Advances in Nursing The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Stigma towards People Living on HIV/AIDS and Associated Factors among Nurses’ Working in Amhara Region Referral Hospitals, Northwest Ethiopia: A Cross-Sectional Study Sun, 19 Mar 2017 00:00:00 +0000 Introduction. HIV/AIDS-related stigma occurs in the world towards people living with HIV/AIDS in a different form. Stigma among nurses in health care setting is one of the main challenges towards the prevention and management of HIV/AIDS in developing countries. It is one of the main reasons keeping patients from seeking health care service. Therefore assessing the magnitude of stigma and associated factors towards people living on HIV/AIDS among nurses is of paramount importance for the quality of nursing care as well as service utilization. Methods. An institutional based cross-sectional study was conducted in March 2013. Pretested and structured questionnaire via self-administration was used in the tool of HIV/AIDS Stigma Instrument-Nurse (HASI-N). Data were entered using EPI info version 3.5.3 and transferred to SPSS version 20 for further analysis. Descriptive statistics were conducted to summarize the sample characteristics. A backward stepwise logistic regression model was fitted and adjusted odds ratio with 95% confidence interval was calculated to identify associated factors. Results. A total of 386 nurses participated yielding a response rate of 97.2%. Nearly two-thirds (64.5%) of them have shown stigma towards people living with HIV/AIDS in the health institution. Qualification level of diploma or certificate, lack of training, experiences of <06 years, low HIV patient caseload seen in the last six months, and the absence of guidelines/protocols about HIV/AIDS in their health institution were associated factors for stigma. Conclusions. The findings of this research showed high magnitude of stigma towards people living with HIV/AIDS among nurses. For stigma to be decreased nurses need to update their knowledge through training and experience sharing with senior staff. And it is crucial that the Ethiopian Ministry of Health, Amhara Regional Health Bureau, and the two hospitals work for decreasing stigma by creating educational development, ensuring accessibility of guidelines about HIV/AIDS, and providing access to training. Mohammed Hassen Salih, Gizachew Assefa Tessema, Endeshaw Admassu Cherkos, Abebaw Jember Ferede, and Degefaye Zelalem Anlay Copyright © 2017 Mohammed Hassen Salih et al. All rights reserved. Adult Patients’ Satisfaction with Inpatient Nursing Care and Associated Factors in an Ethiopian Referral Hospital, Northeast, Ethiopia Tue, 07 Jun 2016 08:50:55 +0000 Introduction. Patient satisfaction with nursing care is considered as an important factor in explaining patients’ perceptions of service quality. Care assessed to be high quality according to clinical, economic, or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Objective. The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in Dessie Referral Hospital, Northeast Ethiopia. Methods. Institution based quantitative cross-sectional study was conducted among patients admitted in medical, surgical, orthopedics, gynecology, and ophthalmology wards of the hospital from March 24 to April 30, 2013. All admitted patients who stayed in the study wards for at least two days during the data collection time were interviewed. Newcastle Satisfaction with Nursing Scale questionnaire was used to collect the data and was analyzed using SPSS version 20. Odds ratios with their 95% confidence intervals and values in a multiple logistic regression were used to identify factors associated with patient satisfaction with nursing care. Result. The overall patient satisfaction was 52.5%. Respondents’ sex, age, admission ward, self-reported health status, and class of admission were the variables significantly associated with patient satisfaction with nursing care. Conclusion and Recommendation. The rate of patient satisfaction with nursing care was found to be low in this study. Being female, younger age group (18–30 years), good self-reported current health status, being admitted in ophthalmology ward, and first class of admission were significantly associated with better patient satisfaction with nursing care. In-service training programs for nurses, with special emphasis on communication skills, are recommended. Kokeb Haile Eyasu, Akilew Awoke Adane, Fisseha Zewdu Amdie, Tesfaye Bisenebit Getahun, and Mulunesh Abuhay Biwota Copyright © 2016 Kokeb Haile Eyasu et al. All rights reserved. Perceived Clinical Competence among Undergraduate Nursing Students in the University of Gondar and Bahir Dar University, Northwest Ethiopia: A Cross-Sectional Institution Based Study Tue, 24 May 2016 05:54:23 +0000 Introduction. To produce competent, confident, critical thinker with the ability to lead, to question, and to be questioned is needed in nursing education. This study aimed to assess perceived clinical competence among nursing students. Methods. This cross-sectional study was conducted in two nursing schools in Ethiopia. Data were collected using pretested, semistructured questionnaire. Clinical competence was measured by Short Nursing Competence Questionnaires. Binary logistic regression model was fitted to identify associated factors. An adjusted odds ratio with 95% confidence interval was computed. Results. Overall, 48.7 % of the participants perceived themselves as clinically competent. Social support [moderate (AOR = 5.87, CI: 1.346, 9.586), high (AOR = 6.27, CI: 1.741, 7.608)], type of institution [(AOR = 3.20, CI: 1.331, 7.694)], year of study [(AOR = 1.89 (4.760, 18.510)], attending theoretical classes [(AOR = 0.83 CI: 0.017, 0.412)], and clinical environment [poor (AOR = 5.65, CI: 1.837, 13.453), fair (AOR = 7.31, CI: 2.790, 15.356), good (AOR = 9.31, CI: 3.260, 19.967)] were associated with clinical competence. Conclusion. More than half of the study participants perceived themselves as incompetent. Social support, type of institution, year of study, attending theory classes, and clinical environment were associated with perceived clinical competence. Authors suggested that nursing students attend their theoretical class and utilize the available resource. Berhanu Boru Bifftu, Berihun Assefa Dachew, Bewket Tadesse Tiruneh, Mengistu Mekonnen Kelkay, and Netsanet Habte Bayu Copyright © 2016 Berhanu Boru Bifftu et al. All rights reserved. Preterm Birth and Associated Factors among Mothers Who Gave Birth in Gondar Town Health Institutions Wed, 11 May 2016 06:52:51 +0000 Background. The birth of a preterm infant has a greater risk of developmental disabilities, health, and growth problems than infants born at full term. The main aim of this study was to assess the prevalence and associated factors of preterm birth Northwest Ethiopia, Gondar town health institutions. Methods. Facility based cross section study was undertaken. Systematic sampling was used to select 540 study participants. Both bivariate and multiple logistic regression were fitted. Variables with value < 0.05 and 95% CI in multivariate were considered statistically significant. Result. This study showed that 4.4% from the total 540 mothers gave a preterm birth. The covariates of pregnancy induced hypertension (AOR 5.36 (95% CI 1.8, 15.96)) and being HIV positive (AOR 3.4 (95% CI 1.25, 9.2)) were found to be significantly associated with preterm birth. Conclusion. The main factors for preterm birth were pregnancy induced hypertension and being HIV positive. Therefore, still efforts have to be made to decrease the prevalence of preterm birth and for timely management of pregnancy induced hypertension and identifying pregnant women at the risk of preterm delivery like HIV positive women and proving quality of healthcare may decrease the rate of preterm birth and its consequences. Kahsay Gebreslasie Copyright © 2016 Kahsay Gebreslasie. All rights reserved. Preceptorship versus Clinical Teaching Partnership: Literature Review and Recommendations for Implementation in Ghana Mon, 11 Apr 2016 14:01:41 +0000 Clinical education is an essential component of the education of nursing students. However clinical nursing education in Ghana is currently facing challenges of poor working relations between hospitals and health training institutions, inadequate preceptor preparations, and inadequate faculty supervisions. Although the dominant clinical education model used in Ghana is the preceptorship model, health service and education industries are faced with challenges of lack of qualified staff, inadequately prepared preceptors, and inadequate supervision from faculty. These challenges undermine the effectiveness of the clinical learning environment and the use of the preceptorship model. The purpose of this paper was to review preceptorship and clinical teaching partnership (CTP) and make recommendations for improving clinical nursing education in Ghana. A literature review was undertaken through a search of databases that included Google Scholar, EBSCOhost, CINAHL, and HINARI. A literature review identified advantages for using clinical teaching partnership (CTP) in clinical nursing education in Ghana. Recommendations were made for the use of CTP in Ghana. Confidence Alorse Atakro and Janet Gross Copyright © 2016 Confidence Alorse Atakro and Janet Gross. All rights reserved. Adherence and Associated Factors towards Antidiabetic Medication among Type II Diabetic Patients on Follow-Up at University of Gondar Hospital, Northwest Ethiopia Sun, 17 Jan 2016 16:36:10 +0000 Background. The prevalence of diabetes mellitus (DM) is rising worldwide and is more in the developing countries which unfortunately are already suffering from communicable diseases. The aim of this study was to assess adherence and associated factors towards antidiabetic medication among type II diabetic patients in University of Gondar Hospital, Diabetic Clinic, Gondar, Northwest Ethiopia. Methods. Institutional based cross-sectional study was conducted. Systematic sampling technique was used. Morisky Medication Adherence Scale (MMAS) scores were used for labeling patients as adherent or nonadherent. Data were entered and analyzed using SPSS version 20. To see the association of variables logistic regression with OR and 95% CI was done. Results. A total of 288 study participants were interviewed with response rate of 100%. The level of adherence was found to be 85.1%. Factors found to be significantly associated with antidiabetic medication adherence were level of education (AOR = 14.27, 95% CI = 3.0, 67.82), duration of diabetes (AOR = 6.10, 95% CI = 2.03, 18.34), and knowledge about DM and its medications (AOR = 28.05, 95% CI = 8.96, 87.8). Conclusions and Recommendations. Large proportion of respondents in this study were found to be adherent to their antidiabetic medications. Level of education, duration of diabetes, and knowledge about DM and its medication were significantly associated with antidiabetic medication