Abstract:

Postoperative patients experience moderates to severe pain within first 48 hours and this minimizes comfort. This study aims to establish level of nurses’ knowledge, attitudes and practices of postoperative pain assessment and management in Cape Coast. A descriptive quantitative, cross- sectional research design was used. A purposive sampling technique was used to select a sample of 200 nurse anaesthetists and registered nurses from Cape Coast Teaching Hospital and Cape Coast Metropolitan Hospital, Central Region, Ghana. The respondents’ knowledge, attitudes and practices of postoperative pain management were evaluated using opened and closed-ended questionnaires. The findings of the study revealed, more than half of the respondents stated that postoperative pain is best told by the patients themselves but significant number 34% stated health care practitioners can best tell patient pain intensity. Less than half of the respondents observed the effect of pain medication on patients. Almost half of the respondents agreed patients would be addicted when they are given opioids analgesics. It was concluded that there were adequate knowledge of postoperative pain assessment and management among respondents but there is knowledge gap with regards to who best tell if patient experiences pain or not. Knowledge and practices of postoperative pain assessment and management were statistically significantly related and there is a strong relationship between knowledge and practice of postoperative pain assessment management. It was recommended that pain assessment and management should be done before and after administration of analgesia. Pain medications such as opioids should be given as and when necessary.

References:

[1].   Australian and New Zealand College of Anaesthetists (ANZCA). (2005). Acute pain management; scientific evidence. Retrieved from http://www. nursingtimes.net

[2].   Chapman, C. R. & Syrjala, K. L. (2001). Measurement of Pain. In J. D. Loeser (Eds.), Bonica’s Management of Pain (3^rd ed.), pp. 310-328. Philadelphia: Lippincott Williams & Wilkins.

[3].   Chronic Pain Policy Coalition. (2007). A New Pain Manifesto. Retrieved from

www.paincoalition.org.uk

[4].   Good, M., Stanton-H., Grass, J. A., Anderson, G. C., Makii, M. & Geras, J. 2000). Pain after gynaecologic surgery. Pain Manage Nurs. Sep; 1(3): 96-104.

[5].   Gordon, D., Pellino, T. A., Higgins, A. G., et al. (2008). Nurses’ opinions on appropriate administration of PRN range opioid analgesic orders for acute pain. Pain Management Nursing, 9(3), 131-140.

[6].   Hartrick, C. T. (2004). Multimodal postoperative pain management. Am J Health-Syst Pharm, 61, S4-S10.

[7].   Helme, R. D., & Gibson, S. J. (2001). The epidemiology of pain in elderly people. Clinics in Geriatric Medicine, 17(3), 417-431.

[8].   Horner, K. J., Hanson, L. C., Wood, D., Silver, A. G., & Reynolds, K. S. (2005). Using Quality Improvement to Address Pain Management Practices in Nursing Homes. Journal of Pain and Symptoms management, 30(3), 271-277.

[9].   Jablonski, A., & Ersek, M. (2009). Nursing Home Staff Adherence to Evidence-Based Pain Management Practices. Journal of Gerontological Nursing, 35(7), 28-34.

[10].     Jackson, A. (1995). Acute pain: its physiology and the pharmacology of analgesia. Nursing Times. 91(16). 27-28.

[11].     Jackson, D. (1989). A study of pain management: patient controlled analgesia versus intramuscular analgesia. J Intravenous Nurs., 12, 42–51.

[12].     Johansen, A., Romundstad, L., Nielsen, C. S., Schirmer, H. & Stubhaug, A. (2012). Persistent postsurgical pain in a general population: Prevalence and predictors in the Tromsø study. Pain 153(7),1390–1396.

[13].     Kaasalainen, S., Martin-Misener, R., Carter, N., DiCenso, A., Donald, F., & Baxter, P. (2010). The nurse practitioner role in pain management in long‐term care. Journal of Advanced Nursing, 66(3), 542-551.

[14].     Khan, R. S., Ahmed, K. & Blakeway, E. (2011). Catastrophizing: a predictive factor for postoperative pain. Am. J. Surg. 201(1),122–131.

[15].     Klopfenstein, C. E., Hermann, F. R., Mamie, C., Van Gessel, E., & Forster, A. (2001). Pain intensity and pain relief after surgery: A comparison between patients’ reported assessments and nurses’ and physicians’ observations. Acta Anaesthesiologica Scandinavica, 44(1). doi.org/10.1034/j.1399-6576.2000.440111.x.

[16].     Mackintosh-Franklin, C. (2007). Assessment and management of patients with post-operative pain. Nursing Standard, 22(5), 49-55. DOI: 10.7748/ns2007.10.22.5.49.c4640.

[17].     Peters, M. L., Sommer, M., Van Kleef, M. & Marcus, M. A. (2010). Predictors of physical and emotional recovery 6 and 12 months after surgery. Br. J. Surg.97(10),1518–1527.

[18].     Poomnikom, N. (2000). Nurses’ knowledge and practice on pain assessment and pain control in postoperative patients. Master’s thesis of Nursing Science (Adult Nursing), Faculty of Graduate Studies, Mahidol University.

[19].     Prevost, S. (2005). Relieving pain and providing comfort. In Martin, P., Fontaine, D., Hudack, C. et al, editors: Critical care nursing: a holistic approach, ed 8, Philadelphia, Williams & Wilkins.

[20].     Price, D. D. & Bushnell, M. C. (2004). Psychological Methods of Pain Control: Basic Science and Clinical Perspectives, Progress in pain research and management volume 29 International association for the study of pain (pp. 3-18). Seattle: IASP Press.

[21].     Sloman, R., Wruble, A, W., Rosen, G., & Rom, M. (2007). Determination of Clinically Meaningful Levels of Pain Reduction in Patients Experiencing Acute Postoperative Pain. Pain Management Nursing, 7(4), 153-8.

[22].     Swain, M. (2008). The effect of education about pain management on the knowledge and attitudes of nurses. (Unpublished master’s thesis) California State University, Long Beach, CA.

[23]. Taylor, L. K., Kuttler, K. L., Parks, T. A. & Milton, D. (1998). The effect of music in the postanaesthsia care unit on pain levels in women who have had abdominal hysterectomies. J Perianesth Nurs. 13(2). 88-94.

[24].     Watcha, M. F., Issioui, T., Klein, K. W. & White, P. F. (2003). Costs and effectiveness of rofecoxib, celecoxib, and acetaminophen for preventing pain after ambulatory otolaryngologic surgery. Anesth Analg; 96:987.

[25].     Wilson, B. (2007). Nurses’ knowledge of pain. Journal of Clinical Nursing, 16(6), 1012-1020.

Abstract:

Previous quantitative studies have been conducted on breast cancer patients in terms of understanding and comprehending the nature of the disease. However, little is known about the lived experiences of caregivers of breast cancer patients. The study aimed to understand the lived experiences of caregivers of patients with breast cancer.

A Gadamerian-phenomenological approach and Van Manen methodological approach were used in the study. Data were collected using in-depth individual interviews. Researchers utilized unstructured which was aided with audio and/or video recorders. Seven participants included, who provide regular assistance in their activities of daily living, whose age from 21 -65. Data transcription and analysis used van Manen’s hermeneutic phenomenological approach.

The meaning of lived experiences of caregivers of patients with breast cancer revealed thematic categories: caregivers being human, challenges as a caregiver thoughts and emotions emerging, lifting life above illness, caring as a choice, support despite challenges, strengthened relationship, light during darkness, escape amidst difficulties, accepting inevitable death, accepting a loss of a loved one.

It revealed that there is diversity in caregiving experiences among the participants despite going through the same situation, sharing nearly similar experiences of giving care to these patients. The study asserts that there is universality of the caregiving phenomenon across cultures similar or otherwise even with subsets of smaller cultures.

The study can potentially benefit any agencies or institutions that renders care to patient with cancer. This study can potentially add credence to their efforts of providing support mechanisms to the caregivers of breast cancer patients.

References:

[1].   Ainsworth, M. B. (1991). An Ethological Approach to Personality Development. American Psychologist, 333-341.

[2].   Armer, J. S. (2009). 30-Month Post-Breast Cancer Treatment Lymphoedema. Journal of Lymphoedema, 14-18. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826842/

[3].   Aycock, N. B. (2009). Interventions to manage compassion fatigue in oncology nursing. Clinical journal of oncology nursing, 183-91.

