Midwives’ Views and Perceptions of Patient Dignity in Midwifery Services

Background and objective: Human dignity which is defined as respect to human individu-ality is a highly recommended necessity to be taken into account in medical settings to de-liver high-quality services and raise the patients’ satisfaction. Due to a lack of well-defined provisions and instructions in midwifery practice in the Kurdistan region of Iraq, human dignity is threatened in this field. The present study was an attempt to figure out the meaning of patient dignity, what threatens patients’ dignity, and how to promote patients dignity in midwifery settings in maternity departments and clinics in Erbil, in the Kurdistan region-Iraq. Method: The present qualitative study was conducted on 10 Kurdish registered midwives who were working delivery room of Maternity Teaching Hospital and Dyke Private Hospital located in Erbil, Iraqi Kurdistan. In-depth semi-structured interviews were conducted with the midwives to collect required data. The interviews were recorded and then transcribed verbatim and analyzed using the six methodological activities proposed by Van Manen, and the themes and subthemes were extracted. Results: Analyzing the transcribed interviews resulted in emergence of one main theme, namely “need for holistic support” which had subthemes, namely “need for medical sup-port”, “need for mental support”, and “need for sympathetic support”. Conclusion: Human dignity of pregnant and childbearing mothers in maternity depart-ments and clinics is relatively low due to lack of sufficient equipment and facilities and in-sufficient number of midwives and maternity staff. Therefore, appropriate measures need to be taken in these regards.

Indications of Labor Induction at Delivery Room of Maternity Teaching Hospital in Erbil City

Background and objectives: Induction of labour means stimulation of contractions before the birth starts spontaneously, with or without ruptured membranes. The most common indications include oligohydramnios, pre-labour rupture of the membranes, high blood pressure during pregnancy, severe fetal growth restriction, post-term pregnancy, and var-ious maternal medical conditions such as chronic hypertension and diabetes. The aim of the study was to find out the different indications of labour and associated obstetrical factors in a local tertiary hospital. Methods: A cross-sectional study was conducted among 120 parturient women who attended a delivery room in the Maternity Teaching Hospital in Erbil City from the period of 2nd June to 2nd October 2020. After reviewing the literature, a questionnaire was pre-pared to obtain socio-demographic data, data related to reproductive characteristic and data related to the indications for labour induction. The data were analyzed using descrip-tive and inferential statistical approaches. Results: The study included 120 patients with the highest percentage of the patients (49.1%) were 16 to 23 years old and more than half of the sample (51.6%) had a post-term pregnancy, gestational hypertension and pre-eclampsia (15%). There were highly significant statistical differences between parity, gestational age and indication of labour induction, and significant differences between gravidity and antenatal care visits and indi-cations for labour induction. Conclusions: The majority of the sample had a post-term pregnancy of 40 and 42 weeks as an indication for induction of labour followed by gestational hypertension and pre-eclampsia, oligohydramnios and pre-labour rupture of membrane. There was a statistical-ly significant difference between the antenatal care visit and parity with the induction of labour.

Assessment and Clinical Outcomes of Fall Related Injuries at Emergency

Background and objectives: Falls are significant cause of mortality and morbidity with a considerable burden on societies, families and victims. The study aims to determine the interventions and outcomes of fall-related injuries, and the association between injury se-verity and fall height. Methods: A descriptive cross-sectional study was conducted among 322 fall-related in-jured persons in West and East emergency hospitals in Erbil City from September 2020 to February 2021. Study sample demography, location of injury, place of affected body re-gions, outcome, and hospital stay were analyzed. Results: Of the 322 patients studied, 68.9% were males, and 31.1% were female. Less than half of the samples (48.8%) were between the ages 18 to 36 years old. The most common location for fall-related injuries was residential facilities (44.1%) followed by the place of work (35.1%). According to the type of fall, fall from ground was 38.4%, and fall from a fall height of 1-3 meters was 48.8%. Finally, according to the injury classification, more than half (56.5%) of the study sample had a significant degree of severity. The discharged status of disposition at the emergency room had the highest percentage (64.9%) of the study sample. There was a significant difference between the scores of the items of fall conse-quences and outcomes regarding to type of ground (soft or hard). There was a significant relationship between injury severity and fall height (p-value = 0.00). Conclusion: Fall-related injuries are the most common cases at emergency departments in Erbil city. Among ages 18 to 36, men are more frequently exposed to falls than women. The highest risk of fall is occupation with construction laborers at the greatest risk. Fall-related injury is a burden on the health care system, particularly on emergency services in developing countries like Iraq in relations cost of care and resources.