adherence of patients. Health education including adherence counseling to create awareness towards DM and its medications is mandatory. Mastewal Abebaw, Anteneh Messele, Mignote Hailu, and Fisseha Zewdu Copyright © 2016 Mastewal Abebaw et al. All rights reserved. Is There Significant Difference between Digital and Glass Mercury Thermometer? Mon, 04 Jan 2016 08:20:46 +0000 Background. Children’s decisions concerning investigation and treatment may be based on the results of temperature alone. Although the accuracy of axillary temperature measurement is affected by a number of factors, device dwell time and device type are common. Objective. Compare body temperature between glass mercury thermometer (GMT) and digital thermometer (DT). Method. Comparative descriptive study was used. A total of 101 samples were taken with convenient sampling technique, but 98 were analyzed. Statistical significance () and clinical significance (°C) were used in the analyses. Correlations and Bland-Altman plots were used to observe agreements of the recording. Results. Mean difference (MD) of 10 min GMT and DT was . Statistically significant differences were noted in 10 min GMT and DT (). But the correlations were strong positive () and all MD were at the limit of agreement in Bland-Altman plot. Clinically, it is not significant (°C). Conclusion and Recommendations. Even though statistical significant differences () were noted between 10 min GMT and DT, the strong correlation, good agreements, and clinical insignificances make DT good alternative to the traditional GMT. Their variation in temperature is not likely to change any clinical decision. So, health professionals should use DT for measuring body temperature in under-5 febrile illnesses. Hadgu Gerensea and Rajalakshmi Murugan Copyright © 2016 Hadgu Gerensea and Rajalakshmi Murugan. All rights reserved. Assessment of Nurses’ Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government Hospitals, Addis Ababa, Ethiopia, 2015 Tue, 22 Dec 2015 09:15:33 +0000 Background. Although pressure ulcer development is now generally considered as an indicator for quality of nursing care, questions and concerns about situations in which they are unavoidable remain. Awareness about the significance of the problem, positive attitude towards prevention, and an adequate level of knowledge are cornerstones to effectively prevent pressure ulcers. Objective. To assess nurses’ knowledge, attitudes, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals. Methods and Materials. This is a cross-sectional study by design. A total of 217 eligible nurses participated in the study and data were collected through pretested self-administered questionnaire. Results. When queried, 61.2% of the respondents had adequate knowledge on pressure ulcer prevention practices, while 68.4% had favorable attitudes towards prevention practices. Moreover, 67.3% of participants had good pressure ulcer prevention practices. Conclusion and Recommendation. More than half of the nurses were found to have adequate knowledge about pressure ulcer prevention and their attitude towards it was overall favorable. Expressed pressure ulcer prevention practice was affected by the participant’s level of knowledge, attitude, and barriers of care. To provide effective prevention of pressure ulcer, nurses’ level of knowledge and attitude should be enhanced besides resolving these barriers. Abebe Dilie and Daniel Mengistu Copyright © 2015 Abebe Dilie and Daniel Mengistu. All rights reserved. Registered Nurses’ Experiences with the Medication Administration Process Sun, 20 Sep 2015 09:40:43 +0000 Background. Registered nurses (RNs) have a role in the medication administration process (MAP) multiple times per day in a hectic hospital environment. This requires a great deal from the RNs in order to accomplish the demanding task of avoiding adverse drug events. However, the process has not been widely studied from the nurses’ perspective. Aim. The aim of this study was to describe the different stages of MAP from the RNs’ perspective. Methods. A qualitative descriptive research design, with a purposive sample involving thematic interviews of 20 RNs and questions to them in a paper form, was conducted in two medical units. Data was analyzed by using deductive content analysis. Results. The results revealed that RNs confront numerous problems such as equivocal prescriptions, problems with information technology (IT), unavailability or incompatibility of the medicines, a substantial amount of generic substitutions, and changing medicine brands. Disruptions and distraction run through each stage of the MAP, excluding prescribing. The RNs desire support in all stages of the MAP. Conclusion. There are areas to improve in each stage of the MAP from the RNs perspective. Real-time and ubiquitous documentation, along with software including the data and knowledge required in medication management, is needed. Hanna Pirinen, Lotta Kauhanen, Riitta Danielsson-Ojala, Johan Lilius, Ilona Tuominen, Natalia Díaz Rodríguez, and Sanna Salanterä Copyright © 2015 Hanna Pirinen et al. All rights reserved. The Effects of Nonpharmacological Treatment on Uremic Pruritus Patients: A Systematic Review Mon, 15 Jun 2015 14:34:16 +0000 Background. Around 50–90% of hemodialysis patients develop pruritus. Although studies examining nonpharmacological treatments for itchy skin have been conducted, the conclusions have not been decisive. Purpose. Through a systematic review of the literature, this