[4].   Bauer, D. (1976). An exploratory study of development changes in children's fears. Journal of Child Psychology, Psychiatry, 69-74.

[5].   Beattie, G. W. (1978). Floor apportionment and gaze in conversational dyads. British Journal of Social and Clinical Psychology, 7-15.

[6].   Beattie, G. W. (1981). A further investigation of the cognitive interference hypothesis of gaze patterns during conversation. British Journal of Social Psychology, 243-248.

[7].   Benzein, E. N. (2001). The meaning of the lived experience of hope in patients with cancer in palliative home care. Palliative Medicine, 117-126.

[8].   Berkowitz M.C., K. L. (2001). Moses presages Kubler-Ross: five stages in accepting death, as seen in the midrash. The Mount Sinai Journal of Medicine, 378-83.

[9].   Cegala, D. S. (1979). An Investigation of Eye Gaze and Its Relation to Selected Verbal Behaviour. Human Communication Research, 99-108.

[10].  Chandra, P. D. (2007). Denial as an experiential phenomenon in serious illness. Indian Journal of Palliative Care, 8-14.

[11].  Clark, J., & Lecky, J. (2008). Philosophy, understanding and the consultation: a fusion of horizons. British Journal of General Practice, 58-60.

[12].  DeSteno, D. P. (2000). Beyond Valence in the Perception of Likelihood: The Role of Emotion Specificity. Journal of Personality and Social Psychology, 397-416.

[13].  Cherniack, E. P., & Cherniack, A. R. (2014). The Benefit of Pets and Animal-Assisted Therapy to the Health of Older Individuals. Current Gerontology and Geriatrics Research, 2014, 1-9.

doi:10.1155/2014/623203

[14].  Effendy, C., Vernooij-Dassen, M., Setiyarini, S., Kristanti, M. S., Tejawinata, S., Vissers, K., & Engels, Y. (2014). Family caregivers' involvement in caring for a hospitalized patient with cancer and their quality of life in a country with strong family bonds. Psycho-Oncology 24:, 585-591.

[15].  Elnasseh, A. (2016). Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina. International Journal of Alzheimer’s Disease, 1-10.

[16].  Farran C.J., K.-H. E. (1991). Finding meaning: an alternative paradigm for Alzheimer's disease family caregivers. The Gerontologist, 483-9.

[17].  Finlay, L. (2006). ‘Rigour’, ‘Ethical Integrity’ or ‘Artistry’? Reflexively Reviewing Criteria for Evaluating Qualitative Research. British Journal of Occupational Therapy, 69(7), 319–326. https://doi.org/10.1177/030802260606900704

[18].  Fishbein, M., & Ajzen, I. (1980). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.

[19].  Fleming, V. G. (2003). Hermeneutic research in nursing: developing a Gadamerian-based research method. Nursing Inquiry, 113-120.

[20].  Perez, J., & Perez, J. (n.d.). Educational Profile of the Philippines and Best Practices in Filipino Schools and Classrooms. Retrieved from

https://www.academia.edu/7574715/EDUCATIONAL_PROFILE_OF_THE_PHILIPPINES_AND_BEST_PRACTICES_IN_FILIPINO_SCHOOLS_AND_CLASSROOMS

[21].  FRANKL, V. E. (2019). DOCTOR AND THE SOUL: From psychotherapy to logotherapy. Place of publication not identified: VINTAGE.

[22].  Fronczek, A. E. (2015). A phenomenologic study of family caregivers of patients with head and neck cancers. Oncology Nursing Forum.

[23].  Grypdonck, M. V. (2011). Adherence to leg ulcer lifestyle advice: qualitative and quantitative outcomes associated with a nurse-led intervention. Journal of clinical nursing, 429-43.

[24].  Guest, G. B. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 59-82.

[25].  Herrera AP, L. J.-V. (2009). Religious coping and caregiver well-being in Mexican-American families. Aging & mental health, 84-91.

[26].  How to manage stress how to - Mind, the mental health charity. (n.d.). Retrieved from https://www.mind.org.uk/media/1993364/how-to-manage-stress_2015.pdf

[27].  Hunt, J. C. (2003). The quality of spiritual care--developing a standard. International Journal of Palliative Nursing, 208-15.

[28].  Jacobson, D. (1986). Types and timing of social support. Journal of health and social behavior, 250-264.

[29].  Juth, V., Silver, R. C., & Sender, L. (2015). The shared experience of adolescent and young adult cancer patients and their caregivers. Psycho-Oncology 24:, 1746-1753.

[30].  Kaataoka-Yahiro, M. R., Ceria, C., & Yoder, M. (2004). Grandparent Caregiving in Filipino American Families. Journal of Cultural Diversity. Vol. 11, No. 3.

[31].  Kleinman, A. (2009). Caregiving: The odyssey of becoming more human. The Lancet , 292-293.

[32].  Kloosterhouse, V. A. (2002). Families' use of religion/spirituality as a psychosocial resource. Holistic Nursing Practice, 61-76.

[33].  Kongsuwan, W. C. (2011). Thai Buddhists' experiences caring for family members who died a peaceful death in intensive care. International journal of palliative nursing, 329-36.

[34].  LeSeure, P. C.-a. (2015). The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis. J. Pers. Med, 406-439.

[35].  Lkhoyaali, S., Ait El Haj, M., El Omrani, F., Layachi, M., Ismaili, N., Mrabti, H., & Errihani, H. (2015). The burden among family caregivers of elderly cancer patients: prospective study in a Moroccan population. BMC Research Notes.

[36].  Lopez, V. C. (2012). Male Caregivers of Patients With Breast and Gynecologic Cancer. Cancer Nursing, 402-410.

[37].  McLellan, E. M. (2003). Beyond the Qualitative Interview: Data Preparation and Transcription. Field Methods, 63-84.

[38].  Mellon, S. K.-G. (2006). A family-based model to predict fear of recurrence for cancer survivors and their caregivers. Psycho-Oncology 16:, 214-223.

[39].  Moloney, S. G. (2015). Empathy and spiritual care in midwifery practice: Contributing to women's enhanced birth experiences. Women and birth: journal of the Australian College of Midwives, 323-8.

[40].  Morrison, M. L. (2007). Health Benefits of Animal-Assisted Interventions. Complementary Health Practice Review, 12(1), 51–62. https://doi.org/10.1177/1533210107302397

[41].  Niemiec, R. S. (2011). Understanding Death Attitudes: The Integration of Movies, Positive Psychology, and Meaning Management. Death Studies, 387-407.

[42].  Nolan, P. (2001). Mental health nurses’ perceptions of nurse prescribing. Journal of Advanced Nursing, 527–534.

[43].  Norbeck, J. (1981). The development of an instrument to measure social support. Nursing research, 264-9.

[44].  Otis-Green, S. J. (2012). Enhancing the Social Well-Being of Family Caregivers. Seminars in Oncology Nursing, 246-255.

[45].  Prigerson HG, H. M. (2013). Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11. PLOS Medicine, 10-12.

[46].  Redhwan, A. A. N., Sami, A. R., Karim, A., Chan, R., & Zaleha, M. (2009). Stress and coping strategies among management and science university students: A qualitative study. The International Medical Journal of Malaysia, 8(2), 11–15.

[47].  Rothing, M. M. (2015). Balancing needs as a family caregiver in Huntington's disease: a qualitative interview study. Health and social care in the community, 669-76.

[48].  Senden, C. V. (2015). The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: A qualitative study. International Journal of Nursing Studies, 197-206.

[49].  Shumaker, S., & Brownell, A. (1984). Toward a theory of social support: Closing conceptual gaps. Journal of social issues, 40(4), 11-36.

[50].  Silverman, J., Kurtz, S. M., & Draper, J. (2013). Skills for communicating with patients. London: Radcliffe.

[51].  Stajduhar, K. I. (2003). Examining the perspectives of family members involved in the delivery of palliative care at home. Journal of palliative care, 27-35.

[52].  Tilden, V. (1986). New perspectives on social support. The nurse practitioner, 60-61.

[53].  Treloar, L. L. (2002). Disability, spiritual beliefs and the church: the experiences of adults with disabilities and family members. Journal of Advanced Nursing, 594-603.

[54].  Watson, J. S. (2002). Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development. Journal of Advanced Nursing, 452-461.

[55].  Weaver, A. F. (2004). Religion and spirituality in three major general medical journals from 1998 to 2000. Southern medical journal, 1245-9.

