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Texila International Journal of Nursing

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1 Changing Approach to Human Resource Principles in Mobile Internet Generation (i –generation) , Article by Sam Bodunrin Management, Texila American University E-mail: bodunrinbs12@yahoo.com
People and culture are expedient in work place and they determine how strong or successful any organization is in terms of talent wealth and people optimization. However, the paradigm shift of managing talent in new age of mobile internet generation (i – generation) is drastically eroding from what we used to know and the ability of organizations to swiftly realize and catch-up with this innovative trend will determine their survival strategy in competitive Red Ocean. The purpose of this research work is focused on the new trend of work culture in i-generation and compares the evolution of change in various categories relating to functions in a Human Resource Management. Furthermore, a research survey was conducted to establish how this mobile generation thinks and their most preferred medium of doing things regarding work pattern. The result of our findings was shared in this article with the reaction of most millennia agreed to prefer being reached out to work via their mobile phones or social media which they access mostly. The article also matched other work areas such as performance management in mobile generation, employee productivity and engagement, learning system via clouding and virtual method, resourcing and social media impact in i-generation, talent value as related to intellectual property compares to stock option for the big bosses, virtual work efficiency against traditional physical office amongst others. Keywords: I-Generation, Millennial, Mobile-Internet Generation, Talent, HR Evolution, Baby Boomers and Gen X.
2 Effect of Implementing Evidence-Based Care Bundle on Prevention of Pressure Injury in Dependent Burned Patients , Article by Shaimaa Ahmed Awad, Walaa Nasreldin Othman, Reham Abdelhamed Abdelmawla
Background: Pressure injury results in significant physical, social and physiological problems for patients. It is important to implement strategies that prevent pressure injury development in burn patients. A care bundle is a structured group of interventions based on clinical practice guidelines that improve processes of care, encourage compliance to guidelines, and have been shown to improve patient outcomes. Aim: To evaluate the effect of implementing evidence-based care bundle on prevention of pressure injury in dependent burned patients. Methods: Quasi-experimental research design was utilized. A purposive sample of 50 burned patients were assigned into 2 equal groups; a control group received routine nursing care and a study group experienced the evidence-based pressure ulcer care bundle. Results: All items of comprehensive skin assessment namely; temperature, color, moisture, turgor, integrity and tissue perfusion were significantly improved post implementation of evidence-based pressure ulcer care bundle in the study group. A significant difference was found between the study and control group regarding Braden risk assessment in the fourth and seventh days of follow up. Conclusion: It can be concluded that implementing the evidence-based pressure ulcer care bundle significantly reduced the development of pressure ulcer in burned patients. Keywords: Care bundle, Pressure injury, Burn, Evidence based skin care bundle, Braden scale.  
3  Effect of an Educational Programme on Dialysis Nurses’ Knowledge and Practices Related to Blood Borne Diseases during Haemodialysis Procedures, in Khartoum State, Sudan , Article by Mohammed Ezzeldien Hamza Mustafa, Dyaeldin Mohammed Elsayed, Hassan Abuaisha, Waleed Ameen Mohammed, Ahmed Abdallah Jaralnabi
This study was conducted to assess the effects of the educational programme on knowledge and practices of nurses working in haemodialysis centres Khartoum State 2014-2016 about Blood Borne Diseases. There is a lack of knowledge and practices of nurses working in haemodialysis centres, which may lead to outbreaks of blood-borne diseases in haemodialysis patients and even the nurses themselves. Due to this, an educational programme was designed to solve this problem. The lack of knowledge and practices of nurses working in haemodialysis centres was the leading cause of blood-borne disease outbreaks. The general objective is to assess the impact of an educational programme about blood-borne diseases on knowledge and practices of nurses working in haemodialysis centres. Study design, Interventional quasi-experimental study design, health facilities based study. The total number of the study subjects in this study revealed that the knowledge of nurses in the haemodialysis centres regarding prevention of blood-borne diseases show significantly improved, the knowledge improved from 65±7.6%to75±6.6 P<0.0001 practices were improved from 42.8±3.5% to 62.7±9.5 P<0.0001 after the application of the educational programme. We recommend applying the tested educational programme and raise haemodialysis nurses’ awareness about infection control by periodic training and assessment. The limitations of this study are starting in 191 and ended by 140 the attrition rate is 26.7%. Keywords: Educational Programme, Dialysis, Knowledge, Practices, Blood Borne Diseases, Haemodialysis.  
