Masters Theses: School of Nursing

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    Assessment of Association between Perceived Stigma, Social Support and Substance Abuse among Clients at the Comprehensive Care Centre at the Coast Province General Hospital.
    (University of Nairobi, 2014) Maina, Elizabeth W.
    Introduction: Clients in Comprehensive Care Centres (CCC) usually face stigma and have poor social support which results in poor coping mechanisms including substance (alcohol and illicit drugs) abuse. The prevalence of substance abuse among patients infected with the Human Immunodeficiency Virus (HIV) is higher than that in the general population. HIV infected patients abusing substances are not easily contracted into treatment which delays initiation of Highly Active Antiretroviral Therapy (HAART). Substance abuse also poses a great challenge in adherence to management and prevention of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome contributing to high morbidity and mortality. Aim/objectives: This descriptive cross-sectional study was to explore the association between perceived stigma, social support and substance abuse among Comprehensive Care Centre clients at the Coast Province General Hospital – Mombasa. Method: The CAGE – AID (acronym for cut down, annoyed, guilty, eye opener – adapted to include drug use) tool was used to screen patients for substance abuse and a score of ≥2 was considered significant. A sample of 235 patients was selected by convenience sampling method. Patients with a CAGE-AID score of ≥2 who consented were subjected to a socio-demographic questionnaire, the multidimensional scale of perceived social support and the HIV stigma instrument for People Living With HIV/AIDS (PLWHA). Data analysis: Data analysis was done using Statistical Package for Social Sciences version 21.0. Descriptive statistics were used to examine demographic characteristics while the Pearson’s Chi square test was used to test the significance of association between perceived stigma, social support and substance abuse in HIV. Multivariate analysis was further done to test for association between the variables. The confidence interval was set at 95%, p value at ≤0.05.The findings of the study demonstrate a significant statistical association between lack of social support, stigma and substance abuse among people infected with HIV/AIDS. Conclusion: An assessment of perceived stigma and social support is instrumental in identifying HIV infected patients at risk of substance abuse. A reduction in perceived stigma among PLWHA and adequate social support would come in handy in dealing with substance abuse in HIV/AIDS which would see a reduction in HIV related morbidity and mortality. HIV/AIDS patients with substance abuse disorders should be linked with further counselling and probably psychiatric follow up. HIV/AIDS support groups should be established and membership encouraged.
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    Ethical Dilemmas Experienced by Nurses in the Critical Care Units in Kenyatta National Hospital
    (University of Nairobi, 2012-07) Mutinda, Jostine
    Introduction- Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depend on the caregiver, optimally the nurse working in the critical care unit. As a result nurses working in the Critical Care Units are faced with ethical dilemmas on a day to day basis in the course of executing their duties. Ethical dilemmas have therefore become one of the priority concerns in the nursing profession that require urgent attention in Kenya. As the provision of care to the critically ill becomes more complex due to technological advancement, and the profession of nursing more autonomous, professional accountability cannot be overemphasized. (Fry, 2002). The complex nature of the health problems faced by patients admitted in ICU coupled with extensive use of very sophisticated technology requires at times rapid decision making. Ethical dilemmas confront even the most experienced nurse (Breen C.M. et al, 2004). Those working in KNH ICU are not any different particularly considering particularly considering that KNH is public hospital having the biggest ICU in the country. Additionally it admits patients from various walks of life and the nurses have diverse socio- demographic factors. However their perception and magnitude of ethical dilemmas they face while working in these areas and how they resolve them have not been studied. Duration of the study: The study took five weeks. Pretesting of the questionnaires took two days. Objective: To explore ethical dilemmas experienced by nurses working in the critical care areas at Kenyatta National Hospital and factors influencing the nurses‟ ethical decision making. Study question: What ethical dilemmas face nurses working in the critical care areas at KNH and how do they resolve them? Materials and methods: An exploratory survey study design was adopted whereby 123 nurses shall be requested to participate in the study upon signing an informed consent. These participants were employees of KNH working in the critical care areas during the time of data collection. The study was conducted in the critical care units of KNH. Permission to conduct the study was sought from