[56].          Williams, F. J. (2015). Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study. Health Expectations, 631-642.

[57].  

Abstract:

Background: Clinical skills acquisition is an essential part of nurse training. However, acquisition of clinical skills could be influenced by the clinical learning environment. The objective of the study was to explore factors influencing student nurses’ learning during clinical practice and develop guidelines for learning enhancement.

Methods: A descriptive cross-sectional study was conducted at Rusangu University in Monze, Southern Province and the study population were nursing students. A total of 50 respondents participated in the study. A proportional stratified random sampling method was used to select the sample. Data was collected using a self-administered questionnaire; analysed using the Statistical Package for the Social Sciences software for Windows version 20. Pearson Chi-Square was used to assess relationship of specific factors and students’ learning experience with a significance level of 0.05.

Results: 50% of the respondents were aged between 21 and 25 years of age, 64% were females whereas 36% were males. Students level of training, 50% were in fourth and above year and 40% were allocated to the clinical area for a minimum of one to two weeks duration. Students overall rating for clinical learning was average at 54%; availability of clinical teachers and Ward Managers was rated at 70%. Communication among students and staff was rated as being good at 58%; 66% of the respondents said staff had a positive attitude towards them. A significant association between level of training and support received during first week of placement (p= 0.000) and time allocated to the unit or ward (p= 0.045) was found Staff shortage, lack of equipment and medical surgical supplies, short practice time in some specialised units, inaccessible ward managers for consultations and clinical supervisors affected students learning.

Conclusion: The School should address the above-mentioned factors and design strategies to improve the clinical learning environment.

References:

[1].   M. A. I. Abdulmutalib, M. A. N. El Seesy, and A. S. Yousuf, H, ‘Nursing Students’ Opinions on Facilitating and Hindering Factors in the Clinical Training Setting, American Journal of Nursing Science (2019), Vol. 8, No. 1, pp. 1-8.

[2].   S. Adibelli, F. Korkonaz, ‘Factors affecting nursing students learning in clinical practice’. Conference paper: Annual Worldwide nursing conference, (2017).

[3].   S. Baraz, R. Memarian, and Z. Vanaki, ‘Learning challenges of nursing students in clinical environments: A qualitative study in Iran’. Journal of Education and Health promotion, (2015). 4:52.

[4].   B. P. Basavantapa, Nursing Research. Jaypee Brothers Medical Publishers LTD, New Delhi India (2007).

[5].   R. Borzou, M. Safari, M. Khodavisi and B. Torkaman, the viewpoints of nurses towards applicability of nursing curriculum in hospitals affiliated to Hamedan University of Medical Sciences, Iranian Journal of Medical Education. (2009), vol. 8, no. 2, pp. 205–211, 2009. View at Google Scholar.

[6].   Y. Botma, J. Jeggels and, R. Uys,’ Preparations of preceptors. Trends in nursing,’ (2012). Retrieved 17 November 2018 from http://fundisa.journals.ac.za.

[7].   J. Bruce, H. Klopper and J. Mellish, ‘Teaching and Learning the Practice of Nursing’. Fifth ed. Cape Town, South Africa: Heinemann (2011).

[8].   P., N. Ellemes, T. Bvumbwe, and M., C. Chipeta, ‘Using preceptors to improve nursing students’ clinical learning outcomes: A Malawian students’ perspective’, Mzuzu University (2017).

http://www.elsevier.com/journals/international-journal-ofnursing-sciences/2352-0132. Accessed on 11^th July 2018.

[9].   M. H. Gemuhay, A. Kalolo, R. Mirisho, B. Chipwaza and E. Nyangena, ‘Factors Affecting Performance in Clinical Practice among Preservice Diploma Nursing Students in Northern Tanzania. Nursing Research and Practice,’ (2019), Volume 2019, Article ID 3453085, 9 pages,

https://doi.org/10.1155/2019/3453085.

[10].  E. Gurkava, K. Ziakova, S. Cibrikova, D. Magurova, A. Hudakova and, S. Mvoskova, ‘Central European Journal of Nursing and Midwifery,’ (2016), 7 (3):470-475.

[11].  N. Jamshidi, Z. Molazem, F. Sharif, C. Torabizadeh, and M., N. Kalyani, ‘The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study,’ The Scientific World Journal. (2016), 1-7.

[12].  V. Lambert and M. Glecken, ‘Clinical education facilitators: A literature review. Issues in Clinical Nursing,’ (2005), 14: 664-673. PMid: 15946274 http://dx.doi.org/10.1111/j.1365-2702.2005.01136.x Accessed on 11^th July 2018.

[13].  Lawal, J., Weaver, S., Bryan, V., and Lindo, L., M., J. Factors that influence the clinical learning experience of nursing students at a Caribbean school of nursing. University of the West Indies, Mona, Jamaica. Journal of Nursing Education and Practice (2016), Vol. 6, No. 4

[14].  S. N. Lipinge and E. S. Venter, ‘Student nurses’ experiences during a rural community placement programme in Namibia,’ (2003), 26 (4):5-12. https://www.scribd.com/archive/plans?doc=292633382. Accessed on 7^th August 2018.

[15].  S. Llewellyn-Johnson, S. Lopez, and J. L. M Lindo Stress and burnout experienced by BScN final year nursing students in Jamaica,’ West Indian Medical Journal (2011); (Suppl. 4): 60.

[16].  B. T. Mabuda, E. Potgieter, and U. U. Alberts, ‘Student nurses’ experiences during clinical practice in the Limpopo Province,’ (2008), 31, 19–27.

[17].  M., R. Moeti, S. E. Van Niekerk, and C. E. Van Velden,’ Perceptions of the clinical competence of newly registered nurses in the North West Province,’ (2004) 27(3):72-84.

[18].  P. T. Motsilanyane, Exploring the clinical accompaniment challenges second-year students experience at nursing education institution in North West. Pretoria: University of Pretoria (2015).

[19].  G. Msiska, P Smith, T Faucet (2014). The life world of Malawian undergraduate student nurses: The challenges of learning in resource poor clinical settings. IJANS 1: 35 -34.

[20].  F. Murphy, M. Rosserand, R. Bevan, Nursing students’ experiences and preferences regarding hospital and community placements. Nurse Education in Practice. (2012); 12(2012): 170-175. PMid: 22265991 http://dx.doi.org/10.1016/j.nepr.2011.12.007 . Accessed on 11^th July 2018.

[21].  F. H. Nabavi, Z. Vanaki, ‘Professional approach. The key feature of effective clinical education in Iran. Nurse Education Today,’ (2010), 30:163-168.

[22].  M. Nabolsi, A. Zumot, L. Wardam, and F. Abu-Moghli,’the experience of Jordanian nursing students in their clinical practice,’ Procedia-Social and Behavioral Sciences, (2012), vol. 46, pp. 5849–5857, 2012. View at Publisher View at Google Scholar.

[23].  E. Papastavrou, E. Lambrinou, and H. Tsangari, Student nurses experience of learning in the clinical environment. Nurse Education in Practice (2010). 10(3): 176-182. PMid: 19700368

http://dx.doi.org/10.1016/j.nepr.2009.07.003. Accessed on 11^th July 2018.

[24].  L Rajesweran (216). Clinical experiences of nursing students at a selected Institute of Health Sciences in Botswana. Health science Journal volume 10, Issue 5.

[25].  M. Saarikoski, P. Kaila, E. Lambrinou, R., M. Pérez Cañaveras, E. Tichelaar, M. Tomietto, and Warne, T. Students’ experiences of cooperation with nurse teacher during their clinical placements: an empirical study in a Western European context. Nurse Education in Practice (2013); 13(2):78–82.

[26].  F. Sharif, and S. Masoumi, ‘A qualitative study of nursing student experiences of clinical practice,’ (2005), BMC Nurs. 4:1–7.

[27].  U. S. Tiwakeni, C. L. Caranto and L. J. J. T. David, the real world: Lived experiences of student Nurses during clinical practice, (2015), Volume 5, No 2.

[28].  T. Warne, U. B. Johansson, E. Papastavrou, E. Tichelaar, M. Tomietto, K. Van den Bossche, M.F. Moreno, and M. Saarikoski, ‘An exploration of the clinical learning experience of nursing students in nine European countries.’ Nurse Education Today (2010); 30. (8):809–815.Zanovitová M, Lepiešová.