4 Impact of Prevention of Mother to Child Transmission of HIV/AIDS in General Hospital Bajoga Gombe State , Article by Rifkatu Dauda Samaila
Background: There has been increasing public outcry following the frequency of children infected with HIV/AIDS, despite measures on the ground to prevent the occurrences. It is also not uncommon to find infants infected with the infection. The study focusses on the impact of prevention of mother to child transmission of HIV/AIDS in General Hospital, Bajoga, Gombe State, Nigeria. Method: A cross-sectional survey was conducted among fifty women attending the study area, who gave written consent. Information on socio-demographic characteristics, knowledge, perception and opinion on prevention of mother to child transmission of HIV/AIDS was collected, using a semi-structured, interviewer-administered questionnaire. Data were analysed using descriptive statistics and chi-square test. Level of significance was set at p ≤ 0.05. Results: The average age group was 20-25 years (60%). Majority 35 (70%) of participants had heard about prevention of transmission of HIV/AIDS from mother to child. 1 (2%) have not heard. Greater number 45 (90%) of respondent had HIV negative children, with 5 (10%) had positive children. 45 (90%) respondent believed that transmition from mother to child results from unskilled birth attendants during delivery. Majority 39 (78%) thinks that protected sexual intercourse can prevent transmition. Greater number 50 (100%) are of the opinion that counselling will help greatly in preventing the mother to child transmition of HIV/AIDS. There was no significant association between socio-demographic characteristics, knowledge, perception and opinion of the participants. Conclusion: There is need for continuing education and counselling of the public on prevention of mother to child transmition of HIV/AIDS. Keywords: Impact, prevention, transmition, mother, child, HIV/AIDS.  
5 Perception of Nursing Students regarding Blended Learning Method at The University of Lahore, Pakistan , Article by Muhammad Afzal, Tazeen Saeed Ali, Syed Amir Gilani
Introduction: Blended learning (BL) is positive development in education. This method provokes the learner’s critical thinking and enables them to integrate their knowledge in real life. In the developed countries in 1990s and so on researchers had evaluated qualitative characteristics of blended learning effectiveness in education whereas in Pakistan this concept and in nursing this methodology is in its infancy stage hence based on the gap in the literature this study has explored the perception of the undergraduate nursing students enrolled in blended learning teaching strategy semesters. Methodology: To answer the research objective phenomenological study design was deployed. 12 in depth interviews were conducted of the undergraduate students who have learned in both blended learning and traditional lecture-based semesters in Lahore School of Nursing, The University of Lahore. Sampling strategy was purposive. Results: Analysis of 12 students’ interview was conducted with the major themes of Awareness, Learning Strategies, Learning Activities, Evaluation, and Interpersonal Skills. Participants shared a lot of experiences regarding the effectiveness of blended teaching environment comparatively to lecture based teaching semester. Blended learning fosters the nursing students learning and is beneficial to students’ learning in a tertiary environment. Conclusion: This study adds to the unrevealed area of nursing education related to quality teaching strategy for undergraduate nursing students in order to enable them fully for provision of quality care to the individuals in hospitals and community environment. Thereafter, institutions, policy makers and regulatory bodies should incorporate this strategy in the nursing curriculum in Pakistan.  
