Nursing Research and Practice

Introduction. Discharge against medical advice is a global phenomenon where patients voluntarily terminate their consent to medical care before the medical team declares them fit for discharge. The phenomenon adversely affects the delivery of quality health care. Methods. A retrospective study was conducted at a Ghanaian teaching hospital involving patients who were admitted to the emergency settings within a 2 years period. Data were retrieved from the hospital records and patients discharged against medical advice were identified and studied. Data were cleaned and coded with Excel application and analyzed with SPSS version 23. Results. A total of 8,565 admissions were made into the ward within the period under review with 210 patients been discharged against medical advice. The prevalence rate was 2.5% with high prevalence seen in male and younger populations. Fractures and head injuries were the commonest conditions for which patients requested to be discharged against medical advice, whilst financial constrains and preference for herbal treatment were the major factors for which patients requested to be discharged against medical advice. Conclusion. Discharge against medical advice exists and negatively affects the delivery of quality health care in the Ghanaian health sector. Education especially towards at-risk groups such as the younger populations and patients with fractures as well as effective communication between medical team and patients and their families are some proposed measures to reducing the prevalence and negative impacts associated with discharges against medical advice.

Background. Nurses experience caring burdens, which can affect their caring behaviors. Caring for highly infectious patients, in particular COVID-19, is a new phenomenon and little is known about it. Considering that caring behaviors can be influenced by various factors and cultural differences of the society, it is necessary to conduct studies about caring behaviors and caring burdens. Thus, this study aimed to determine caring behavior and caring burden and their relationship with some associated factors among nurses who cared for patients with COVID-19. Materials and Methods. This cross-sectional, descriptive design study was conducted by census sampling on 134 nurses working in public health centers in East Guilan, the north of Iran, in 2021. The research instruments included the Caring Behavior Inventory (CBI-24) and the Caregiver Burden Inventory (CBI). Descriptive and inferential statistics were used to analyze the data using SPSS software version 20 with a significant level of 0.05. Results. The mean score of caring behavior and caring burden in nurses was 126.50 (SD = 13.63) and 43.65 (SD = 25.16), respectively. There was a significant relationship between caring behavior and some demographic characteristics (education, place of living, and history of COVID-19) and between caring burden and some demographic characteristics (housing status, job satisfaction, intention to change job, and history of COVID-19) ( < 0.05). Conclusions. Findings showed that despite the new emergence of COVID-19, the caring burden on nurses was moderate and they had good caring behavior. Despite these results, it is necessary for the relevant managers to pay special attention to protecting health workers during a national crisis such as COVID-19 so that they experience less caring burden and improve caring behavior.

Background. Violence against emergency nurses is a global concern with undesirable physical and psychological consequences. This study was conducted to investigate the characteristics of physical and verbal violence against emergency nurses in Iran. Methods. In this cross-sectional study, 150 nurses working in seven hospitals affiliated to Kermanshah University of Medical Sciences were included in the study using the stratified random sampling method. The data collection tools included a personal information form and a researcher-made questionnaire. Violence-related characteristics were assessed using descriptive statistics. Logistic regression was used to identify factors related to physical and verbal violence. Results. The frequency rates of physical and verbal violence during the past 12 months were equal to 62% (n = 93) and 94.7% (n = 142), respectively. In both types of physical violence (49.5%, n = 46) and verbal violence (40.4%, n = 57), the nursing station was the most common place of violence. In both physical (n = 40, 43.0%) and verbal violence (n = 101, 71.1%), the most common perpetrator was the patient’s family. Most physical violence (57.0%, n = 53) and verbal violence (35.2%, n = 50) occurred in the night shifts. No statistically significant relationship was found between physical and verbal violence and gender, age, marital status, type of employment, and work experience. Discussion. The results indicate the seriousness of workplace violence against nurses. It is necessary to adopt a global approach along with providing sufficient manpower and psychological empowerment of nurses. Further studies with a forward-looking approach are suggested.

