Open Access Systematic Review Article

Cesarean Section Rates and Indications in Turkey: A Systematic Review and Meta-Analysis

Ayşe Şenoğlu, Melike Öztürk, Zekiye Karaçam

Asian Journal of Research in Nursing and Health, Page 31-57

Background: The World Health Organization reports that acceptable cesarean section delivery rate would be 10%-15%. High cesarean rates in Turkey constitutes a risk to mother and baby health.

Aims: The aim of this study was to determine total and primary cesarean section rates and indications based on the results of studies conducted in Turkey.

Study Design: The aim of this study was to determine total and primary cesarean section rates and indications based on the results of studies conducted in Turkey.

Place and Duration of Study: The study was carried out over the period January 1-31, 2020 by means of a search of Turkish and English literature indexes.

Methodology: The study was carried out over the period January 1-31, 2020 by means of a search of Turkish and English literature indexes. The searching was carried out in the PubMed, Medline, EBSCO, Web of Science, Google Scholar, National Thesis Center, Dergipark, Ulakbim. The data extracted were combined through meta-analysis.

Results: Data from 31 cross-sectional studies and a total of 479.440 women were included in this systematic review and meta-analysis. It was determined that 177.484 of the women had undergone a cesarean delivery. The meta-analysis indicated that the estimated total cesarean rate was 43% (CI: 0.39-0.47; P< .001) while the primary cesarean rate was 26% CI: 0.12-0.47; P= .028). It was found that cesarean rates at the training/research hospitals (42%; CI: 0.39-0.45; P< .001) and university hospitals (69%; CI: 0.60-0.76; P< .001) were higher than at the state hospitals (29%; CI: 0.23-0.37; P< .001).It was seen that the estimated rates for the most common indications of cesarean births were, previous cesarean sections 46% (CI: 0.43-0.50; P= .051) and fetal distress 19% (CI: 0.15-0.23; P< .001).

Conclusion: The results of the study showed that cesarean rates are generally quite high, particularly at the training/research and university hospitals and that indications are varied.

Open Access Systematic Review Article

Organizational Behavior and Nursing Turnover: A Systematic Review of Research Publications

Lawrencia Aggrey-Bluwey, Raphael Nyarkotey Obu, Barbara Twum-Antwi, Fred Yao Gbagbo

Asian Journal of Research in Nursing and Health, Page 210-239

Background: The nursing workforce is a very important one as nurses form a vital component of healthcare delivery worldwide. The global nursing shortage is continuously wreaking havoc at all levels of the global health system, with no end in sight. Nursing turnover intensions leading to actual turnover has been established as a major cause of this shortage globally.

Objectives: Considering the fact that organizational behavior variables have been established in literature as closely related to nursing turnover, this study sought to present a systematic literature review of empirical literature in the field of organizational behavior and nursing turnover research to chart a path forward.

Methods: The study is a systematic review of literature obtain form published papers relating to the research topic. The authors examined the research issues, theoretical and conceptual approaches, methodologies, geographical distribution and key research trends and gaps related to organizational behavior and nursing turnover research globally. Five electronic databases (i.e., PubMed, Science Direct, Google Scholar, Wiley and Emerald) were the main search engines used. String such as, Nurses turnover intentions, Nurses turnover behavior, organizational behavior and nursing guided the search. More focused inclusion and exclusion criteria were further applied to screen the search results yield 77 most relevant papers used for the review.

Results: Research issues commonly examined in organizational behavior and nursing turnover research are the organizational behavior variables which serve as predictors of nursing turnover (58%). Further, most organizational behavior and nursing turnover papers are atheoretical in nature (44%), employ a quantitative approach to data collection and analyses (96%), are mostly conducted in Asia and Europe (56% and 19%), and focus mostly on the micro level of analyses (38%). From these findings, methodological, contextual, theoretical and operational gaps as well as challenges in the level of analysis and publication outlets. The authors recommend increased funding opportunities for research and publication in this area to whip interest of researchers particularly in developing countries who have funding challenges to research and publish in this area for of global interest.

Open Access Short Communication

Patients’ Perceived Outcome of Specialist Palliative Care at the Komfo Anokye Teaching Hospital, Ghana

Gladys Anyane, Rasheed Ofosu-Poku, Alberta Delali Dzaka

Asian Journal of Research in Nursing and Health, Page 134-140

Aim: To explore the outcome of specialist palliative care services from the perspective patients at the Komfo Anokye Teaching Hospital in Ghana.