6 Challenges and Future Vision to Improve Nursing Practice- A Systematic Review , Article by Nahid Khalil Elfaki  
Background: Quality nursing care improves health outcomes, but quality nursing care cannot be provided without good vision. The aim: for this review was to identifying the future nursing vision along with challenges and how to overcome them Methodology: It was a literature review in which meta-analysis were utilized. A total of 181 articles related to the review title were accessed. After secondary reviewing, only thirty-three studies were included in the systematic review and meta-analysis during the period from November, 2018 up to February, 2019. The databases that used were PubMed, Google Scholar, SAGE and Academic Search Complete Magazines and journals (EBSCO). Results: The most cited future nursing vision was to improve health globally by raising the profile and status of nurses worldwide. For achieving this vision, there were some major challenges should be overcome. These challenges and obstacles had been categorized into six major groups which were financial, educational and training, clinical and working environment, technological, social and environmental determinants and multi-sectoral approach. Keywords: Future vision, Nursing, Nursing practices, Challenges.  
7 Assessment of Nurses Competency in the Management of Spinal Cord Injured Patients in Accident and Emergency/Orthopaedics Department of University of Port-Harcourt Teaching Hospital (UPTH) Nigeria , Article by Timighe, Gift Cornelius, Sylvester Atanga , J. J. Asongu, Okolue-Davies Miriam-Therese, Mohammed Ibrahim Kawu
The purpose of the study was to assess Nursing Competences in the Care of Spinal Cord Injured Patients in Accident and Emergency/Orthopedics Department UPTH. Observational research design was used, Instruments for data collection was source from the primary sources using developed Spinal Cord Injured Assessment Questionnaire, using descriptive statistical tools simple averages. The results however revealed that; Nurses competences in diagnoses and assessment shows a total means of 2.3, nursing intervention 2.30, militating factors such as physical factor shows a total mean of 3.13 and Psychological factor 3.02 in the care of SCI patients. Hypothesis H1: The emergency/orthopedic nurses at Accident and Emergency Department in UPTH are competent in the management of spinal cord injured patients. H2: There are no mitigating factors against the care of spinal cord injured patients. It was therefore Recommended that management of the UPTH, should work on the militating factors, against the nurses for effective nursing care of spinal cord injured patients. Only Emergency/Spinal/Orthopedic specialist trained nurses should be posted to accident and emergency Department of the trauma unit for effective management. The community and insurance companies should work in the welfare and rehabilitation of the patients. Keywords: UPTH, spinal cord, Orthopedic, Emergency, Competence, Port-Harcourt.  
8 Knowledge and Practice of Nurses Towards the Prevention of Postoperative Infection , Article by Ahmed Abdalla, Ahmed Jarelnape  
Objectives: This study was carried out to determine the level of nurse’s knowledge and practice regarding postoperative infection prevention who work in the surgical departments of the military hospital in Sudan. Background: Postoperative infection is known worldwide as one of the five several causes of harm to patients and preventable patient safety problem, also frequently described as a sign of the quality of care provided by health care organizations. Methods: An institution-based cross-sectional survey was conducted among 122 nurses. A structured self-administered questionnaire was used for data collection. Data analysis was done using SPSS version 23. Statistical package. Descriptive statistics were used to describe the study population in relation to related variables. The results: The analysis of knowledge scores of the total sample showed the participant knowledge level regarding postoperative infection prevention was poor based on their results only (37.6%) of the participants give correct answers. Regarding a practice, was found the nurses has a good practice about postoperative infection prevention, 63.2%. Some barriers have been found, such as insufficient knowledge, Staff shortage, inadequate facilities, equipment, and lack of a surveillance system. Conclusion: Concluded that the nurse's working in a military hospital in Sudan that their knowledge regarding postoperative infection was found to be inadequate. Should the higher educational status, tending approved practice, being further encountered showed a positive and significant connection with knowledge. Whereas staff shortage, inadequate facilities, were found to be affected by the practice of postoperative infection prevention. The study recommended In-service practicing updating programs and ensuring the availability of the required equipment are some of the important steps to improve nurses' knowledge and practice. Keywords: Knowledge, Practice, Postoperative, Infection, Prevention.  