study aimed to understand nonpharmacological interventions carried out in clinical trials for uremic pruritus and to evaluate and consolidate the information regarding these improvements and their effectiveness. Methods. A literature search focusing on studies published between January 2004 and December 2013 was conducted from 5 electronic databases. After screening based on inclusion criteria and excluding duplicates, nonpharmacological treatments examined in randomized clinical trials were selected for further analysis and synthesis. A modified Jadad scale was used to evaluate the quality of the identified articles. Results. Seven nonpharmacological studies met the inclusion criteria. The interventions to improve uremic pruritus included using emollients, phototherapy, acupuncture, and thermal therapy. Research showed that using emollients, phototherapy, and acupuncture significantly reduces uremic pruritus. Conclusion. Nonpharmacological interventions are effective for hemodialysis patients with pruritus. Emollients were found to provide the most relief compared to the other methods and constitute a readily available and cost-effective intervention to improve pruritus symptoms. Chiu-Feng Wu, Ya-Chu Hsiao, and Pi-Chen Ko Copyright © 2015 Chiu-Feng Wu et al. All rights reserved. Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses Thu, 14 May 2015 14:11:07 +0000 Introduction. The new demands of a fast changing world necessitate expanding the traditional concepts of nursing, extending the classical aspects to cover new areas. Purpose. Based on their professional duties, the nursing team in the pharmacy of a second-level hospital aimed to establish a theoretical and situational framework for nurses working in the central services. Material and Methods. Application of the nursing process to nursing work in an area with no direct contact with patients. Results and Discussion. The application of the NANDA diagnoses to professional practice enabled the establishment of a nursing diagnosis with the implementation of measures designed to overcome a stressful situation with a risk of becoming unmotivated. Main Conclusion. The capacity to adapt the nursing profession to undertake new roles in the field of healthcare and the power of nursing own methodological resources permit the indirect care of “faceless” patients to be complemented with the inclusion of nurses from other services as clients, forming the focus of care, who can thus be helped with their daily care work. Inmaculada Gómez-Villegas, Belén Ruíz-Pérez, Dolores López-del-Pino, and Francisco García-España Copyright © 2015 Inmaculada Gómez-Villegas et al. All rights reserved. Prevalence and Associated Factors of Nonexclusive Breastfeeding to Infants within the First 6 Months in Gondar Town, Northwest Ethiopia, 2014 Tue, 17 Mar 2015 09:50:27 +0000 Introduction. Nonexclusive breastfeeding (NEBF) is giving infants other foods or fluids in addition to the breast milk within the first six months of age. According to Ethiopian Demographic and Health Survey 2011, prevalence of NEBF was found to be 48%; this has a great impact on the health and development of the child. Objectives. To assess the prevalence and associated factors of NEBF to infants within the first six months. Methods. Community based cross-sectional study design was employed from March 1 to 31, 2014, among 828 mothers with infants 6 to 12 months old. Systematic random sampling technique was used to select study subjects. Logistic regression analysis with 95% CI was computed to identify predictor variables. Result. A total of 828 mothers with infants aged between 6 and 12 months were interviewed with 100% response rate. Prevalence of NEBF was 47.5%. Mothers who completed primary school ( [95% CI: 0.30, 0.71]) were less likely practicing NEBF compared to mothers with no formal education. Governmental employees ( [95% CI: 1.45, 4.46]) were more likely practicing NEBF. Conclusion. NEBF was practiced by 47% of mothers. Maternal educational status, occupation, and knowledge of initiation of complementary feeding were factors significantly associated with NEBF. Mengistu Berhanu, Workie Zemene, and Mengistu Mekonnen Copyright © 2015 Mengistu Berhanu et al. All rights reserved. Knowledge, Practice, and Barriers of Foot Care among Diabetic Patients Attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia Wed, 11 Feb 2015 13:03:43 +0000 Introduction. Diabetes mellitus is a chronic debilitating condition characterized by an increased blood glucose level and is associated with significant morbidity, mortality, and increasing health care cost. Diabetic foot ulcers and lower extremity amputations are a common, complex, costly, and disabling complication of diabetes. An estimated 15% of patients with diabetes develop a lower extremity ulcer. Objective. The aim of this study was to assess knowledge, practice, and barriers of diabetic foot self-care among diabetic patients attending Felege Hiwot Referral Hospital. Method. Institution based descriptive cross-sectional study was conducted on 313 diabetic patients using convenient sampling technique. Furthermore, descriptive statistics and binary and multivariate logistic regression were employed to assess the predicators of knowledge and practice of diabetic foot care. Result. Majority of respondents were males (64.9%). The mean age was 39.1 ± 16. The mean knowledge score was 7.5 ± 2.02 of which 56.2% and 43.8% had good and poor knowledge of foot care, respectively. The mean practice score