Lived Experiences of Patients with COVID-19 in the Kurdistan Region, Iraq: A Qualitative Study

Background and objective: COVID-19 has adverse effects on physical and mental health and threatens the quality of life significantly; therefore, it is necessary to help COVID-19 patients with their lifestyle, which is tightly bound to the quality of their lives. The present study aims to develop plans to improve the quality of life among COVID-19 patients by an-alyzing their lived experiences. Methods and patients: The present qualitative study was conducted from August to Sep-tember 2020 on twelve COVID-19 patients hospitalized in Erbil’s Emirates Hospital, the Kurdistan Region of Iraq. In-depth semi-structured interviews (12) were utilized to collect data. Trustworthiness was ensured by making an excellent prolonged relationship with the patients, peer-checking, member-checking, and implementing experts’ suggestion at every stage. Four main themes were extracted from the interviews, which were transcribed ver-batim and analyzed using the six methodological activities proposed by Van Manen. Results: The present study results indicated that COVID-19 patients have a difficult time dealing with the disease and getting adapted to their new situation, leading to a remarka-ble decrease in the quality of their lives. Analyzing the transcribed interviews led to emer-gence of four main themes: “disbelief in being really ill,” “fear and stress,” “changes in lifestyle,” and “seriously adhering to health guidelines.” Conclusion: Our results showed that COVID-19 patients suffer from physical pain and un-dergo poor mental health due to fear and stress resulting in worsening quality of life. A deep understanding of COVID-19 patients’ states and situations is highly significant to help nurses and nursing managers plan effective strategies for caring for patients with COVID-19.

Knowledge of Shaken Baby Syndrome among Hospital Nurses in Erbil City

Background and objectives: Shaken baby syndrome and pediatric abuse head trauma are the most common causes of mortality and morbidity due to physical child abuse. Nurses have a main role in parents’ education regarding child abuse prevention. This study aimed to assess nurses’ knowledge regarding shaken baby syndrome in Erbil City. Methods: A descriptive study was conducted at postpartum units, the delivery room and the ward at the Maternity Teaching Hospital, and the inpatient and intensive care units at Rapareen Pediatric Teaching Hospital in 2017 in Erbil City. A purposive sample of 50 nurses was recruited to the study. The data collection was performed using a questionnaire for interviewing the study participants, and the data were analyzed using descriptive and in-ferential statistical analysis. Results: The study findings revealed that the majority of the study participants were 19-25 years old and most did not have enough knowledge regarding the signs and symptoms of the shaken baby syndrome (irritability, lethargy, poor feeding breathing problems, uncon-trollable crying, vomiting, bluish skin, changes in sleeping pattern, convulsions or seizures and unresponsiveness). Nurses also had insufficient knowledge about the risk factors of this condition. Only a quarter of nurses knew that domestic violence is a risk factor and less than a quarter of them recognized depression and substance abuse of the caregiver as a risk factor. Regarding knowledge of the complications, the study found that a quarter of nurses knew that brain damage, cerebral palsy and blindness are complications of the shaken baby syndrome. Conclusions: Majority of nurses had poor knowledge about causes, signs, symptoms, risk factors and complications of the shaken baby syndrome.