Study Design: Qualitative exploratory study

Place and Duration of Study: Palliative Care Unit, Family Medicine Directorate, Komfo Anokye Teaching Hospital, from 7th May to 28th May 2019.

Methodology: Ten (10) patients with advanced cancer were recruited from the palliative care unit using purposive sampling technique. Face-to-face interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematic analysis done.

Results: Two (2) main themes and four (4) sub-themes were identified. Patients reported renewed sense of hope, enhanced self-dignity, improved symptom control and appreciation with care as the outcome of specialist palliative care services.

Conclusion: Palliative care improves the quality of life of patients by improving symptom control and helping them have enhanced self-dignity and sense of hope.

Open Access Original Research Article

Awareness and Use of Insecticide-Treated Mosquito Bed Nets (ITNs) among Students in the Second Cycle Institutions in the Tamale Metropolis of Northern Region of Ghana

Asumah Mubarick Nungbaso, Florence Assibi Ziba, Ruth Nimota Nukpezah, Abubakari Abdulai, Mahama Ayisha Evelyn, Musah Zakiyya, Mahmud Mohammed Yussif

Asian Journal of Research in Nursing and Health, Page 1-12

Introduction: Insecticide-treated nets (ITNs) are a type of personal protection that has been shown to reduce severe illness and death caused by malaria in endemic areas. Effective malaria prevention  reduces  mortality and morbidity rates associated with malaria. The use of ITNs have been shown as one of the effective and simplest way of preventing malaria among the general population. Yet, the awareness and utisation of ITNs are not encouraging in most African countries including Ghana. This study aimed at assessing students' level of awareness and use of insecticide-treated bed nets in the Tamale Metropolis of Ghana's Northern Region.

Methods: A school-based cross-sectional study design was used. The participants were 368 in total from six different schools within the Metropolis. The study participants were recruited using multistage sampling techniques. Data were collected with a pretested questionnaire and the data were analyzed with SPSS version 24. Descriptive and binary logistic regression models were used. The results were presented in the form of frequencies, percentages, and tables.

Results: The study revealed a high level of knowledge (92.1%), possession of ITN (74.2%), 87.0% knew the use of ITNs to prevent malaria. Majority (69.8%) of respondents use ITNs, out of those who use ITNs, only 14.4% indicated sleeping under ITN throughout the year while 85.6% use ITNs during the season of mosquitoes. Students who had a good understanding of the purpose of ITNs were 1.39 times more likely to use ITNs (AOR=1.39, 95% CI=1.25-7.56, P= .002) and students who did not own ITNs were 97.0% less likely to use ITNs (AOR=0.03, 95% CI=0.07-0.14, P>.001).

Conclusion: The study reported high awareness about ITNs and ownership. The usage of ITN all year round however was low. The success of ITNs usage in second cycle institutions is dependent on the government’s ability to provide adequate infrastructure to allow for some space to enable the students to tie their Nets.  The students of the second cycle institutions should be educated more on ITNs usage and its benefits.

Open Access Original Research Article

Effect of Self-Learning Module (SLM) on Knowledge Regarding Legal Aspects of Nursing Care among Nurses

Premalatha Paulsamy, Shadia Hamoud Alshahrani, Krishnaraju Venkatesan, Pranave Sethuraj, MD. Zaheen Hassan Ansari

Asian Journal of Research in Nursing and Health, Page 13-17

Every nurse must demonstrate safe and appropriate clinical practise in order to practise nursing care within legal regulations. It is essential to have up to date knowledge on legal implications of nursing care, to practice safe care. This study was performed to assess the effect of self-learning module (SLM) on knowledge regarding legal aspects of nursing care among nurses working in primary health centres(PHC).The Quantitative approach with one group, pre and post test design was used in this study. Fifty nurses working in primary health centres were selected using convenient sampling technique. A self – learning module (SLM) developed which refers to an independent learning material generated systematically by researchers on legal elements of patient care, such as admission and discharge procedures, protecting confidentiality, informed consent, common laws, and torts relating to patient care. The results show that the increase in knowledge level was significant at p = 0.001 in the post test. The gender (p =0.05) and academic qualification and previous knowledge on legal aspects of patient care was significant at p = 0.01 level.