was 25.2 ± 6.466 of which 53.0% had good and the remaining 47.0% had poor foot care practice. Of 162 respondents having barriers, 56.8% reported “poor communication between patients and health care providers,” 50.6% cited “I did not know what to do,” and 44.4% responded “inconveniency for work” as barriers of foot care. Conclusion and Recommendation. Knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, lack of adequate knowledge, and inconveniency for work were commonly cited barriers of foot care. Policy makers should initiate interventional foot care education program throughout the regional state. The study hospital should consider establishing a specialized diabetic clinic in which foot care education can easily be integrated into follow-up care. Awole Seid and Yosief Tsige Copyright © 2015 Awole Seid and Yosief Tsige. All rights reserved. A Qualitative Study of Communication between Young Women with Disorders of Sex Development and Health Professionals Mon, 12 Jan 2015 11:52:53 +0000 Background and Objectives. Health communication is a critical aspect of care for both providers and recipients having a direct influence on engagement and outcomes. Communicating which in this context includes talking and listening in order to share information or support young women to understand their DSD can be difficult especially since the topic area is sensitive. Methods. In this qualitative study thirteen young women (aged 14–19 years) with a disorder of sex development who engaged with health care professionals were purposively recruited between 2011 and 2012 from three specialist centres across the United Kingdom. The young women either were interviewed or completed a diary about their experiences of communication with a range of health care professionals. An interpretative phenomenological approach was used to analyse these data. Results. By analysis of data the young women were able to clearly articulate the qualities and skills health professional needed in relation to communication. Two main categories focused on the duty in which professionals have to share information and their role in supporting young women to manage this information. Discussion and Conclusion. The study results revealed that these young women with a DSD expected to meet skilled professionals who could recognise the emotional aspects of dialogues in the short and longer term. Caroline Sanders and Bernie Carter Copyright © 2015 Caroline Sanders and Bernie Carter. All rights reserved. Quantification of Patient and Equipment Handling for Nurses through Direct Observation and Subjective Perceptions Sun, 11 Jan 2015 06:21:11 +0000 Background. Musculoskeletal disorders have continued to plague nurses in hospitals and long-term care facilities. Low back and shoulder injuries are the most prevalent, frequently linked to patient handling activities. Exposure to patient handling has been predominantly quantified by subjective responses of nurses. Objective. To directly observe handling of patients and other medical equipment for nurses during a 12-hour work shift. Methods. Twenty nurses working in three different intensive care units at a Midwest teaching hospital were directly observed during 12-hour day shifts. Direct observation included documenting frequency and type of handling performed and whether lift assist devices were utilized. Two additional surveys were completed by nurses to assess current pain levels and perceptions of lifting being performed. The observed lifting was compared to the perceived lifting with simple inference statistics. Results. Nurses have a high prevalence of manually lifting patients and medical devices but limited use of lifting assist devices. Nurses handled patients 69 times per shift and medical equipment 6 times per shift, but less than 3% utilized a lift assist device. Nurses suffered from high levels of pain at the end of the shift, with the highest prevalence in the lower back, lower legs, and feet/ankles (all above 60%). Tiffany Poole Wilson, Kermit G. Davis, Susan E. Kotowski, and Nancy Daraiseh Copyright © 2015 Tiffany Poole Wilson et al. All rights reserved. Effect of Kegel Exercises on the Management of Female Stress Urinary Incontinence: A Systematic Review of Randomized Controlled Trials Tue, 30 Dec 2014 08:59:31 +0000 Objective. The purpose of this study was to evaluate the effect of Kegel exercises on reducing urinary incontinence symptoms in women with stress urinary incontinence. Methods. Randomized controlled trials (RCTs) were conducted on females with stress urinary incontinence who had done Kegel exercises and met inclusion criteria in articles published between 1966 and 2012. The articles from periodicals indexed in KoreaMed, NDSL, Ovid Medline, Embase, Scopus, and other databases were selected, using key terms such as “Kegel” or “pelvic floor exercise.” Cochrane’s risk of bias was applied to assess the internal validity of the RCTs. Eleven selected studies were analyzed by meta-analysis using RevMan 5.1. Results. Eleven trials involving 510 women met the inclusion criteria. All trials contributed data to one or more of the main or secondary outcomes. They indicated that Kegel exercises significantly reduced the urinary incontinence symptoms of female stress urinary incontinence. There was no heterogeneity in the selected studies except the standardized bladder volumes of the pad test. Conclusion. There is some evidence that, for women with stress urinary incontinence, Kegel exercises may help manage urinary