the KNH management. Clearance to conduct the study was sought from University of Nairobi and KNH ethical research committee. Sampling was done using simple random sampling method whereby 123 nurses were picked from the total of 184 nurses. Out of these 3 did not return the questionnaires. Questionnaires were distributed to the participants to give the information needed. Data management: Upon completion, data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables. Finally, propositions and conclusions were made based on apparent patterns or relationships within the data. Results: This study on has sought to ascertain what nurses experience as ethical dilemmas while working in the critical care areas and how they have dealt with these issues. The dilemmas which were of major concern to nurses included: prolonging the dying process, withdrawing/ withholding treatment, resuscitation (DNR) orders (table 8), unsafe nurse- patient ratios and allocation of scarce medical resource, rights of pediatric patients, and nursing of critically ill patients who may pose a risk to the nurses. In dealing with the issues majority of the nurses of the respondents indicated that they would consult with the physicians. Others reported to the nurse team leaders while a few made decisions without consulting a third party. Some socio- demographic factors were shown to influence the experience of ethical dilemmas by the respondents. These included: the age, level of knowledge on ethical issues, professional qualification and availability of work place resources. It was noted those aged below 35 years experienced more dilemmas than others while those whose level of knowledge was low experienced less dilemmas probably due to their inability to identify the dilemmas as accurately as those more knowledgeable. Those who reported to have adequate work place resources experienced fewer dilemmas. They probably knew the channels to follow to resolve issues compared to their colleagues who reported inadequate resources. Conclusion and recommendations- this study shows that ethical dilemmas are an issue of concern among the nurses working in the critical care units of the KNH. The experience of ethical dilemmas is influenced by various socio- demographic factors. In resolving the dilemmas most nurses would consult the Doctors showing that probably the profession is still at the place of subordination to the medical profession. It is notable that some nurses chose to make decisions without consulting. They may probably be confident of their ability to solve problems without involving a third party. Results of the study will be used to make recommendations for shaping of the curriculum for training of critical care nurses to include ethical decision making process as this need for education on ethical issues has been identified as shown in the results. The findings can be utilized as literature for further research on ethical issues.
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    Instructional Roles in Diploma Nursing Education in Meru: Adaptation, Self Sufficiency and Sustainability
    (Kenya Methodist University, 2013) Gitonga, Pius
    Nursing education forms the basis of professional existence, development and sustainable future. The purpose of this study was to establish how nurse educators adapted to increased instructional workload, how they were self-sufficient in performing, and how they would sustain instructional roles in diploma nursing training in colleges within Meru. The target population was fifty two nurse educators who were all invited to participate. Forty six nurse educators participated in the study by availability, willingness to participate and giving a signed consent. A descriptive cross-sectional study design was carried out using a self-administered questionnaire for data collection after a pilot study showed validity and reliability of the tool. Data was collected after consent appointments with the principals and respondents of the participating colleges and was analysed using descriptive statistics performed at 95% confidence interval. The findings are presented in tables, bar graphs, pie charts and a discussion. The study found out that nurse educator to student nurse ratio was 1:20 which indicated instructional role overload. It was evident that there was role overload, teamwork challenges, lack of a mentoring program for novice faculty, and limited role orientation before role assignment. Educators had adequate adaptation mechanisms in planning, adjustment of instructional plans and taking in arising additional instructional roles. Adequate commitment to instructional roles and long service in the same diploma nursing training institution were indicators of selfsufficiency. Adequate adaptation mechanisms and self-sufficiency were indicators of sustainable instructional role performance. The recommendations made were; diploma nursing training institutions to recruit more nurse educators, ensure an orientation program for inducing novice faculty to institutional culture of performing the instructional roles, encourage and ensure planning and execution of plans for instruction and solve instructional challenges as a team for continuity/sustainability of diploma nurse training and education.