Open Access Original Research Article

Socioeconomic and Lifestyle Factors as Risks for Suicidality in Nigeria

Zulkiflu Musa Argungu, Murtala Hassan Hassan, Ahmed Sai’du

Asian Journal of Research in Nursing and Health, Page 18-30

Aims: Suicidal behavior is seen in the context of a variety of mental disorders and while many believe that, in general, first episode psychosis is a particularly high-risk period for suicide, no general agreement regarding higher prevalence of suicide in first episode psychosis is achievable. The aim of this study was to evaluate the associated factors of suicidal ideation (SI) and attempt (SA) among Nigerian adults.

Method: The data were collected from Federal Medical Center Birnin Kebbi and the Ministry of Health and Welfare in Kebbi State, a nationally representative sample recruited using a multi-stage clustered probability design.

Results: Female, previously married status, lower education, and lower-income were associated with SI and SA. In particular, the effect of age on SI presented a reverse pattern based on gender; there was a positive association for men and a negative association for women.

Conclusions: This study suggested that low education, low incomes, marital status and age were predominantly associated with the prevalence of SI and SA in women than men. While the lower prevalence of SI was observed in men who engaged in physical activity.

Open Access Original Research Article

Assessment of Quality of Care for Children with Sickle Cell Disease in the South Tongu District of Ghana: Nurses’ Perspective

Raphael Edem Kudzo Korkortsi

Asian Journal of Research in Nursing and Health, Page 58-74

Sickle cell disease (SCD) is a genetic disorder of erythrocytes with frequent episodes of vaso-occlusive crisis and complex morbidities. Studies identify gaps in quality of care for children with SCD including poor knowledge of providers and inadequate logistics. South Tongu district of Ghana records increasing incidence of SCD children’s morbidities and prolonged hospitalizations.

Aims: The study sought to examine the quality of nursing care for children with SCD in South Tongu district and identify opportunities for improvement. The study was conducted in the two hospitals of the South Tongu district of Ghana.

Study Design: A descriptive cross-sectional survey was employed to examine nurses’ knowledge of comprehensive care and their perspectives on quality of structures, processes and outcomes of care for SCD children.

Methodology: Convenient sampling method was used to obtain data from 74 nurses using structured questionnaires based on Donabedian model.

Results: Results showed a mean score of 10.25 out of 20 (51%) indicating inadequate knowledge of comprehensive care. Nurses’ perception regarding quality of service structures for SCD children obtained the worst evaluations (mean=41.50); mostly in the aspects of service logistics and supplies, and access to emergency vehicles (ambulance). The process dimension had the best evaluation (mean=58.68), followed by outcome (mean=43.17). Communication problems within the nursing team and interpersonal relationships with SCD children/families were major challenges affecting quality care in the process and outcome domains. A weak positive relationship (p=0.188) was found between the process and outcome measures.

Conclusion: The study suggests continuous education and training of nurses on comprehensive care for children with SCD and strengthening of all the dimensions of quality care, particularly the structure.

Open Access Original Research Article

Assessing Intravenous Medication Administration among Nurses in the Emergency Department of the Komfo Anokye Teaching Hospital

Henrietta Delecter Ntow, Albert Opoku, Awube Menlah, Abena Agyekum Poku

Asian Journal of Research in Nursing and Health, Page 75-96

Introduction: Patient safety is a major concept in the provision of health care and a significant factor in the maintenance of quality health care services. Medication errors are among one of patients’ safety issues which needs to be dealt with because of consequences it poses to the patient. Intravenous medications administrations have high incidence of error but there is limited evidence of associated factors or error severity.

Objectives: The objective was to evaluate which elements such as nurses' knowledge, training needs, behaviour, and attitude could prevent medication errors in the emergency department during the administration of intravenous (IV) medications.

Methodology: The study used quantitative descriptive design. One hundred and thirty-nine (139) nurses were selected using a simple random sampling method. Open and closed ended structured questionnaires were used as the data collection tool and analysed with Stata Version 15.1 (IBM) Program. Descriptive and Inferential Statistics were employed to analyse the data.