incontinence. However, while these results are helpful for understanding how to treat or cure stress urinary incontinence, further research is still required. Seong-Hi Park and Chang-Bum Kang Copyright © 2014 Seong-Hi Park and Chang-Bum Kang. All rights reserved. Prevalence and Associated Factors of Pressure Ulcer among Hospitalized Patients at Felegehiwot Referral Hospital, Bahir Dar, Ethiopia Tue, 16 Dec 2014 13:17:19 +0000 Introduction. Pressure ulcers, also known as decubitus ulcers (bed sores), are localized skin injuries that remain a major health problem affecting approximately 3 million adults. Objective. The aim of this study was to assess the prevalence and associated factors of pressure ulcer among hospitalized patients in Felegehiwot referral hospital. Methods. This cross-sectional study used systematic sampling on a sample of 422 patients. The data was collected by trained data collectors through pretested checklist. Bivariate analysis was used principally and variables were then entered into multiple logistic regressions model for controlling the possible effect of confounders and the variables which have significant association were identified on the basis of OR with 95% CI and P value. Results. The finding of this study revealed that 71 (16.8%) of them had pressure ulcer. Prolonged length of stay in hospital, slight limit of sensory perception, and friction and shearing forces were significantly associated with the presence of pressure ulcer. Conclusions and Recommendations. The prevalence of pressure ulcer was high among hospitalized patients. Researches of prospective (follow-up) study required investigating the incidence and associated factors of pressure ulcer for hospitalized patients. Haileyesus Gedamu, Mignote Hailu, and Abdella Amano Copyright © 2014 Haileyesus Gedamu et al. All rights reserved. Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives Sun, 09 Nov 2014 11:12:55 +0000 This study aims to explore the barriers to evidence based practice (EBP) experienced by nurses working in a Maldivian healthcare organisation. A total of 400 questionnaires were distributed to nurses in 5 healthcare facilities and 198 completed questionnaires were returned. The results of this study show that the perceived barriers by the nurses in the Maldives are not significantly different from those reported in developed countries. For healthcare organisations in the Maldives, it is necessary to have a clear understanding of the barriers and facilitators to research practice in order to implement EBP. The study showed that the major barriers to research use were that “the relevant literature is not compiled in one place,” there is “insufficient time on the job to implement new ideas,” and “administration will not allow implementation.” The key facilitating factors for EBP include support, encouragement, and recognition by the management and administration. The findings of this study can be useful for determining strategies that can be introduced in the clinical setting to use EBP. Healthcare organisations must continue their support in order to decrease the barriers and optimise care in healthcare facilities. Fathimath Shifaza, David Evans, and Helen Bradley Copyright © 2014 Fathimath Shifaza et al. All rights reserved. Community Based HIV Prevention Intervention in Developing Countries: A Systematic Review Tue, 23 Sep 2014 05:39:57 +0000 Aim. To describe the features and examine effects of community based HIV prevention interventions implemented in developing countries on HIV-related knowledge and self-reported risk behavior. Background. The HIV epidemic has a significant impact on developing countries, increasing the prevalence of HIV among young persons. Community-based HIV prevention interventions have been designed to improve HIV-related knowledge and decrease engagement in risk behavior. Variations in the design and implementation of these interventions have been reported, which may influence their effectiveness. Design. Systematic review. Method. Data were extracted on the characteristics of the study and interventions and effects of the interventions on knowledge and self-report of risk behavior. Results. In total, 10 studies were included in the review. Overall, the results showed variability in theoretical underpinning, dose, and mode of delivery of the interventions. Multicomponent interventions that used mixed teaching methods produced beneficial effects on knowledge and self-reported risk behavior. Conclusion. Examining the characteristics of HIV-prevention interventions provides direction for researchers in developing efficient interventions to improve knowledge and reduce engagement in self-reported risk behavior and, in turn, decrease transmission of HIV. Sarah Ibrahim and Souraya Sidani Copyright © 2014 Sarah Ibrahim and Souraya Sidani. All rights reserved. An Integrative Review of the Methods Used to Research the Prevalence of Violence against Women in Pakistan Sun, 07 Sep 2014 08:23:30 +0000 This paper is a report of an integrative review conducted to assess the methodological and ethical strategies used to protect participants and researchers in conducting violence against women (VAW) studies in Pakistan. The measurement of the prevalence of violence against women in Pakistan is challenging for researchers given the cultural norms and the traditional role of women. Lack of methodological rigor in addressing the concerns can result in underreporting of violence, create physical and emotional risk for the