Abstract:

Blended learning (BL) is positive development in education. This method provokes the learner’s critical thinking and given different ways for implementation of their knowledge in real life. The objective of the study is to determine the difference of blended learning teaching strategy and lecture-based teaching strategy on the learning outcome of the undergraduate nursing students in Lahore, Pakistan.

Quasi experimental study design was used by utilizing control and experimental groups for comprising two methods of students learning. 197 participants were recruited in control group and experimental groups. The study sample was determined through the convenient sampling method.

In this study the establishing reliability and construct validity of the tool was 0.7 and 0.75 respectively. In addition to this internal consistency Cronbach's coefficient alpha was computed 0.70. Generally, the reliability and validity were considered acceptable and satisfactory above 0.70.

The results findings revealed that blended learning has significant relationship with awareness (p= < 0.02) learning strategies (p= < 0.07) learning activities (p=< 0.06), evaluation (p=0.04) among the experimental groups.

In the conclusion, blended learning significantly improves the learning of the students and provides the space for better skills in the clinical setting simultaneously. Thereafter, institutions, policy makers and regulatory bodies should incorporate this strategy in the nursing curriculum in Pakistan.

References:

[7].   Sadeghi R, SEDAGHAT MM, AHMADI FS. Comparison of the effect of lecture and blended teaching methods on students’ learning and satisfaction. Journal of advances in medical education & professionalism. 2014 Oct;2(4):146.

[8].   Meguid EA, Collins M. Students’ perceptions of lecturing approaches: traditional versus interactive teaching. Advances in medical education and practice. 2017;8:229.

[9].   Kouti L, Aghsam Z, Bargard MS, Javadi MR, Aghakouchakzadeh M, Eslami K. Comparison of the effectiveness of three educational methods (e-learning, lectures and blended) on pharmacy students' knowledge of non-prescription drugs. Pharmacy Education. 2018 Jun 27;18.

[10].  Yeh YC, Huang LY, Yeh YL. Knowledge management in blended learning: Effects on professional development in creativity instruction. Computers & Education. 2011 Jan 1;56(1):146-56.

[11].  Woltering V, Herrler A, Spitzer K, Spreckelsen C. Blended learning positively affects students’ satisfaction and the role of the tutor in the problem-based learning process: results of a mixed-method evaluation. Advances in Health Sciences Education. 2009 Dec 1;14(5):725.

[12].  Vo MH, Chang ZH, Diep NA. Blended Learning Components Important to Student Learning: A Study on the Perceptions of Instructors. Turkish Online Journal of Educational Technology. 2017 Nov 1:123.

[13].  Ramnanan CJ, Pound LD. Advances in medical education and practice: student perceptions of the flipped classroom. Advances in medical education and practice. 2017;8:63.

[14].  Ramzan M, Ansar A. Learning and Teaching Styles at Wah Medical College; A Qualitative Approach. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2018 Jan 10;13(4):275-80.

[15].  Taroc RD, Paculba HL, Tan RA, Maghanoy MC. The Performance of Bachelor of Science in Maritime Education Students of Siquijor State College, Siquijor, Philippines in General Chemistry and Their Attitudes Towards the Subject. CNU Journal of Higher Education. 2018 Jan 16;9:197-206.

[16].  Pradhan D, Mukherjee V, Zakhary B, Sauthoff H. A23 EMERGING STRATEGIES TO TRAIN MEDICAL PROFESSIONALS: A Novel Blended Learning Course On Ultrasound For Rapid Assessment Of Acute Respiratory Failure. American Journal of Respiratory and Critical Care Medicine. 2017;195.

[17].  Cummings C, Mason D, Shelton K, Baur K. Active learning strategies for online and blended learning environments. InFlipped Instruction: Breakthroughs in Research and Practice 2017 (pp. 88-114). IGI Global.

[18].  Springer S, Springer A. How English Learners Say Blended Learning Improves Their Language Skills. InE-Learn: World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education 2018 Oct 15 (pp. 985-988). Association for the Advancement of Computing in Education (AACE).

Abstract:

Social and cultural beliefs in different communities of Zambia have continued to perpetrate Gender Based Violence and this has affected victims in many ways. The impact of GBV has led to an increase in morbidity and mortality rates globally after its physical, mental, emotional and social inflictions on the victims. This has placed a cost on the quality of life as lifestyle changes occur. Therefore, the aim of this study was to establish the socio-cultural factors that are associated with Gender Based Violence in Chipata City. This study adopted an explorative mixed method design. The study sequentially collected quantitative and qualitative data. Responses were gotten from 381 respondents. The sample was deduced from 1,922 female victims were registered from 2014 to 2016 at the GBV One Stop Centre. The discussions about the study revealed that and weak community support, poor relationships, alcohol and poverty, are among the major contributing factors to GBV. The major health effects could be either physical implications like a loss of an organ after assault, unwanted pregnancies and STI infections. Most of these findings were attributed to the spouses/partners. Sensitization, in this case, could be the answer to curb the incidences of GBV. In conclusion, the study explored the experiences female survivors in Chipata city have had following Gender Based Violence. Socio-cultural and economic factors have had a major impact in enhancing GBV and victims mentioned that poverty, substance abuse and inactive law enforcement directly fueled the acts of violence. The key recommendation is massive sensitization about GBV and reinforcing laws to strengthen the curbing of violence.

References:

[1].   Abdi, A. M. (2016). Refugees, gender-based violence and resistance: a case study of Somali refugee women in Kenya Women, Migration and Citizenship (pp. 245-266): Routledge.

[2].   Aberdeen, S. (2015). Concept mapping: a tool for improving patient care. Nursing Standard, 29(48), 49-58.

[3].   Alesina, A., Brioschi, B., & Ferrara, E. L. (2016). Violence against women: A cross-cultural analysis for Africa (No. w21901) National Bureau of Economic Research.

[4].   Alesina, A., Brioschi, B., & Ferrara, E. L. (2016). Violence against women: A cross-cultural analysis for Africa (No. w21901). National Bureau of Economic Research.

[5].   Bryman, A. (2016). Social research methods: Oxford university press.

[6].   Castellino, J., & Bradshaw, S. (2015). Sustainable development and social inclusion: why a changed approach is central to combating vulnerability. Wash. Int'l LJ, 24, 459.

[7].   Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches: Sage publications.

[8].   Crisman, B., Dykstra, S., Kenny, C., & O'Donnell, M. (2016). The Impact of Legislation on the Hazard of Female Genital Mutilation/Cutting: Regression Discontinuity Evidence from Burkina Faso. Center for Global Development Working Paper (432). Retrieved from

http://dx.doi.org/10.2139/ssrn.2840992.

[9].   Danielson, L. (2018). Fundamentals of clinical research. 2: Designing a research study. Anaesth Pain & Intensive Care, 22(1), 131-138.

[10].  Decker, M. R., Latimore, A. D., Yasutake, S., Haviland, M., Ahmed, S., Blum, R. W., & Astone, N. M. (2015). Gender-based violence against adolescent and young adult women in low-and middle-income countries. Journal of Adolescent Health, 56(2), 188-196. Retrieved from

https://www.wilsoncenter.org/event/gender-based-violence-sub-saharan-africa-review-demographic-and-health-survey-findings-and.

[11].  Decker, M. R., Lyons, C., Billong, S. C., Njindam, I. M., Grosso, A., Nunez, G. T., . . . Baral, S. (2016). Gender-based violence against female sex workers in Cameroon: prevalence and associations with sexual HIV risk and access to health services and justice. Sex Transm Infect, 92(8), 599-604. Retrieved from http://dx.doi.org/10.1136/sextrans-2015-052463.

[12].  Ditmore, M. (2015). Trafficking in lives: How ideology shapes policy Trafficking and prostitution reconsidered (pp. 149-168): Routledge.

[13].  Edström, J., Hassink, A., Shahrokh, T., & Stern, E. (2015). Engendering men: a collaborative review of evidence on men and boys in social change and gender equality. doi:

http://opendocs.ids.ac.uk/opendocs/handle/123456789/7059.

[14].  Ellsberg, M., Arango, D. J., Morton, M., Gennari, F., Kiplesund, S., Contreras, M., & Watts, C. (2015). Prevention of violence against women and girls: what does the evidence say? The Lancet, 385(9977), 1555-1566. doi:

https://doi.org/10.1016/S0140-6736(14)61703-7.