Results and Finding: The results from the study indicated that more than half (65%) of the respondents had adequate knowledge on IV medication administration. Also less than half (19.4%) of the respondents had correct answers on the calculation and dosing of IV medications. The majority (55%) of respondents have poor attitude and poor behaviour (53%) towards IV drug administration. Training on IV medication administration was significant on the behaviour of nurses.

Conclusion: Training should be maximized on calculation and dosing skills of nurses. There should be regular update on the knowledge of nurses on IV medication administration to improve the safety of patients. Standardised reporting systems should be available in the facility so that errors will be captured and audited to reduce the incidence of errors.

Open Access Original Research Article

Ghanaian Nurse Practitioners' Experiences in Negotiating Antibiotic Prescription Stewardship for Upper Respiratory Tract Infections

Abubakari Yussif, Kennedy Asuo-Tannor, Ruth Nimota Nukpezah

Asian Journal of Research in Nursing and Health, Page 97-108

Background: Antibiotic misuse and antimicrobial resistance (AMR) are becoming increasingly serious global health concerns, It necessitates urgent multisectoral action. Although many countries have established antibiotic guidelines, little has been done to investigate nurse practitioners' experiences in negotiating antibiotic prescription stewardship for upper respiratory tract infections.

Aim: To explore Nurse Practitioners' experiences in negotiating antibiotic prescription stewardship for upper respiratory tract infections.

Methods: A semi-structured interview guide was used in this qualitative study. In-depth, face-to-face interviews were held between June 15 and July 22, 2021, with a Purposively sampled 10 nurse practitioners from the Tamale Metropolis. Interviews were recorded on a dictaphone. The recorded interviews were transcribed verbatim and the data were subsequently analyzed using a thematic approach.

Results: Nurse Practitioners' experiences in negotiating antibiotic prescription stewardship for upper respiratory tract infections were classified into five themes: “Antibiotic prescription Governance”, “Professional Practice”, “Reliance on abilities and skills”, “Outcomes of Antibiotic prescriptions” and “Expectations”

Conclusion: A better understanding of the nurse practitioners antimicrobial stewardship for Upper respiratory tract infections is needed to inform antimicrobial prescription behaviour and prevent improper antibiotic administration among the nurse practitioners.

Open Access Original Research Article

Prevalence of Hypertension among Traders in International Market on Orlu Local Government of Imo State

E. Ibebuike Julia, Bienose Gloria Lucy, J. Ogoke Ogechukwu, Nwagwu Adanma Solomon

Asian Journal of Research in Nursing and Health, Page 116-125

The study dwelt on practice of prevalence of hypertension among traders in international market in Orlu Local Government Area of Imo State. The study adopted a descriptive design with a population of 300 traders and all 300 for data collection. The researcher developed three research questions and formulated one null hypothesis. The sampling technique adopted was a simple random sampling method. A well-structured questionnaire was the instrument need for data collection which was validated by two experts in Measurement and evaluation and the supervisor who is an expert in research methods. The collected data were analyzed using the frequency and percentage score statistic while the mean score statistics and correlation method was used to establish the relationship posed in the null hypothesis. Results obtained from the analysis revealed that 100% of the respondent knows about hypertension, majority of the respondents had a good blood pressure value. Some recommendations were proffered among which are: eating adequate diet that is low in sodium, reducing the intake of alcohol and stress management, also hypertensive patients/traders should make sure they try to heed to the instructions of their health care providers, as going for hospital treatment when it develops is not the best option.

Open Access Original Research Article

A Multi-Component Cognitive Stimulation Program among Older People with Dementia in Day Care Centers of Taiwan: A Pilot Study

Su-Hsien Chang, Ming-Hsin Chen, Ching-Len Yu

Asian Journal of Research in Nursing and Health, Page 126-133

Aims: To examine the effectiveness of this multi-component, cognitive stimulation program in day care centers for older people with dementia to prevent cognitive function decline, self-care abilities decline, and behavior problems or the development of depressive moods.

Study Design: Pre- and post-test experimental study with two groups.

Place and Duration of Study: Subjects were recruited from day care centers located in southern Taiwan, between May 2018 to December 2018.

Methodology: Subjects in the experimental group were treated with the multi-component, cognitive stimulation program (MCCSP). Subjects in the comparison group were provided with their usual activities. Activities of MCCSP contained: structured brain exercise activities and music-leading exercise activities. There were twenty-three subjects (n = 14, in the experimental group; n = 9 in the comparison group) participated the study.