9 Registered Nurses Perception of Shared Governance with Index Professional Nursing Governance Tool Perception of Shared Governance , Article by Shila Sajan, Al Faisal W
The present study explores how registered nurses perceive shared governance and how they implement in their workplace, especially on how they lead or how they are being led. The analyses of survey data provide us with valuable information specific to nurse's perceptions in a different work environment. It might forecast aid in innovative decision-making processes. Method: A descriptive survey with Hess Index of professional nursing governance was used in the study. All RNs working on the clinical side and in the administrative area are selected to participate in the study. Data were analyzed using SPSS version 20. Results: Data analysis in the study revealed RN s perception towards the type of governance was determined by the mean score and find out that shared governance is practiced as per the guidelines set up by the IPNG Tool. As per the objective of my study, it revealed that there is no significant difference in the perception between administrative nurses and clinical side nurses in all IPNG subscale, It can be due to the difference in the number of participants, as 13% of administrative nurses only participated in a survey whereas 87% were clinical nurses. Comparing the clinical specialty with subscales showed a significant difference in participation, goals, and practice where P value is < 0.05, and also related to education. But no significant difference noticed among age or gender. Conclusion: This study seeks to understand the relationship between different perceptions and views related to shared governance. Keywords: Registered nurse, Shared governance, Perception, Index Professional Nursing Governance, decision making, empowerment.  
10 Awareness and Knowledge of Sickle Cell Disease in Rivers State, Nigeria , Article by Okolue Davies Miriam Therese, Shuaibu bukhari Isah, Timighe, Gift Cornelius, Elijah Tokunbo Daniel, J. J. Asongu, Sylvester Ndaeso Atanga, A. A Babadoko
Previous study has assessed patient awareness about management of sickle cell disease (SCD) which indicates that there is a lack of awareness about the disease and possibly a need for more awareness. Therefore, our study aimed at Awareness & Knowledge of Sickle Cell Disease in Rivers State, Nigeria. The study was conducted from October 2018 to February 2019. A questionnaire was distributed among 154 persons selected from among the general public. Most (75.0%) had heard of SCD and 35.0% knew that it can be diagnosed by a blood test, but 33.3% did not know the prevalence of SCD in Nigeria. 50(41.7%) recognized it as a hereditary disorder. Professional/university students gave the most correct answers; Females showed better knowledge than males and married persons seems to know more about SCD than unmarried ones. There is a fair level of knowledge about SCD among the respondents, though some of the respondents were confused about the difference between the carrier state of a disease and the disease itself. Health education should be intensified to impact sufficient comprehensive knowledge about SCD to enable the public take informed decision about their marriage so as to prevent procreation of children affected with SCD. Keywords: Awareness, Knowledge Sickle Cell Disease, Rivers State, Nigeria.  
11  Utilizing the Intervention Mapping Protocol to Improve the E-learning Self-efficacy of Operating Room Nurses , Article by Paul John G. Aventurado  
This study developed an intervention to improve the e-learning self-efficacy of operating room nurses utilizing the Intervention Mapping Protocol (IMP). The 6-step process of IMP which includes (1) Logic Model of the Problem, (2) Logic Model of Change, (3) Intervention Design, (4) Intervention Production, (5) Implementation Plan and (6) Evaluation Plan was followed which resulted to a self-administered, computer-based intervention, which embedded theory-based strategies into a learning management system for implementation. The effect of the intervention was determined through a quasi-experimental, one group pretest-posttest design involving 31 operating room nurses of Cebu Doctors’ University Hospital. E-learning self-efficacy was measured using the Modified E-learning Readiness Assessment Tool (MERAT). The median score for e-learning self-efficacy among the participants of the study during pretest was 66, with scores ranging from 43 to 78. The e-learning self-efficacy median score increased to 72, with scores ranging from 53 to 80, during the posttest. Data were statistically treated using Wilcoxon Signed-ranks test. The difference between the pretest and posttest scores was found to be significant with p<0.05 at 95% level of confidence (z=-3.103, p=0.002). A medium effect size (r=0.56) was reflected in the analysis. This study highlighted the potential of IMP as a systematic framework to develop evidence-based interventions in the field of nursing. Keywords: Intervention Mapping Protocol, e-learning, nursing informatics, operating room.  