[15].  Ellsberg, M., Arango, D. J., Morton, M., Gennari, F., Kiplesund, S., Contreras, M., & Watts, C. (2015). Prevention of violence against women and girls: what does the evidence say? The Lancet, 385(9977), 1555-1566.

[16].  England, P. (2017). Households, employment, and gender: A social, economic, and demographic view. Routledge.

[17].  Essia, U. (2015). Rethinking the Gender Discourse in Africa.

[18].  Evans, A. (2018). Cities as catalysts of gendered social change? Reflections from Zambia. Annals of the American Association of Geographers, 108(4), 1096-1114. Retrieved from

https://doi.org/10.1080/24694452.2017.1417820.

[19].  García-Moreno, C., Zimmerman, C., Morris-Gehring, A., Heise, L., Amin, A., Abrahams, N., . . . Watts, C. (2015). Addressing violence against women: a call to action. The Lancet, 385(9978), 1685-1695. doi: https://doi.org/10.1016/S0140-6736(14)61830-4.

[20].  Green, J., & Thorogood, N. (2018). Qualitative methods for health research: Sage.

[21].  Grose, R. G., Roof, K. A., Semenza, D. C., Leroux, X., & Yount, K. M. (2019). Mental health, empowerment, and violence against young women in lower-income countries: A review of reviews. Aggression and Violent Behavior. Retrieved from https://doi.org/10.1016/j.avb.2019.01.007.

[22].  Guedes, A., Bott, S., Garcia-Moreno, C., & Colombini, M. (2016). Bridging the gaps: a global review of intersections of violence against women and violence against children. Global health action, 9(1).

[23].  Gurung, S., & Acharya, J. (2016). Gender-based violence among pregnant women of Syangja District, Nepal. Osong public health and research perspectives, 7(2), 101-107. Retrieved from

https://doi.org/10.1016/j.phrp.2015.11.010.

[24].  Halcomb, E. J., & Hickman, L. (2015). Mixed methods research.

[25].  Hegdahl, H. K., Fylkesnes, K. M., & Sandøy, I. F. (2016). Sex differences in HIV prevalence persist over time: evidence from 18 countries in sub-Saharan Africa. PLoS ONE, 11(2), e0148502. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148502.

[26].  Heise, L. L., & Kotsadam, A. (2015). Cross-national and multilevel correlates of partner violence: an analysis of data from population-based surveys The Lancet Global Health, 3(6), e332-e340.

[27].  Imperial Writers. (2016). How to calculate a reliable sample size using Taro Yamane method. Retrieved from https://uniprojectmaterials.com/view-blog/how-to-calculate-a-relaible-sample-size-using-taro-yamane-method.

[28].  Ingham-Broomfield, R. (2015). A nurses' guide to qualitative research. Australian Journal of Advanced Nursing, The, 32(3), 34.

[29].  Ingham-Broomfield, R. (2015). A nurses' guide to qualitative research. Australian Journal of Advanced Nursing, The, 32(3), 34.

[30].  Jaffe, P. (2018). Children exposed to domestic violence: Current issues in research, intervention, prevention, and policy development. Routledge. Retrieved from

https://books.google.co.zm/books?hl=en&lr=&id=pD62BQAAQBAJ&oi=fnd&pg=PA209&dq=Rosewater,+A.+(2009).+Promoting+Prevention,+Targeting+Teens:+An+Emerging+Agenda+to+Reduce+Domestic+Violence.+San+Francisco,+CA:+Family+Violence+Prevention+Fund&ots=YUuJBbesnx&sig=wuf1JqDOaIFenvNYd0bDdXG5hLA&redir_esc=y#v=onepage&q&f=false.

[31].  Jayanthi, P., Thirunavukarasu, M., & Rajkumar, R. (2015). Academic stress and depression among adolescents: a cross-sectional study.

[32].  Jayasinghe, N., & Ezpeleta, M. (2019). Ensuring women follow the money: Gender barriers in extractive industry revenue accountability in the Dominican Republic and Zambia. The Extractive Industries and Society. doi: https://doi.org/10.1016/j.exis.2019.04.003.

[33].  Kalev, A., & Deutsch, G. (2018). Gender inequality and workplace organizations: Understanding reproduction and change Handbook of the Sociology of Gender (pp. 257-269).

[34].  Kaur, D. (2017). Interlinking Globalization and Gender. Journal of Asia Pacific Studies.

[35].  Kelmendi, K. (2015). Domestic violence against women in Kosovo: A qualitative study of women’s experiences. Journal of interpersonal violence, 30(4), 680-702. Retrieved from

https://doi.org/10.1177/0886260514535255.

[36].  Krizsan, A. (2018). Translating domestic violence norms in five countries of Central Eastern Europe Policy Experiments, Failures and Innovations: Edward Elgar Publishing.

[37].  Kumar, R. (2019). Research Methodology, A step by step guide for beginners (3rd Edition ed.). London SAGE Publications Ltd.

[38].  Lamprell, G., & Braithwaite, J. (2017). Mainstreaming gender and promoting intersectionality in Papua New Guinea’s health policy: a triangulated analysis applying data-mining and content analytic techniques. International Journal for Equity in Health, 16(1), 65. Retrieved from

https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0555-5.

[39].  McCloskey, L. A. (2016). Focus: Sex and Gender Health: The Effects of Gender-based Violence on Women’s Unwanted Pregnancy and Abortion. The Yale journal of biology and medicine, 89(2), 153. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918882/.

[40].  McCloskey, L. A., Boonzaier, F., Steinbrenner, S. Y., & Hunter, T. (2016). Determinants of Intimate Partner Violence in Sub-Saharan Africa: A Review of Prevention and Intervention Programs. Partner Abuse, 7(3). Retrieved from

http://www.domesticviolenceintervention.net/wp-content/uploads/2016/08/Africa.DV_.Programs.pdf.

[41].  Ministry of Gender and Child Development. (2014). National Gender Policy 2014. Retrieved from http://extwprlegs1.fao.org/docs/pdf/zam152916.pdf.

[42].  Moser, C. A., & Kalton, G. (2017). Survey methods in social investigation. Routledge: Sage publications.

[43].  Mueller, V., Peterman, A., Billings, L., & Wineman, A. (2019). Exploring Impacts of Community-Based Legal Aid on Intrahousehold Gender Relations in Tanzania. Feminist Economics, 1-30. Retrieved from

https://doi.org/10.1080/13545701.2018.1554906.

[44].  Mukhopadhyay, M. (2016). Mainstreaming gender or “streaming” gender away: feminists marooned in the development business The Palgrave Handbook of Gender and Development (pp. 77-91): Springer.

[45].  Mutumba, M., Wekesa, E., & Stephenson, R. (2018). Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis. BMC Public Health, 18(1), 430. Retrieved from

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5331-y.

[46].  Mwaba, S. O. (2016). Gender Based Violence: The Zambian Situation. Studies in Social Sciences and Humanities, 4(2), 105-118. Retrieved from www.rassweb.org/rss_weblogin/pages/ResearchPapers/Paper%205_1496409059.pdf.

[47].  Mwale, A. T. (2018). Women’s empowerment and use of Maternal Health Services in Zambia in 2010s. Harare: Cordaid.

[48].  Nakray, K., & Kafukanya, N. M. (2019). Gender mainstreaming in multi-level political governance in urban Zambia: A critical review of Millennium Development Goal (MDG) achievements. Development Southern Africa 36(1), 111-126. doi: https://doi.org/10.1080/0376835X.2018.1486180.

[49].  Oakley, A. (2016). Sex, gender and society. London: Routledge.

[50].  Odimegwu, C., Bamiwuye, O. S., & Adedini, S. A. (2015). Gender-based violence as a new proximate determinant of fertility in sub-Saharan Africa. Southern African Journal of Demography, 16(1).

[51].  Oluwaseyi, S. D., & Latifat, I. (2015). Intimate Partner Violence and Contraceptive Behaviour: Evidence from Malawi and Zambia. Southern African Journal of Demography, 16(1), 123.

[52].  Parsons, J., Edmeades, J., Kes, A., Petroni, S., Sexton, M., & Wodon, Q. (2015). Economic impacts of child marriage: a review of the literature. The Review of Faith & International Affairs, 13(3), 12-22. doi: https://doi.org/10.1080/15570274.2015.1075757.