Results: For both two groups, the mini-mental status score (MMSE), the score in Cornell Scale for Depression in Dementia (CSDD), the score in Clifton Assessment Procedures for the Elderly Behavior Rating Scale (CAPE-BRS) were slightly improved. The score of ADLs was slightly improved in the experimental group but was declined in the comparison group. Hence, to examine post-intervention changes between experimental and comparison groups, scores showed statistical significant differences in CAPE-BRS and CSDD, but no statistical significant differences in MMSE and ADLs.

Conclusion: The multi-component cognitive stimulation program can delay the occurrence of behavioral problems, depressive mood, and cognitive function declined among older people in day care centers.

Open Access Original Research Article

Quality of Life, Discrimination Experience and Associated Factors among Asian American Nursing Staff in the U.S. during the COVID-19 Crisis

Lihong Ou, Angela Chia-Chen Chen, Wei Li, Karen J. Leong

Asian Journal of Research in Nursing and Health, Page 141-153

Aims: To investigate Asian American nursing staff’s overall quality of life (QoL), discrimination experience and the contributing factors during the Coronavirus disease 2019 (COVID-19) pandemic.

Study Design:  Cross-sectional survey.

Place and Duration of Study: Participants were recruited from national and state-wide nursing organizations in the United States of America to complete online survey between October -December 2020.

Methodology: A convenience sampling approach was adopted for the study. Sample: we recruited 98 Asian American nursing staff (86% female) from six ethnic groups, including Chinese, Filipinos, Indian, Japanese, Korean, and Vietnamese. Valid and reliable measures were used to assess theoretical constructs related to the Vulnerable Populations Conceptual Framework (resources availability, relative risk, health status/QoL). We also conducted descriptive statistics, ANOVA and multiple regression analyses using IBM® SPSS® Statistics 27.0. For the open-ended survey responses, we used thematic content analysis to analyze the qualitative data. Discrepancies in the interpretation were resolved by reaching a consensus among the four researchers.

Results: The mean QoL score of the participants was 69.93 (SD = 13.22), with females demonstrating better QoL than males. Ethnicity was marginally, significantly associated with QoL (P =.06), Moreover, 22% of the participants experienced discrimination and 49% of them reported witnessed discrimination, with race/ethnicity reported as the most common reason. Their QoL was negatively associated with witness discrimination (P =.003), while positively associated with social support (P < .001) and resilience (P =.001).

Conclusion: Our findings provide a timely understanding of AA nursing staff's discrimination experience and factors associated with their QoL during this challenging time. Tailored interventions to mitigate discrimination, strengthening social support and coping strategies to promote resilience are needed to promote QoL among AA nursing staff.

Open Access Original Research Article

Pregnancy Outcomes in Women of Advanced Maternal Age: A Retrospective Cohort Study from Imo State University Teaching Hospital, Orlu

E. Ibebuike Julia, Bienose Gloria Lucy, J. Ogoke Ogechukwu, C. Emesowum Anthonia

Asian Journal of Research in Nursing and Health, Page 154-164

The study dealt on pregnancy outcomes in women of advanced maternal age in Imo State University Teaching Hospital Orlu, Imo state. The study adopted a descriptive survey research design. The researchers developed three research questions with one formulated hypothesis to guide the study. From a target population of 520, a sample of 200 respondents formed the representative sample for the study and this sample was obtained using a simple random sampling technique. However, a well developed four point Likert scale structured questionnaire was validated by experts in measurement and evaluation and the supervisor who is also a research method expert. The records collected from the hospital was used to answer research question one, while the data collected from the questionnaire was analyzed using the mean score statistic, and the Pearson Product moment correlation method was employed to answer the null hypothesis. Results obtained from the analysis revealed that advanced maternal age pregnancy is one that concerns women of age 35 years and above, that many women postpone child bearing to pursue higher educational and other goals and hence become advanced in age by the time they get married and fecundity decreases at that advanced age of 40 years, and so on. Some recommendations were proffered, some of which are: women are advised to engaged in early childbearing at least from the age of 20 through 30 years to run away from fecundity decrease; as caesarean section is too costly, many young ladies should try to carry out early childbirth and later pursue their higher and professional careers; advanced age women who have stopped child bearing should be well informed through community programs of the dangers of mistaken pregnancies at advanced age and train them on the importance of using contraceptives.