12 Attitude of Nurses towards Professional Development for Improved Service Delivery at the Jos University Teaching Hospital , Article by Stella Chinazor Uba, Chuwang B. Zi
Professional development is desirous for any nursing official who is engaged in patient’s care and teaching or mentoring of student nurses. This research paper evaluated the attitude of nurses toward professional development trainings, assessed the reasons for their attitude in the professional development trainings and tried to proffer suggestions that will improve on the professional development of the nurses. It was a prospective, randomized, questionnaire-based cross-sectional descriptive survey of the attitude of nurses towards professional development among nurses working at the Jos University Teaching Hospital, Jos, Nigeria. One hundred and thirty-one nurses were studied, 99 (76%) were females and 22 (24%) were males (F: M=4.5:1). Results showed that the majority of the nurses had adequate knowledge about the nursing profession and professional development, and were would like to embrace further professional training given the opportunity, necessary motivation, support and encouragement. Many factors militated against the nurses’ interest in the professional development trainings, including family commitment, distances, time and lack of institutional financial support. It is recommended that professional development trainings should be encouraged. Nurses may be motivated and encouraged to participate in the professional development trainings in order to achieve the individual and organizational goal of quality health care delivery to patients. Keywords: Professional training, Nurses’ attitude, Professional development, Service delivery, motivation and quality health care.  
13 The Effect of Pre-Procedure Teaching Module for Patients Undergoing Shock Wave Lithotripsy on Anxiety, Claustrophobia, Pain Perception and Urolithiasis Clearance , Article by Amina Ibrahim Badawy, Rahma Abdelgawad Mohamed Elkalashy
Background: Shock wave lithotripsy (SWL) is the best choice treatment for renal stone. Aim of the study is to test the effect of pre-procedure teaching module for patients undergoing SWL on patients' anxiety, claustrophobia and pain perception, and stone clearance. Methods: A quasi-experimental research design was utilized in this study, setting: The study was conducted in SWL unit at Prince Mutaib Bin Abelaziz Central Hospital, Saudi Arabia. Sample: A convenience sample consisted of 74 patients they divided equally into study and control groups. Tools: (1) An interviewing questionnaire sheet which included two parts; A) demographic and medical data and B) patients' knowledge questionnaire, (2) Beck Anxiety Inventory, (3) Numerical pain rating scale and (3) Visual analogue scale for claustrophobia. Results: Before receiving pre-procedure teaching module 100% of patients in both groups had poor level of knowledge. After receiving teaching; the study group had significant improvement in their knowledge, decrease in anxiety, claustrophobia and postoperative pain scores as well as an increase in rate of successful treatment and stone clearance than the control group (p <0.05). Conclusions: Overall results revealed that pre-procedure teaching for patients experiencing SWL procedure Led to improvement of patients' knowledge and reduction of anxiety, claustrophobia and pain scores after procedure as well as an increase in rate of successful treatment and urolithiasis clearance in the study group than the control group. Recommendations, planned teaching and simple Arabic booklet about SWL, preoperative instructions, post-procedure management, nutritional habits and life style modifications should be provided to patients before SWL. Keywords: Pre-procedure teaching module - Shock wave lithotripsy - Anxiety - Claustrophobia - Pain – urolithiasis.  