[53].  Simona, S., Muchindu, M., & Ntalasha, H. (2018). Intimate Partner Violence (IPV) in Zambia: Socio-demographic Determinants and Association with Use of Maternal Health Care. International Journal of Social Science Studies, 6(42). Retrieved from https://heinonline.org/HOL/LandingPage?handle=hein.journals/ijsoctu6&div=64&id=&page=&t=1560828589.

Abstract:

The study attempted to answer the following research questions; what factors influence student nurses’ clinical learning during their clinical practice allocation and how does clinical learning environment influence student nurses learning? A phenomenological approach methodology was used to conduct the study. Eight clinical teachers at Rusangu University in Monze participated in study. The findings showed that study participants provided teaching and learning support to student nurses on attachment and integrated theory into practice by either discussing conditions or observing and demonstrating procedures when students were in the clinical areas. They also stated that communication was also good among the school staff and students. The study revealed that students face challenges during students’ placements in their respective clinical sites. The main challenges included lack of medical surgical supplies, equipment and stationary s and students congesting the ward coming from different schools of nursing. This made teaching and learning for student’s difficulty. The study suggests a necessity to use to look into the challenges faced by the clinical teachers in order to facilitate learning in clinical practice and creating a conducive clinical learning environment.

References:

[1].   Awuah-Peasah, Sarfo, D L. A. and Asamoah, F. 2013. “The attitudes of student nurses toward clinical work,” International Journal of Nursing and Midwifery, vol. 5, no. 2, pp. 22–27, 2013. View at Publisher · View at Google Scholar.

[2].   Chaun OL, Barnett T. Student, tutor and staff nurse perceptions of the clinical learning environment. Nurse Education in Practice. 2012; 12(4): 192-197. PMid:22277167

http://dx.doi.org/10.1016/j.nepr.2012.01.003[6]

[3].   Gemuhay, M H., Kalolo, A Mirisho, R, Chipwaza, B and Nyangena, E. 2019. Factors Affecting Performance in Clinical Practice among Preservice Diploma Nursing Students in Northern Tanzania. Nursing Research and Practice. Volume 2019, Article ID 3453085, 9 pages,

https://doi.org/10.1155/2019/3453085.

[4].   Vermaak, AF. 2013. Factors influencing the clinical learning environment: a student perspective. A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Science in Nursing

[5]. Dube, BM., Mlotshwa, RP. 2018. Factors influencing enrolled nursing students’ academic performance at a selected private nursing education institution in KwaZulu-Natal. Curationis, vol 14. No.1.

[6].  Kelly C. Student’s perceptions of effective clinical teaching revisited. Nurse Education Today. 2007; 27(8): 885-892. PMid:17321013

http://dx.doi.org/10.1016/j.nedt.2006.12.005[18] Andrews M, Roberts D. Supporting student nurses learning.

[7]. Melincavage SM. Student nurses’ experiences of anxiety in theclinical setting. Nurse Education Today. 2011; 31(8):785-789. PMid:21641701

http://dx.doi.org/10.1016/j.nedt.2011.05.007

[8]. Murphy F, Rosser M, Bevan R, et al. Nursing students’ experiences and preferences regarding hospital and community placements. Nurse Education in Practice. 2012; 12(2012): 170-175. PMid:22265991

http://dx.doi.org/10.1016/j.nepr.2011.12.007

[9].   Nash R, Lemcke P, Sacre S. Enhancing transition: An enhanced model of clinical placement for final year nursing students. Nurse Education Today. 2009; 29: 48-56. PMid:18692279

http://dx.doi.org/10.1016/j.nedt.2008.06.004 Melincavage SM. Student nurses’ experiences of participant.

[10].  Shabana IA, Khater WA, Akhu-Zaheya LM. Undergraduate nursing students’ stress sources and coping behaviours during their initial period of
clinical training: A Jordanian perspective. Nurse Education in Practice. 2012; 12(4): 204-209. PMid:22281123

http://dx.doi.org/10.1016/j.nepr.2012.01.005 Steivy U.

Abstract:

Main objective: To investigate the effects of postoperative care program on leg pain and functional performance after lumbar spine surgery at Nakhon Phanom Hospital.

Method: This was experimental research used a pretest-posttest for the 2 groups, which was done before and after to determine the effects of postoperative care program on leg pain and functional performance after lumbar spine surgery. This study performed on 40 patients who received lumbar spine surgery. Data was collected using the numerical rating scale and the postoperative functional performance questionnaire.

Results: The findings showed that the experimental group who received postoperative care will have reduced leg pain and better postoperative functional performance improvement than the control group (p<0.005 and p<0.001, respectively).

Conclusion and recommendation: Postoperative care program in combine with medical treatment reduced leg pain and yielded beneficial effects on some aspects of postoperative functional performance among lumbar spine surgery.

References:

[1].  Srimoragot, P. (2008). Medical-surgical nursing: clinical management for positive outcomes. 7^th ed. Bangkok: I Group Press Limited.

[2].  Kang, K. K., Shen, M. S., Zhao, W., Lurie, J. D., & Razi, A. E. (2016). Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function. Spine J, 13, 367-37.

[3].  Kitteringham, C. (1996). The effect of straight leg raises exercises after lumbar decompression surgery-A pilot study. Physiotherapy, 82(2), 115-123.

[4].  Grøvle, L., Haugen, J. A., Keller, A., Natvig, B., Brox, I. J., & Grotle, M. (2010). The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain. Eur Spine J, 19(2), 263–269.

[5].  Sangsaikaew, A., Duangpaeng, S., & koontaley, A. (2017). Factors Influencing postoperative symptom cluster after lumbar spine surgery. The Clinical Academia, 41(1), 17-25.

[6].  Prommated, P. (2011). Nursing care for Low Back Pain [homepage on the Internet]. [cited 2018 Sep 16]. Available from: http://www.med.cmu.ac.th/hospital/nis/download/spine2011/nurse_care_lbp.pdf.

[7].  The Burden of Musculoskeletal Diseases in the United States [homepage on the Internet]. (2014). Trends in spinal fusion procedures, United States 1998-2011. [cited 2018 June 11]. Available from:

http://www.boneandjointburden.org/2014-report/iie1/spinal-fusion.

[8].  Information center. (2016). Hospital Nakhon Phanom. lumbar spine surgery in statistical Report. Nakhon Phanom Hospital. Thailand.

[9].  Skolasky, R. L., Scherer, A. E., Wegener, T. S., & Tosteson, D. T. (2018). Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. Spine J, 1318–1324.

[10]. Polit, D. E., & Hungler, B. P. (2001). Nursing Research: Principle and Methods. Philadephia.

[11]. Prasat Neurological Institute Department of Medical Services. (2017). Clinical Nursing Practice Guideline for Surgical Spine [Internet]. Bangkok: Tana press Thailand 2018 [cited 2018 Feb 1]. Available from:

http://pni.go.th/pnigoth/wp-content/uploads//2017/12.pdf.

[12]. Lenz, E. R., Pugh, L. C., Milligan, R. A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: an update. Adv Nurs Sci, 19(3), 14-27.

[13]. Wongrattana, C. (2017). Statistical techniques to research. 13th ed. Bangkok: PB Foreign Book Centre.

[14]. Burns, N., Grove, S. K. (2009). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. 6th ed. New York: Saunders Elsevier.

[15]. Lin, C-WC., McAuley, H. J., Macedo, L., et al. (2011). Relationship between physical activity and disability in low back pain: A systematic review and meta-analysis. Pain, 152, 607-613.

[16]. Deesomboon, S. (2008). The home-based physical activities program in daily life among older adults [Thesis]. [Bangkok]: Mahidol University. 203p. [in Thai].

[17]. Therkleson, T. (2018). Ginger and Osteoarthritis. Australia. [cited 2018 Sep 30]. Available from:

http://cdn.intechopen.com/pdfs/30687/intech-ginger_and_osteoarthritis.pdf.

[18]. Jurícek, M., Rehák, L., Tisovský, P., & Horváth, J. (2010). The effect of complications on the quality of life after surgery for lumbar spine degenerative disease. Acta Chir Orthop Traumatol Cech, 77, 112–117.

[19]. Roopsawang, I., Aree-Ue, F., Putwatana, P. (2009). A Follow-Up Study of Health Status in Patients with Chronic Low Back Pain before and after Spinal Surgery. Rama Nurs J, 15(3), 344-60. [in Thai].