Open Access Original Research Article

Zinc Composition in Breast Milk of Lactating Mothers in Urban and Sub-urban Areas in Rivers State

Kalaotaji Glory Biambo, Jonathan Nyebuchi, Emeji Roseline, Amadi Chikadibia Fyneface, Nwisah Laurretta

Asian Journal of Research in Nursing and Health, Page 165-169

Breast milk includes complex proteins, lipids, carbohydrates, and other components that are physiologically active. The composition varies both throughout the lactation period and over a single meal. Zinc is an essential micronutrient of proper development and growth. The aim of this study is to compare breast milk zinc composition between breastfeeding mothers in urban and sub-urban areas in Rivers State. The study was conducted among 59 postpartum subjects between 0 and 10days of child delivery in each group. Sampling was done through a simple random sampling method. Human breast milk was collected using a manual breast pump and analyzed using Atomic Absorption Spectrophotometer (AAS) for the analysis of zinc concentration. Result revealed that there was a significant difference in zinc level between both groups (p<0.05). This work has shown that zinc composition in breast milk of postpartum women vary based on urban and sub-urban settlements.

Open Access Original Research Article

Knowledge and Practice of Blood Transfusion by Nurses at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Abdul Karim Boakye Yiadom, Albert Opoku, Ahmed Adu Oppong, Andrew Adjei Druye, Olivia Nyarko Mensah

Asian Journal of Research in Nursing and Health, Page 170-185

Objective: To assess the knowledge and practice of nurses and midwivies in blood transfusion at Komfo Anokye Teaching. Hospital.

Methodology: This study used the descriptive cross-sectional approach with a total population of 280 Nurses and Midwives from Accident and Emergency, Surgical, Medical and Obstetric and Gyaenacology wards of Komfo Anokye Teaching Hospital. The total number of nurses and midwives working in the hospital is 1194. The sample comprised 280 nurses and midwives working in the selected wards of the hospital.

Results: Most respondents (67.1%) had never participated in an in-service training programme on blood transfusion. Among those who had attended, 15.3% attended once, 7.1% twice, 5.1% thrice and 1.4% more than thrice. Further training needs identified by respondents included sampling (38.9%), administration of blood transfusion (35.4%), adverse reactions (46.1%) and serious hazards (35.4%). Ninety-two nurses and midwives constituting 32.4% indicated there were no written blood administration policy whiles 11.6% did not know of its existence. Among those who indicated there was blood administration policy, the majority (76.1%) had read the policy whereas 23.9% had never done so. Among those who said there was no blood administration policy or who had no knowledge of its existence, almost all except one (124) thought there was a need for one.

Conclusion: In conclusion, this study demonstrates a huge knowledge and training gap for blood transfusion among nurses and midwives at the Komfo Anokye Teaching Hospital.

Open Access Original Research Article

Patient’s Characteristics that Influence Provider Initiated HIV Testing and Counselling Service Uptake in Siaya County, Western Kenya

Vincent O. Ibworo, Anne Ayieko Ibworo

Asian Journal of Research in Nursing and Health, Page 186-194

Introduction: Human Immunodeficiency Virus (HIV) / Acquired Immunodeficiency Syndrome (AIDS) contributes 29.3% of all deaths in Kenya and is among leading causes of mortality in the Country. Kenya National HIV prevalence is at 4.9% with 38% of people living with HIV unaware of their HIV status, hence the need to assess patient’s characteristics that influence Provider Initiated HIV Testing and Counseling (PITC) service uptake.

Methodology: This was a cross sectional study design done in Siaya County western Kenya. Data was collected from 369 patients using structured questionnaire and variable characteristics summarized descriptively.

Results: 55.0%(203) of patients were aged 18-27 years and 70%(258) were female. Those with basic education were 77.5%(286) and 51.3%(189) were married. Patients aged 28-37 years were twice more likely to take up PITC services (OR=2.084, 95%CI=0.137-2.964, p-value=<0.001). The singles (OR=8.509, 95%CI=0.275-1.350, p-value=0.033) were nine times more likely to take up PITC services as compared to the married. Patients with secondary school education (OR=1.640, 95%CI=0.163-1.701, p-value=0.021) were more likely to take up PITC services as compared to those with primary level of education. Employed patients were more likely to take up the PITC services as compared to those in business (OR=3.549, 95%CI=0.005-0.736, p-value=0.027). Repeat HIV testers were four times more associated with PITC service uptake as compared to the first time testers (OR=4.350, 95%CI=1.259-1.822, p-value=0.018). Knowledge on HIV was twice more associated with the uptake of PITC service as compared to HIV stigma reduction (OR=2.403, 95%CI=0.251-1.682, p-value=0.018).