Dialysis-Related Factors Affecting Activities of Daily Living among Hemo-dialysis Patients in Erbil City

Background and objectives: Hemodialysis procedure is one of the important replacement therapies for patients with renal failure. Maintenance hemodialysis is associated with many complications that play a significant role in the activities of daily living. The present study aimed to find out the factors affecting activities of daily living among patients with maintenance hemodialysis in Erbil City in the Kurdistan Region of Iraq. Methods: The cross-sectional study was conducted on 268 patients undergoing mainte-nance hemodialysis for more than two months, and at least two times per a week at two dialysis centres in Erbil City from December 2019 to April 2020. The activities of daily living and complications from the hemodialysis procedure questionnaire to collect research da-ta. The data analysis was conducted using descriptive statistical approach including fre-quency, percentages, and inferential statistical analysis consisting chi-square test. Results: According to the findings of the study, the majority of participants were above 51 years of age, able to read and write, with middle income, and from an urban area. Almost half of the study sample were males, and most were on hemodialysis between one and three years. The majority of them had hypertension and complications associated with he-modialysis such as headache and hypotension, and more than half had back pain. A highly significant association was found between dependency in activities of daily living and some socio-economic and clinical variables. Furthermore, a significant association was found be-tween dependency in activities of daily living and some hemodialysis complications with P<0.001. Conclusion: According to the result of the study, the researchers concluded that partici-pants suffered from chronic diseases, hemodialysis complications and low level of activities of daily living. The complications of hemodialysis treatment were significantly affecting the activities of daily living. Haemodialysis patients need more education and nursing care to reduce treatment complications and to increase their activities.

Health Professional’s Knowledge and Attitude Regarding Adolescent Pregnancy Care in Primary Health Care Centers in Erbil City

Background and objectives: The World Health Organization defines adolescent pregnancy as pregnancy in which the mother is under the age of 20 at the time the pregnancy ends. About 16 million girls aging between 15 and 19 years give birth every year. The study aimed to assess the level of knowledge and attitude among nurses and physicians in Erbil Primary Health Care Centers regarding adolescent pregnancy care and comparing them. Methods: A quantitative; descriptive cross-sectional study was conducted in maternal and child health care units at twenty three Primary Health Care Centers in Erbil city, between November 15th , 2018 and November 15th , 2019. Non-probability, Convenience sam-pling technique was used for selecting sample which includes 95 from the total of 100 health professionals. Data was collected through interview (face to face) by using ques-tionnaire form which was designed by the investigator. Data were analyzed using the Chi square test, Fisher’s exact test. Results: Health professionals mean age + SD was 41.95 + 8.40 years, ranging from 27 to 62 years. The median was 42 years. Less than half (42.1%) of the sample were nurses, and the rest were physicians of different specialties. The highest percentage of the nurse’s knowledge and attitude were in medium level (42.5% and 47.5%, respectively). The high-est percentage of physician’s knowledge and attitude were in high level (58.3% and 65.5% respectively). There were significant difference between them regarding their knowledge (p = 0.32) and attitude (p = 0.006). Conclusions: Health professionals working in maternal and child health care units need improving their knowledge and attitude regarding adolescent pregnancy care. Nurses need more information and training sessions regarding that.

Nurses’ Self-report on the Infection Control Unit Activities and their Experience in the Hospital toward Nosocomial Infections in the Sulaimani Hospitals

Background and objectives: Nurses can prevent the occurrence and transmission of noso-comial infections by following infection control measures such as wearing gloves and masks, using appropriate disinfection of skin and preventing accidental needle-stick inju-ries. This research aimed to evaluate the availability of hospital uniforms, personal protec-tive equipment, and infection control activities at hospitals in Sulaimani in the Kurdistan Region of Iraq, and to examine nurses’ experience of nosocomial infections. Methods and materials: A cross-sectional study was performed at 10 governmental hospi-tals during the period from 20th February to 28th September 2018. 525 nurses were se-lected as participants by a convenience sampling method. A self-administrated question-naire was used to collect data, which were analysed using SPSS software. Results: The results showed that 268 nurses (51%) reported that their hospitals provided sufficient uniforms to all the medical staff and the majority of nurses, 444 respondents (84.6%) stated that they were responsible for cleaning their working uniforms. 441 nurses reported that they did not acquire a nosocomial infection, and 479 (91.2%) did not have an accident during their work in the hospital. 79.9% of the nurses (404) reported recapping syringe needles after the usage, and 98 (18.7%) gave a low rating to the infection control unit activity in their hospitals. Finally, more than half of nurses (330) representing 62.9% of the sample were vaccinated against nosocomial infections. Conclusions: Most of Sulaimani governmental hospitals are providing sufficient uniforms for the health staff, the majority of nurses were vaccinated against one or more nosocomi-al infections, and the majority of nurses do needle syringe recapping.