participants, interviewers, and researchers, and impose threats to internal and external validity of VAW studies. Using Whittemore and Knafl’s process for conducting an integrative review, 11 studies published between 1999 and 2012, reporting on prevalence, experiences, and factors associated with violence in a marital relationship were analyzed. Overall, studies reveal an underreporting of exposure to violence and threats to women and interviewers’ safety in the conduct of such studies, both of which present threats to study rigor. The utilization of WHO ethical and safety recommendations to guide VAW studies in this context should be considered. Farhana Irfan Madhani, Catherine Tompkins, Susan M. Jack, and Anita Fisher Copyright © 2014 Farhana Irfan Madhani et al. All rights reserved. The Power of Synergy: An Academic/Clinical Partnership for Transformational Change Wed, 20 Aug 2014 11:22:20 +0000 Background. A programme of postgraduate study was developed in partnership between a health board and a university in New Zealand, having identified critical thinking and practice change as key determinants of good care delivery. Aim. To explore the impact after 12 months of a postgraduate programme for registered nurses on patient assessment and clinical reasoning, and the status of implementation plans for improved patient care. Design. Outcome evaluation using a survey and focus groups. Setting. On location at a hospital in a small city in New Zealand that provides healthcare services for 102,000 people across rural and urban areas. Participants. Registered nurses who had completed the programme () and seven clinical mentors. Methods. A survey, focus groups, and follow-up data about quality improvement projects were used to explore how the programme was experienced and its impact. Results. The survey revealed perceptions of improved knowledge and skills but a lack of confidence in communicating with medical staff. Of 28 quality improvement projects planned, all but three had been implemented and were still in use. Two themes were generated from focus group data: “new ways of thinking” and “doing things differently.” Conclusions. This academic/clinical partnership positively influenced nurses’ knowledge and skills, encouraged critical thinking and self-efficacy, and resulted in the sustained implementation of nurse-initiated projects intended to improve patient care. Ann McKillop, Cheryl Atherfold, and Gary Lees Copyright © 2014 Ann McKillop et al. All rights reserved. Critically Reflexive Theory: A Proposal for Nursing Education Thu, 24 Jul 2014 11:45:46 +0000 Nursing is a discipline in transition. As the complexity and acuity of patients increase, nurses are taking on a more comprehensive role in health care leadership and patient outcomes. As the discipline has evolved so has the curricular framework of nursing educational programs, moving from being based on a specific nursing theory, to a general metaparadigm, to the current focus on meeting curricular content standards developed by national accrediting agencies. When considering the skills needed to fully engage in critical thinking and patient advocacy there may be room for an additional curricular focus: that of metacognitive development based on critical theory and constructivism. The empowerment of students via metacognitive and self-evaluative practices also supports the critical theory pedagogy. If graduating nurses are presented with a cohesive and comprehensive curriculum that meets the need for competent and critically reflexive nurses the discipline of nursing can continue to expand in function and voice. The use of metacognition, constructivism, competency, and critical pedagogies in a unified and broad curricular framework allows for the development of these essential skills in contemporary nursing practice. This paper presents this innovative curricular framework that embodies these various teaching and learning perspectives. Jayne Josephsen Copyright © 2014 Jayne Josephsen. All rights reserved. Assessing the Effectiveness of an Educational Program on Compliance with Hand Hygiene in a Pediatric Intensive Care Unit Tue, 22 Jul 2014 00:00:00 +0000 Objective. To identify the impact of an educational intervention on compliance of health professionals with hand hygiene. Method. The survey involved nurses, doctors, and physiotherapists who work in pediatric intensive care unit of a pediatric hospital. A multifaceted hand hygiene educational program was introduced with compliance assessed during successive observational surveys. Results. The total healthcare professionals’ compliance increased from 31.8% in the baseline period to 51.5% immediately after the first educational intervention, and it remained at improved levels (45.9%) six months later, while after the completion of the second educational intervention it increased to 67.7%. The nurses’ and doctors’ compliance increased from 30.4% and 28.3% at baseline period to 71.5% and 60.2%, respectively, during the study phases. Finally, physiotherapists’ compliance increased from 37.5% at baseline period to 73.9% after the completion of the second educational intervention. Conclusion. The degree of the staff’s compliance with hand hygiene in the pediatric intensive care unit after the educational program increased substantially. The continuing education and training of health professionals contribute to increasing the degree of compliance with the international recommendations for hand hygiene. Charalampia Nteli, Petros Galanis, Despoina