Conclusion: Patients aged 28-37 years, secondary school education, single never married, being employed, a repeat HIV tester and having knowledge on HIV were factors influencing PITC service uptake. Siaya county government needs to design communication strategies targeting the elderly, illiterate, married and put in place mobilization and advocacy approaches that will increase public knowledge on HIV testing.

Open Access Original Research Article

Effect of Different Seasons on Pregnancy Gender Outcome in Sample of Iraqi Women

Israa, F. Jaafar, Safa Muntadher Fawzi, Islam Muntadher Fawzi

Asian Journal of Research in Nursing and Health, Page 204-209

Background: Sex ratio is important for human life since its creation, some families prefer male than females, also its related to some medical problems that affect certain sex than another. Studies showed that   males are more fragile, and might die earlier than females. Climate has a certain effect on  male to female ratio of the pregnancy outcome and certain  seasons  are in favor of male than female reproduction.

Objectives:  To evaluate the effect of climate and seasonal variation on the sex of live births in a sample of pregnant Iraqi women.

Subjects and Methods: This  study was carried out   on 2424 live babies (apart from 225 miscarriages) of  women attending Al–Numan teaching hospital and Al-Husaynia health care center, from  January 2017 till January 2019.The time of last menstrual period recall was taken from each mother of this study. an early ultrasound test was done to confirm the accuracy of pregnancy duration. The gender of live babies, maternal age and parity were recorded.

Results: The highest birth rate were in Autumn (721) then Winter (662), Spring (577) and the least in summer  (521).

The male to female ratio increased with maternal age. Mothers of  30 years and over have 1.09male female ratio as compared with those under the age of  30 years (0.929).

The male female ratio was highest in Autumn 1.06 compared with other seasons; 0.97, 0.9233, 0.887  Winter, Spring and Summer respectively. The abortion rate was only (0.09) from total births.

Conclusion: The best season for conception in Iraq was Autumn. The total male female ratio regardless the season was 0.9659. The male female ratio was best in Autumn then Winter, Spring, lastly Summer. Sex differences shows that;  males  are conceived in seasons of more favorable conditions for reproduction.

Open Access Original Research Article

Nurses Knowledge and Attitudes on Pain Management in Children at the Tamale West Hospital

Nicholas L. Yombei, Vida Nyagre Yakong, Keren-Happuch Twumasiwaa Boateng

Asian Journal of Research in Nursing and Health, Page 240-250

Background: Pain is one of the worse symptoms experienced by hospitalized patients and the major reason for seeking medical and surgical intervention. Despite the existence of guidelines on pain assessment and management, children continue to experience unrelieved pain during hospitalization.

Purpose: The study aimed at assessing Nurses Knowledge on Paediatric Pain Assessment and Management at the Tamale West Hospital.

Methods: A descriptive cross-sectional survey was conducted among 120 registered nurses at the Tamale West Hospital in Ghana. The consecutive sampling technique was employed to recruit participants. A structured questionnaire was used for data collection. Data was analyzed and presented using descriptive and inferential statistics. Data was collected using the Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain.

Findings: The study revealed that majority of nurses at the Tamale West Hospital in Ghana have insufficient knowledge toward pain in children. There is the urgent need to intensify education in this area so as to adequately prepare these nurses to cater for the pain needs of vulnerable children and their families.

Recommendations: Future studies should focus on how student’s theoretical knowledge and attitudes are linked to pediatric pain assessment and management practices.

Open Access Original Research Article

Exploring the Impact of Electronic Health Records Systems on the Performance of a Healthcare Organisation-A Qualitative Study in Ghana

Charles Owusu-Aduomi Botchwey, Richmond Opoku, Francis Acquah

Asian Journal of Research in Nursing and Health, Page 251-257

Introduction: The application of the Electronic Health Record System has been extensively acknowledged as an instrument by healthcare establishments to increase efficiency, operational effectiveness and successfully boost revenue generation.

