - the child - have attracted limited attention. OBJECTIVE: The study explores challenges of confidentiality linked to a third party in nurse-patient relationships in a rural Tanzanian HIV/AIDS context. STUDY CONTEXT: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. METHODS: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. ETHICAL CONSIDERATIONS: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. FINDINGS AND DISCUSSION: The material indicates a delicate balance between the nurses' attempt to secure the HIV-free survival of the babies and the mothers' desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient's restricted disclosure came to light during follow-up of the HIV-positive women and the third party - the child who is at risk of HIV infection through mother's milk. World Health Organization's substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (c) The Author(s) 2015.