Abstract:

This capstone project is to wrap up three blocks - Medical/Surgical nursing, Maternal and Child health nursing and Mental Health Nursing. Using a case study of nineteen months old male child hospitalized with Delayed Developmental Milestone and Cerebral Palsy; a three-segment self –structured survey was carried out to elicit the Knowledge of Nurses on the Holistic Care of a Child with Delayed Developmental Milestone and Cerebral Palsy. Data collated from 24 Registered Nurses revealed 83.3 % are conversant with Delayed Milestone, 54.2% of nurses are not aware of the services to be rendered to a child in need, only 33.3% correctly listed other facilities and services for the holistic care. 66.7% are aware of their role in influencing the treatment protocol, 62.5% have nursed a child with Milestone delay, while 45.8% Cerebral Palsy. Only 25% correctly completed the third segment of the survey that expressed their knowledge in writing despite their experience and qualification, which may limit their skill in early identification of delayed milestone. Most experts agree that the earlier the diagnosis for Cerebral Palsy, the better. Thus the need for nurses to upgrade themselves to enhance early identification and referral of such problem for early developmental milestone screening, diagnosis, treatment plan, and early intervention to achieve an overall holistic care and development of the child; and increases the family chances of qualifying to get support measures from the government and non-governmental agencies.

References:

[1].   Center for Parent Information & Resources Developmental Delay, Sep 16, 2016 https://www.parentingcenerhub.org/dd

[2].   Parenting Feb 20, 2014 Developmental Milestones- Does my child have a delay? Children MDMOM DOCS helping moms on the go Children’s Hospital –St Louis https://childrensmd.org/browse-by-age

[3].   USA HEALTH Education | Healthy Living Following A Child’s path of Developmental Milestone Aug 1st, 2018

https://www.usahealthsystems.com/news

[4].   Kenneth A. Stern informational website: Mychild at CerebralPalsy.org

https://www.cerebralpalsy.org/about-cerebralpalsy

[5].   Collins PY, Pringle B, Alexander C, Darmstadt GL, Heymann J, Huebner G, et al (2017) Global Services and support for children with developmental delays and disabilities: Bridging research and policy gaps. PLoS Med 14(9): e1002393. Doi: 10.1371/journal.pmed.1002393.Sep 18, 2017 https://journals.plos.org/plosmedicine

[6].   Community for mothers and mothers to be in Nigeria .10 Schools for Children with Special Needs in Nigeria Mamalette.com

[7].   Altamira Pereira, Neusa Collet., Sophie Helena Eichmann, Marilia (2015) Child Development Surveillance: intervention study with nurses of the family health strategy

[8].   Rev. Lat Am Enfermagem.2015 Sept-Oct; 23(5): 954-962.

Doi:10.1590/0104-1169.0272.2636 PMCID: PMC4660419 PMID: 26487147

https://dx.doi.org/10.1590/0104-1169.02722636

Abstract:

Lesbian, gay, bisexual and transgender population experience myriads of health disparities. The purpose of this study was to examine the health disparities among the LGBT population in Ghana, as no study has been specifically conducted in Ghana to examine such area of study. The study specifically sought to determine the mental, physical and the behavioral health disparities among the LGBTs in Ghana. A total of 494 self-identified LGBTs, recruited via non-probability sampling technique of snow-ball participated in the study. The survey included four categories of survey items: demographic information, mental health behavioral health, and the physical health conditions of the LGBTs. The findings of the study indicated that the LGBT population in Ghana experience a number of health disparities, ranging from behavioral, physical and mental health. The results from the one-way analysis of variance revealed that lesbian and gay population in Ghana experience mental, behavioral, and physical health conditions more than their bisexuals and transgender. It was found that lesbians and gay engage in excessive use of tobacco, over-use of alcohol, use of drugs, and engage in unprotected sex behaviours more than their bisexual and transgender counterparts (p<.05). The findings of the study also revealed that the lesbians and gays in Ghana have higher risks of cancer, being overweight or obese, and the risk of being diagnosed with stroke (p<.05). Based on the findings of the study, it is recommended that the mental behavioral and the physical health of the LGBTs in Ghana should be given the needed attention.

References:

[1].   Adams, R.E., Boscarino, J.A., Galea, S., 2006, Alcohol use, mental health status and psychological well-being 2 years after the World Trade Center attacks in New York City. Am J Drug Alcohol Abuse, 32, 203–24.

[2].   Allotey, N. M., 2015, Perceptions of youth towards homosexuality in Ghana. Date of access: 24/03/2019. https://pdfs.semanticscholar.org

[3].   Balsam, K. F., Rothblum, E. D. and Beauchaine, T. P., 2005, Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. Journal of Consulting & Clinical Psychology, 73(3), 477–487.

[4].   Berman S.L., Weems C.F., Stickle T.R., 2006, Existential anxiety in adolescents: prevalence, structure, association with psychological symptoms and identity development. J Youth Adolesc., 35, 303–10.

[5].   Boehmer, U., Bowen, D.J., Bauer, G.R., 2007, Overweight and obesity in sexual-minority women: evidence from population-based data. American Journal of Public Health, 97(6):1134–1140.

[6].   Bontempo, D.E., Augelli, A.R., 2002, Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behaviour. Journal of Adolescent Health, 30, 364–374.

[7].   Boyd C.J., Bostwick W.B., Hughes T.L., et al., 2010, Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health, 100(3), 468-75.

[8].   Carlson L.E., Angen M., Cullum J., Goodey E., Koopmans J., Lamont L., et al, 2004, High levels of untreated distress and fatigue in cancer patients. Br J Cancer, 90:2297–304.

[9].   Case, P., Austin, S.B., Hunter, D.J., Manson, J.E., Malspeis, S., Willett, W.C., Spiegelman, D., 2004, Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. Journal of Womens Health (Larchmt), 13(9), 1033–1047.

[10].           Centers for Disease Control and Prevention, 2013a, HIV among gay, bisexual, and other men who have sex with men. Date of access: 23/07/2019. https://www.cdc.gov/hiv/statistics/overview/ataglance.html

[11].  Centers for Disease Control and Prevention, 2013b, Sexual orientation and health among U.S. Adults: National health interview survey, 2013. Date of access: 23/07/2019. https://www.cdc.gov/nchs/data/nhsr/nhsr077.pdf

[12].  Chae, D.H., Ayala, G., 2010, Sexual orientation and sexual behavior among Latino and Asian Americans: implications for unfair treatment and psychological distress. Journal of Sex Research, 47(5), 451–459.

[13].  Clements-Nolle, K., Marx, R., & Katz, M., 2006, Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of homosexuality, 51, 53-69.

[14].  Cochran S. D., Sullivan J. G., and Mays V. M., 2003, Prevalence of mental disorders, psycho­logical distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53–61.

[15].  Cochran S.D., & Mays V.M., 2000, Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: Results from NHANES III. American Journal of Public Health, 90(1), 573–578.

[16].  Cochran S.D., Mays V. M., Alegria M., Ortega A. N. and Takeuchi D., 2007, Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5),785–794.

[17].  Cochran, S.D., 2001, Emerging issues in research on lesbians’ and gay men’s mental health: does sexual orientation really matter? American psychologist, 56(11):931–947

[18].  Coley, R. L., and Hernandez, D.C., 2006, Predictors of paternal involvement for resident and non-resident low-income fathers. Dev Psychol, 42, 1041–56.

[19].  Conron, K.J., Mimiaga, M.J., Landers, S.J., 2010, A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10),1953–1960

[20].  Coultas, D., Frederick, J., Barnett, B., Singh, G., Wludyka, P., 2005, A randomized trial of two types of nurse-assisted home care for patients with COPD. Chest, 128, 2017–24.

[21].  D’Augelli, A. R., 2002, Mental health problems among lesbian, gay, and bisexual youths ages 14 to 21. Clinical Child Psychology and Psychiatry, 7(3), 433–456.

[22].  D’Augelli, A.R., Grossman, A.H. (2001). Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. J Interpers Violence, 6(10),1008-1027.

[23].  Dankwa, S. O., 2009, It’s a Silent Trade: Female Same-sex intimacies in post-colonial Ghana. NORA-Nordic Journal of Feminist and Gender Research, 17, 192–205.

[24].  Derogatis, L. R., 1993. BSI Brief Symptom Inventory. Administration, Scoring, and Procedures Manual (Minneapolis, MN: National Computer Systems).