Aim: This study aimed at empirically appraising the impact of electronic health record system on the performance of Pentecost Hospital in Madina in the La Nkwantanang-Madina Municipality in the Greater-Accra Region of Ghana. 

Methodology: The study adopted a qualitative approach with a case study design. In-depth interviews and a focus group discussion of a total of thirty-five (35) respondents including ten (10) key informants of the Pentecost Hospital were purposely selected to participate in the study due to their role in the implementation of electronic health records system in the facility.

Results and Discussions: The study revealed that frequent loss of data, inadequate knowledge in the management of the system, desire to improve upon work efficiency, longing to have easy access to health records of patients, intermittent waste of client or beneficiary time were among the main factors that led to the introduction of the Electronic Health Record System. The study also identified simplification of activities of the various departments of the hospital, improvement in clients’ satisfaction, reduction in waiting time and speed delivery of healthcare, storage of information being faster and lasting, improvement in revenue generation of the hospital and improvement in quality healthcare delivering as some of the effects of the introduction of electronic patient record management on healthcare delivery at the Pentecost Hospital in Accra.

Conclusion: It is imperative to mention that efficient electronic health record system which is geared towards efficient quality healthcare provision would flourish when parity, effectiveness, efficiency and responsiveness of resource utilisation for quality healthcare are considered as the building blocks.

Open Access Review Article

Motivators and Barriers to the Pursuit of Advanced Nursing Education in Nigeria

Oluwaseun Tosin Aina, Aina Daniel Olagoke, Olumide Abraham Ajayi

Asian Journal of Research in Nursing and Health, Page 109-115

Introduction:  Nursing is a profession that keeps evolving in order to improve care for persons, families and communities as a whole. Education is an important tool of training and retraining these professionals in order to make them keep up with the pace of practice and consequently improve outcome of the healthcare system. Thus, a need to understudy advanced nursing education motivators and barriers in Nigeria.

Study Aim: This study was aimed at finding motivators and barriers to the pursuit of advanced nursing education in a teaching hospital in Nigeria. 

Methodology: This is a descriptive correlation study conducted to identify factors that promote and deter nurses from the pursuit of advanced nursing education in Nigeria. The population was made up of nurses from a teaching hospital in Nigeria.  Stratified random sampling technique was used to select 180 elements from the population. Data was analysed using Statistical Package for Social Sciences version 18(SPSS 18).

Results: Findings showed that majority of nurses were interested in advanced nursing education. However, the tuition fees for such education was high. The findings also showed that job security, increased salary, and promotion were motivators for the pursuit of advanced nursing          education.

Conclusion: The study concluded that job incentives, job security, increased salary, and promotion are motivators for the pursuit of advanced nursing education while cost of tuition, work life balance and family commitment are barriers to the pursuit of advanced nursing education. The study therefore recommended that policy makers should make efforts to provide adequate job incentives for nurses and reduce the cost of tuition for advance nursing education to an affordable level.

Open Access Review Article

A Review of the Role of Health Care Workers in Promoting Awareness and Acceptance of Exclusive Breastfeeding among Mothers

Azibator Beatrice Azuonwu, Nkechinyere Ihekwuaba, Comfort Elechi

Asian Journal of Research in Nursing and Health, Page 195-203

Exclusive breastfeeding (EBF) has been found to be the best means of ensuring the health, growth and development of infants. However, for certain reasons, some mothers do not practice it. The responsibility of passing on information on the relevance of this practice mostly lies in the hands of the healthcare workers. Nevertheless, a critical appraisal of related studies has shown that some health workers have little or no knowledge of the advantages of the EBF as such themselves also do not practice it. This literature review article was aimed at presenting the roles of health care workers in fostering the knowledge and practice of exclusive breastfeeding among women by participating in regular relevant trainings, educating and encouraging the husbands and wives to practice EBF as well as follow-up of mothers during post-natal care to ensure the practice is continued. Relevant articles obtained from journal repositories such as PubMed and Researchgate were reviewed to provide a holistic review of the subject topic. The article highlighted the need for health care workers to actively participate in improving the practice of exclusive breastfeeding by gaining the needed knowledge and ensuring they pass same to the mothers. Training and retraining of health workers was identified as the major means of promoting the awareness and practice of exclusive breastfeeding among mothers.