Context specific realities and experiences of nurses and midwives in basic emergency obstetric and newborn care services in two district hospitals in Rwanda: a qualitative study

Background In low and middle-income countries, nurses and midwives are the frontline healthcare workers in obstetric care. Insights into experiences of these healthcare workers in managing obstetric emergencies are critical for improving the quality of care. This article presents such insights, from the nurses and midwives working in Rwandan district hospitals, who reflected on their experiences of managing the most common birth-related complications; postpartum hemorrhage (PPH) and newborn asphyxia. Rwanda has made remarkable progress in obstetric care. However, challenges remain in the provision of high-quality basic emergency obstetric and newborn care (BEmONC). This study is a qualitative part of a broader research project about implementation of an mLearning and mHealth decision support tool in BEmONC services in Rwanda. Methods In this exploratory qualitative aspect of the research, four focus group discussions (FGDs) with 26 nurses and midwives from two district hospitals in Rwanda were conducted. Each FGD was made up of two parts. The first part focused on the participants’ reflections on the research results (from the previous study), while the second part explored their experiences of delivering obstetric care services. The research results included: survey results reflecting their knowledge and skills of PPH management and of neonatal resuscitation (NR); and findings from a six-month record review of PPH management and NR outcomes, from the district hospitals under study. Data were analyzed using hybrid thematic analysis. Results The analysis revealed three main themes: (1) reflections to the baseline research results, (2) self-reflection on the current practices, and (3) contextual factors influencing the delivery of BEmONC services. Nurses and midwives felt that the presented findings were a true reflection of the reality and offered diverse explanations for the results. The participants’ narratives of lived experiences of providing BEmONC services are also presented. Conclusion The insights of nurses and midwives regarding the management of birth-related complications revealed multi-faceted factors that influence the quality of their obstetric care. Even though the study was focused on PPH management and NR, the resulting recommendations to improve quality of care could benefit the broader field of maternal and child health, particularly in low and middle-income countries.

Professional Ethics Relationship with Patient’s Rights Charter Observance among Nurses and Midwives

Introduction: Respect for patients’ rights and observance of professional ethics standards improves medical services that will have an essential role in promoting patients’ health. Objective: This study aimed to determine the relationship between awareness of patient’s rights charter and professional ethics with patient’s rights charter observance. Materials and Methods: This analytical correlational study was performed on 285 staff members (196 nurses and 85 midwives) working in 2 hospitals affiliated to Alborz University of Medical Sciences, Iran, and 2 social security hospitals. They were selected using a stratified random sampling method. The study data were collected using the sociodemographic characteristics questionnaire, awareness and observance of the patient’s rights, and professional ethics charter questionnaires. Descriptive statistics and inferential statistics, including the independent t-test, Pearson correlation, Chi-square tests, and multivariate linear regression, were used for data analysis. Results: The Mean±SD ages of nurses and midwives were 36.2±8.3 and 37.5±7.9 years, respectively. The results also showed an association of professional ethics and awareness of patient’s rights charter with patient’s rights charter observance in both nurses (P=0.0001) and midwives (P=0.0001). Based on multivariate linear regression analysis, there were relationships between gender (B=-0.3; 95%CI; -2.0, 2.0; P=0.000), work experience (B=-0.6; 95%CI; -4.0, 3.0; P=0.000), marital and employment status (B=-3.2; 95%CI; -6.0, -0.0; P=0.045), in nurses and between job position (B=9.5; 95%CI; 5.4, 13.5; P=0.000), interest to work (B=-7.9; 95%CI; -11.5, -4.3; P=0.000), and income status (B=6.3; 95%CI; 3.3, 9.2; P=0.000), in midwives with Observance of the Charter of Patient Rights. Conclusion: It is possible to improve compliance with the charter of patient’s rights and its dimensions by strengthening the knowledge of nurses and midwives in this area and their professional ethics, which results in patient satisfaction in this area.

Increased Accessibility to Primary Healthcare Due to Nurse Prescribing of Medicines

Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses’ competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017–2019.The largest number of prescription visits made by nurses concerned patients aged 50–70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses’ involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients’ access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients.

Connections, rituals and identities: healthcare students’ descriptions of objects that represent resilience

Purpose Health-care student resilience is a well-researched topic, although the concept continues to evolve, not least as “resilience-building” has become an expected feature of health-care student professional education. The study aimed to understand the concept of resilience from the point of view of student nurses and midwives. Design/methodology/approach The study used a novel arts-informed method, informed by Miller’s and Turkle’s work on “evocative objects.” A total of 25 student nurses and midwives from a London-based university selected “resilience objects” which were photographed and discussed during interviews with an artist-researcher. Findings Analysis of the interviews revealed that “resilience” was founded on identity, connection, activity and protection. “Resilience objects” were used in everyday rituals and “resilience” was a characteristic that developed over time through the inhabiting of multiple identities. Practical implications Given that resilience is intertwined with notions of identity, health-care faculties should enhance students’ sense of identity, including, but not exclusively, nursing or midwifery professional identity, and invite students to develop simple rituals to cope with the challenges of health-care work. Originality/value To the best of the authors’ knowledge, this is the first study to locate health-care students’ resilience in specific material objects. Novel insights are that health-care students used everyday rituals and everyday objects to connect to their sense of purpose and manage their emotions, as means of being resilient.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

Knowledge, Attitudes and Practices Toward Traditional and Complementary Medicine Among Nurses and Midwives in North-Western Uganda

Background: Traditional and complementary medicine is globally accepted and steadily gaining popularity among populations. The practices of conventional health care workers toward it vary from one country or setting to another. Limited literature exists on practices of health workers towards this form of medicine in low income settings especially in Africa where it is widely used with limited collaboration, integration and regulation.Purpose: To determine the prevalence and determinants of traditional and complementary medicine practices as well as health problems and reasons for its use among nurses and midwives in North Western Uganda.Materials & Methods: We used a descriptive and analytical cross-sectional design. Data was collected using self-administered structured questionnaires that were distributed to a sample of 300 nurses and midwives drawn from 6 hospitals. Descriptive statistics, chi squared and multiple binary logistic regression analysis were used for analysis.Results: Of all the respondents, 147 (54.9%) had personally ever used traditional and complementary medicine, 69 (25.7%) had personally used it in the past 12 months, 84 (31.3%) had ever recommended use of TCM. The most commonly used therapies were: herbalism (78.2%), traditional birth attendance (67.3%), nutritional supplements (67.3%), body massage (53.1%), spiritualism (24.5%), traditional dentistry (21.1%) and traditional bone setting (14.3%). Traditional and complementary medicine was mainly used for pain management (53.1%) followed by acute diseases (49.6%). The commonest reasons given for use were the fact that it is readily available, accessible and cheap. Chi square analysis showed statistically significant associations between TCM practices (personal use and recommendation to others) and respondents religion (p=0.046), location of hospital (p=0.002), presence of a family member who is a TCM provider (p=0.001), attendance of training on TCM in the years of work (p=0.001), provision of TCM as a business and duration of years served as a health professional (p=0.029).Conclusions: There is need to improve traditional and complementary medicine practices amongst nurses, midwives and other health care professionals. This will avert the negative/undesired effects in the community.