Koumpagioti, Georgios Poursanidis, Eleni Panagiotopoulou, and Vasiliki Matziou Copyright © 2014 Charalampia Nteli et al. All rights reserved. Effectiveness of the Interventions Utilized in Genetic Counseling Thu, 03 Jul 2014 11:21:12 +0000 Background. Advances in genetic science and biotechnology accumulated huge knowledge of genes and various genetic tests and diagnostic tools for healthcare providers including nurses. Genetic counseling became important to assist patients making decisions about obtaining genetic testing or preventive measures. Method. This review was conducted to describe the counseling topics, various interventions adopted in genetic counseling, and their effectiveness. Experimental studies () published between 1999 and 2012 were synthesized. Results. The most frequently covered topic was benefits and limitations of genetic testing on breast cancer ovarian and colorectal cancers. Most of researchers focused on evaluating cognitive aspect and psychological well-being. Conclusion. No single intervention was consistently reported to be effective. Decision aids enhanced with information technologies have potential to improve the outcomes of genetic counseling by providing tailored information and facilitating active engagement of patients in information uptake. Clinical Implication. When nurses are familiar with topics and interventions of genetic counseling, they are well positioned to provide genetic/genomic information to the patient and families. Jeeyae Choi and Hyeoneui Kim Copyright © 2014 Jeeyae Choi and Hyeoneui Kim. All rights reserved. Being Interviewed for Admission to a BSN Program: A Qualitative Inquiry Tue, 01 Jul 2014 11:47:48 +0000 Nursing schools want to choose candidates most likely to successfully finish the program and many include interview as part of the admission process. Research on interviews as a component of admission has yet to address the students’ experience. The purpose of this study was to examine students’ lived experience of being interviewed for admission into a BSN program, with application of findings to more holistically examine the interview process. Three themes resulted from grounded theory analysis of 25 transcribed-verbatim interviews of nursing students. Seeing Me describes how the interview was a positive way of showing a side that was not represented on paper. Participants shared an awareness that qualities needed in a nurse (The Right Stuff) are better assessed with interview. The interview marked when the Beginning of the Nursing Journey felt real. This paper considers the student’s experience and helps us more holistically examine effective processes for admission to a nursing program. Michelle L. Finch, Debra Rose Wilson, Kelly Symonds, and Kim Floyd-Tune Copyright © 2014 Michelle L. Finch et al. All rights reserved. Qualitative Inquiry into the Patients' Expectations regarding Nurses and Nursing Care Thu, 03 Apr 2014 09:58:40 +0000 Background and Objectives. Awareness about the patients’ needs and expectations is quite important in improving the quality of the services they are provided with. Since meeting the needs and expectations of the patients is one of the basic issues in patient care, the present study aimed to investigate the patients’ expectations from nurses and nursing care. Methods. In this qualitative study, 20 hospitalized patients were interviewed. The data were gathered through deep, semistructured interviews. Then, all the recorded interviews were transcribed, reviewed for several times, and analyzed using qualitative content analysis approach. Results. By analyzing of data, three main categories were extracted. The main categories of the patients’ expectations from nurses and nursing care were comprehensive care, ethical performance, and having proper individual characteristics. Discussion and Conclusion. The study results revealed that the patients expected comprehensive care from the nurses. In addition, the nurses were required to apply the ethical principles in what they do as their duties. The findings of the study can be helpful in improving the patient care. Majid Najafi Kalyani, Raziyeh Illon Kashkooli, Zahra Molazem, and Nahid Jamshidi Copyright © 2014 Majid Najafi Kalyani et al. All rights reserved. Problem Based Learning in Nursing Education Tue, 18 Mar 2014 09:58:44 +0000 Background. McMaster University first introduced Problem Based Learning (PBL) in the mid 1960s. However, measuring the relationship between PBL for undergraduate nursing programs and students test performance has not yet been assessed in the USA. Purpose. The main purpose of this paper is to describe the effectiveness of PBL on senior student test performance on content related to PBL in a BSN program. Diabetes mellitus and renal insufficiency were taught by traditional lecture format in the previous years. This was the first year we taught this content by the problem based learning method. Method. Historical control group was used to compare the test performances between the PBL groups and the traditional group using Student’s t-test. Result. The mean of diabetes mellitus related questions missed by the PBL group was less than the traditional group (, and ). The mean of renal insufficiency related questions missed by the PBL group was more than the traditional group (, and ). Discussion. This study produced inconclusive findings. Factors that could be attributed to their performance will be discussed. Weihua Zhang Copyright © 2014 Weihua Zhang. All rights reserved.