The Consequence of Teenage Pregnancy on the Primigravida Health Outcome Delivers at Sulaymaniyah Maternity Teaching Hospital-Kurdistan Region-Iraq

Background and Objectives: Teenage first pregnancy is a significant public health problem as it often occurs in the context of poor social support and maternal wellbeing. It is consid-ered high risk for both the mother and infant. This study aimed to find out the effect of teenage pregnancy on neonatal health outcomes. Methods: A descriptive, cross-sectional, prospective study was conducted in Sulaymaniyah in the Kurdistan Region of Iraq and involved all pregnant teenage mothers admitted to Sulaymaniyah Maternity Teaching Hospital from January 1, 2019, to June 30, 2019. Results: 332 of mothers aged ≤19 years and their newborns were studied. A higher pro-portion of teenage mothers were from rural areas than the urban areas (59.3% vs 40.7%). The percentage of teenage mothers who did not attend antenatal care was 11.14%, and irregular attendees represented 9.94 %. Compared with teenage mothers aged 14–16 years, teenage mothers aged 17–19 years had higher risks of anaemia, systemic infections, coincidental condition, low birth weight, preterm delivery and low Apgar score. The risk of aspiration of meconium and stillbirth among infants born to teenage mothers was statisti-cally not significant after adjustment for gestational age and birth weight, in addition to maternal characteristics and mode of delivery. Teenage pregnancy was associated with higher risks of adverse pregnancy outcomes. Conclusion: Prevention strategies and the improvement of healthcare are essential to re-duce the consequences of teenage pregnancy on maternal and neonatal health outcomes. Teenage women were less likely to receive antenatal care services. Use of community- and health facility-based education programs are necessary to prevent teenage pregnancy and thus reduce adverse maternal and neonatal outcomes.

Physical Activity and Perceived Barriers among Type2 Diabetic Patients in Erbil City

Background and objectives: Physical activity is necessary for providing a healthy lifestyle, improving quality of life, controlling diabetes mellitus and promoting glycemic control. The aim of the study was to assess physical activity and to determine barriers to physical activity among type 2 diabetic patients in Erbil city. Methods: A cross-sectional study was conducted among 400 type 2 diabetic patients, attending Layla Qasim Center in Erbil City during May 27 to 30 August 2019. Data was col-lected using an interview based questionnaire to obtain socio-demographic data, clinical characteristics, Physical activity assessed using Global Physical Activity Questionnaire (GPAQ) and standardized questionnaire developed by the Centers of Diseases Control and Prevention for determining barriers of physical activity. Data were analyzed using descrip-tive statistical approach. Results: Participant were 400 patients with mean age of 57.0 + 9.4 years, 64.3% of the sample were females. (72.3%) of the sample were illiterate, 77.5% were either unem-ployed or housewives. 83.8% of the sample were married, 80.25% of samples had first degree relative positive family of diabetes. 56.5% of samples take oral hypoglycemic me-diactons.39.2% of samples were overweight and 83.7% of samples had poor glycemic con-trol.57.8% of participants didn’t meet recommendations (< 600 minutes per week) of physical activity. The main barriers that keeps patients from being active were lack of en-ergy (54.8%), lack of willpower (53%), and lack of skill (49.3%). Conclusions: According to the finding of the study type 2 diabetic patients had insuffi-cient physical activity to meet the recommended level necessary to achieve optimal gly-caemic control, prevent or decrease diabetic complications. Interventions should include guiding individuals to evolving recreational physical activity and overwhelming barriers to physical activity.