Background. Patients with surgical stoma experience problems, which can lead to their impaired adaptation and self-efficacy. The nursing process provides a framework for planning and implementing nursing care. This study aimed to investigate the effect of education based on the nursing process on ostomy self-care knowledge and performance of elderly patients with intestinal stoma. Materials and Methods. In this quasi experimental study, 52 elderly patients with intestinal ostomy who were referred to Razi Hospital in Rasht and met the inclusion criteria were invited to participate in research. Sampling was done by a simple random method. The intervention group received an educational programme based on the nursing process, whereas the control group received traditional training. The research instruments included a questionnaire to assess the level of ostomy self-care knowledge and ostomy self-care performance. Data were analyzed by SPSS software version 21 using descriptive and inferential statistics at a significant level of . Results. The mean scores of ostomy self-care knowledge and performance in both groups (intervention and control) were increased. However, the improvement in self-care knowledge and performance of the intervention group was significantly greater than that in the control group (). Conclusions. The educational programme based on the nursing process compared to the routine patients training caused more improvement in ostomy self-care knowledge and performance of older adult patients with surgical stoma. Therefore, an educational programme based on the nursing process can be used as an educational model for these patients.

Background. Nurse turnover intention, defined as a measure of nurses’ desire to leave their positions, is a global public health issue with a grave impact on the healthcare workforce. However, literature on it is limited in sub-Saharan Africa, an at-risk region. This study aimed to determine the predictors of turnover intention among nursing staff at a tertiary hospital in Kumasi, Ghana. Methods. This was an institution-basedcross-sectional study conducted among 226 randomly selected nurses and midwives working at a tertiary healthcare center in Kumasi, Ghana. Data were collected by using a structured questionnaire. Significant predictors of turnover intention were analyzed by using multivariate logistic regression analysis. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) and value <0.05 was used. Results. The prevalence of turnover intention among study participants was 87.2% (197/226). About two-thirds (61.5%, 139/226) of the participants were exposed to a high level of workplace hazards. Management support (AOR = 3.09, 95% CI = 1.09–8.75), salary (AOR = 0.07, 95% CI = 0.01–0.46), inadequate number of staff on duty per shift (AOR = 3.36, 95% CI = 1.08–10.47) and participants’ rank (AOR = 6.81, 95% CI = 1.18–39.16) were significantly associated with turnover intention. Conclusion. Overall, the turnover intention was high. Hence, there is a need for policymakers, health administrators, and nurse managers to implement strategies such as increasing staff strength, providing adequate support, incentives, and other forms of motivation for nurses and midwives to help reduce the rate of turnover intention.

Background. The clinical learning environment has been defined as “an interactive network of strengths within the clinical environment that influence the clinical learning outcomes of students. Understanding students’ level of satisfaction with their clinical learning environment is crucial to ensuring the required teaching and learning process. Therefore, this study was designed to assess the level of satisfaction with the CLE among nursing students at the Wolkite University of Ethiopia. Methods. A cross-sectional study was conducted at Wolkite University. This study was carried out in March 2022 on 208 student nurses selected by purposive and convenient sampling techniques. This study used the English version of the Clinical Learning Environment and Supervision + Nurse Teacher (CLES + T) evaluation scale. The collected data were cleaned, coded, and entered into Epi data 3.1, and then, statistical analyses were performed using SPSS version 26. Bivariate and multivariable logistic regression models were used to identify factors associated with the satisfaction level of nursing students towards CLE. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and values < 0.05 were considered to indicate statistical significance. Results. More than half of the study participants were females, and nearly half (50.5%) of the participants were in year three of the nursing program. The study found that 39.9% (95%CI: 32.2%, 46.6%) of students were satisfied with their CLE. Factors that had a significant association with the satisfaction level of nursing students towards CLE were gender (female students) (AOR = 16.053 (6.397, 40.286)), year of study (4th year) (AOR = 6.296 (2.679, 14.796)), and the type of the hospital in which their last clinical placement was held (at a primary hospital) (AOR = 2.961 (1.122, 7.815)). Conclusion. Effective nursing education programs need to be developed to increase satisfaction with clinical practice and to promote positive emotional regulation in nursing students. Nurse practitioners and managers should be aware of their important role in the professional development of students and their satisfaction with clinical placements.