[25].  Diamant, A.L, Wold, C., 2003, Sexual orientation and variation in physical and mental health status among women. Journal of Women’s Health, 12(1), 41–49

[26].  Dibble, S.L., Roberts, S.A., & Nussey, B., 2004, Comparing breast cancer risk between lesbians and their heterosexual sisters. Women’s Health Issues, 14(2), 60-68

[27].  Dilley, J.A., Simmons, K.W., Boysun, M.J., Pizacani, B.A., Stark, M.J.2010, Demonstrating the importance and feasibility of including sexual orientation in public health surveys: Health disparities in the Pacific Northwest. American Journal of Public Health, 100(3),460–467.

[28].  Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W., 2008, Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence do parents and schools have? School Psychology Review, 37(2), 202–216.

[29].  Essien K., and Aderinto, A. S., 2009, Cutting the Heaf of the Roaring Monster: Homosexuality and Repression in Africa. African Study Monographs, 30(3), 121-135.

[30].  Fincham, J.E., 2008, Response Rates and Responsiveness for Surveys, Standards, and the Journal. American Journal of Pharmaceutical Education, 72(2), 43-45.

[31].  Fredriksen-Goldsen, K. I., Kim, H-J, Emlet, C.A., et al., 2011, The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Date of access: 23/07/2019. http://caringandaging.org.

[32].  Fredriksen-Goldsen, K. .I., Kim, H-J, Emlet, C.A., et al., 2012. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. Gerontologist. Date of access: 23/07/2019. http://caringandaging.org.

[33].  Fredriksen-Goldsen, K.I., Kim, H.J, Barkan, S.E., Muraco, A., Hoy-Ellis, C.P., 2013, Health disparities among lesbian, gay male, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103(10), 1802–1809.

[34].  Fredriksen-Goldsen, K.I., Kim, H-J., Muraco, A., Mincer, S. (2009). Chronically ill midlife and older lesbians, gay men, and bisexuals and their informal caregivers: the impact of the social context. Sex Res Social Policy, 6(4),52-64.

[35].  Fredriksen-Goldsen, K.I., Simoni, J.M., Kim, H-J., Lehavot, K., 2014, The health equity promotion model: reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. Am J Orthopsychiatry, 84(6): 653–663.

[36].  Fried, L.P., Guralnik, J.M., 1997, Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc., 45(1), 92---100.

[37].  Frimpong, D., 2018, These are 8 countries in Africa where homosexuality is legal. Date of access: 13/12/2018. https://www.pulse.com.gh

[38].  Ghana Statistical Service (2013). 2010 Population & Housing Census: National Analytical Report. Date of access: 23/01/2019. http://www2.statsghana.gov.gh/

[39].  Gilman, S.E., Cochran, S.D., Mays, V.M., Hughes, M., Ostrow, D., Kessler, R.C., 2001, Risks of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey. American Journal of Public Health, 91, 933–939

[40].  Grant J.M., Lisa, A., Mottet, J. T., Jack, H., Jody, L. H.,& Mara, K., 2011, Injustice at every turn: A report of the national transgender discrimination survey. Date of access: 23/07/2019. http://www.transequality.org/issues

[41].  Green, K., Girault, P., Wambugu, S., Clement, N. F., & Adams, B., 2015, Reaching men who have sex with men in Ghana through social media: A pilot intervention. In C. S. Walsh (Ed.), Transforming HIV prevention and care for marginalized populations: Using information and communication technologies (ICTs) in community-based and led approaches: Digital culture & education (DCE). (pp. 259–265)

[42].  Haruna, U., 2015, Stirring the Hornet’s Nest: a study of student’s awareness, perception and tolerance of homosexuality in a Ghanaian university. Journal of Sociological Research, 6(1), 1-19.

[43].  Herbst, J.H., Jacobs, E.D., Finlayson, T.J., McKleroy, V.S., Neumann, M.S., Crepaz, N., 2008, Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS and Behavior, 12(1):1–17.

[44].  Human Right Watch, 2018, No Choice but to Deny Who I Am’: Violence and Discrimination against LGBT People in Ghana. Date of access: 12/09/2018. https://www.hrw.org/report.

[45].  Krehely, J., 2009, How to Close the LGBT Health Disparities Gap. Date of access: 23/07/2019. https://www.americanprogress.org/issues/lgbtq-rights/reports/2009/12/21/7048/how-to-close-the-lgbt-health-disparities-gap

[46].  Lee, J., Yim, M., & Kim, J.Y., 2018, Test-retest reliability of the questionnaire in the Sasang constitutional analysis tool (SCAT). Integrative Medicine Research, 7,136-140.

[47].  Leonard, W., 2002, What’s the difference?: health issues of major concern to gay lesbian bisexual transgender and intersex (GLBTI) Victorians. Ministerial Advisory Committee on Gay and Lesbian Health (MACGLH). Department of Human Services, Melbourne.

[48].  Lick, D., Durso, L.E., & Johnson, K.L., 2013, Minority stress and physical health among sexual minorities. Pers on Psychological Sci, 8(5), 521-548.

[49].  Mac-Darling, C., 2011, Because of You: Blackmail and Extortion of Gay and Bisexual Men in Ghana: International Gay and Lesbian Human Rights Commission (IGLHRC), Nowhere to Turn: Blackmail and Extortion of LGBT People in Sub-Saharan Africa. Date of access: 12/08/2018. http://www.outrightinternational.org/sites/default/files/484-1.pdf

[50].  McNair, R., Anderson, S., Mitchell, A., 2003, Addressing health inequalities in Victorian lesbian, gay, bisexual and transgender communities. Health Promot J Austr, 11(1), 32–38.

[51].  Murdock, T. & Bolch, M., 2005, Risk and protective factors for poor school adjustment in lesbian, gay, and bisexual (LGB) high school youth: Variable and person-centered analyses. Psychology in the Schools, 42. 159 - 172.

[52].  National LGBT Cancer Network, 2013, Electronic article HPV and Cancer. Date of access: 23/07/2019. https://cancer-network.org/cancer-information/hpv-and-cancer/

[53].  Ofori, E. (2014). Perception of students on the practices of homosexuality amongst students in the Cape Coast. International Journal of Research In Social Sciences, 4(2), 117-122.

[54].  Pew Research, 2013, The Pew global attitudes project. World publics welcome global trade but not Immigration. Date of access: 09/08/2018. http://pewglobal.org/files/pdf/258.pdf.

[55].  Quaye, S., Fisher R. H., Atuahene, K., Amenyah, R., Aberle-Grasse, J., McFarland, W., & El-Adas, A., 2015, Critique and lessons learned from using multiple methods to estimate population size of men who have sex with men in Ghana. AIDS and Behavior, 19, 16–23.

[56].  Riggle, E.D, Rostosky, S.S, Horne, S.G., 2010, Psychological distress, well-being, and legal recognition in same-sex couple relationships. Journal of Family Psychology, 24(1), 82–86.

[57].  Rosenzweig M., Brufsky A., Rastogi P., et al., 2011, The attitudes, communication, treatment, and support intervention to reduce breast cancer treatment disparity. Oncology Nursing Forum, 38(1), 85-9.

[58].  Sandfort, T.G., de Graaf, R., Bijl, R.V., Schnabel, P., 2001, Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85–91.

[59].  Schulden, J.D., Song, B.W., Barros, A., Mares-DelGrasso, A., Martin, C.W., Ramirez, R., Heffelfinger, J.D., 2008, Rapid HIV testing in transgender communities by community-based organizations in three cities. Public Health Reports, 123:101–114

[60].  Shin, S-K, Lukens, E.P., 2002, Effects of psychoeducation for Korean Americans with chronic mental illness. Psychiatric Services, 53(9), 1125-31.

[61].  Wallace, S.P., Cochran, S.D., Durazo, E.M., Ford, C.L., 2011, The health of aging lesbian, gay and bisexual adults in California Policy Brief UCLA Center for Health Policy Research (PB2011-2), 1, 1-8.

[62].  Wallace, S.P., Cochran, S.D., Durazo, E.M., Ford, C.L., 2011, The Health of aging lesbian, gay and bisexual adults in California. Los Angeles: University of California, Los Angeles Center for Health Policy Research.

[63].  World Bank, 2019, World Development Report 2019: The changing nature of work. Washington, DC: World Bank. doi:10.1596/978-1-4648-1328-3

[64]. Worldometers (2019). Ghana Population. Date of access: 23/01/2019. http:// www.worldometers.