14 Evaluation of the Use of NANDA-I nursing diagnoses, Nursing Outcome Classification and Nursing Intervention Classification for Documentation of Care in Primary Health Centres, Ijebu Ode , Article by Odutayo, Patience Omonigho  
Background: Documentation of nursing care is core to the Nursing profession and to share information on patients/clients with other nurses and between clinical disciplines and care settings, data needs to be recorded and stored in a standardized form. Therefore, to make the care nurses give to be visible, NANDA-I, NIC & NOC was endorsed to be used for documentation. Purpose: The purpose of the study was to evaluate whether NANDA-I, NIC, & NOC was used for documentation of care at the maternal and infant welfare units of selected Primary Health Centres (PHCs). Methodology: A retrospective descriptive research design was adopted in this study. Random sampling technique was used to select 5 PHCs. All patient nursing care plan records documented with NANDA-I, NIC & NOC was utilized for data analysis. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for both descriptive and inferential statistics. Results: Findings revealed that nursing care was documented using NNN. There was no significant difference in the NANDA-I nursing diagnoses, NIC & NOC used as the t calculated value of -1.00 was lesser than the critical value of 1.96, which was not significant at 0.05 alpha levels. Conclusion: This study has evaluated the documentation of care using NNN in PHCs. It is imperative to state that using NNN for documentation of care is a way of showing evidence-based practice. The researcher therefore recommends that the use and documentation quality of the NNN be evaluated periodically, and corresponding feedbacks given to nurses. Keywords: Evaluation, Documentation, NANDA-I nursing diagnoses, Nursing Intervention Classification, Nursing Outcome Classification.  
15 Assess the Patients’ Knowledge about Safety Measures Related to Blood Borne Diseases in Haemodialysis Units, in Khartoum State, Sudan , Article by Mohammed Ezzeldien Hamza Mustafa  
This study was conducted to assess the patients’ knowledge about safety measures related to blood-borne diseases in haemodialysis units. There is a lack of knowledge of patients’ knowledge about safety measures related to blood-borne diseases in haemodialysis units. The lack of knowledge of patients in haemodialysis centres was the leading cause of blood-borne disease outbreaks. The general objective is to assess the patients’ awareness about safety measures related to blood-borne diseases in haemodialysis units. The study design is a descriptive study, which is hospital based-cross sectional study. The total number of the study subjects in this study revealed that the knowledge of patients’ knowledge in the haemodialysis centres regarding safety measures related to blood-borne diseases in haemodialysis units show a significant lack of knowledge about safety measures related to blood-borne diseases in haemodialysis units, P-value <0.0001. We recommend increasing study cases, More researches, Health education for patients about the route of transmission of blood-borne diseases, Use the posters which carry pictures learn the patients and new staff the good behaviours to avoid infection, Employ only qualified staff, Supervise the newly staff, Make regular training for staff, Provide well-equipped laboratories for virology screening. There are no limitations of this study starting in 100 subjects and ended by 100 subjects. Keywords: AIDS, Hepatitis B, Hepatitis C, Malaria.  
16 Causes and Rate of Cancellation of Elective Surgeries- A Cross-Sectional Study , Article by Nasreena Navo Nazar  
Cancellation of elective surgeries could be reduced to a greater extend if one knows the reasons or factors leading to cancellations. Cross sectional study conducted in a multi- specialty hospital in Dubai during 2014-2015, to determine the weightage of the causes and the rate of cancellations. Causes were classified into system related, patient related and medical related. Performed quantitative analysis of the causes and rate of cancellations. Trend of cancellations reduced across the period from October 2014 to June 2015. 6008 surgeries were scheduled from October 2014 to June 2015. 5656 surgeries were performed; there were 352 cancellations in total. 6% cases were cancelled. Based on category wise weightage, medical related causes scored the highest reason (69.89%). Patient related causes (15.63%) was slightly more than the system related causes (14.49%). ‘Patient medically unfit for surgery’ ranked highest in the order of the reasons for cancellations. ‘Patients/relatives refused surgery’ was the second highest. ‘Patient had food before the surgery’ though instructed nil oral, ranked the third highest reason. Study of cancellations is important as the identification of the causes of surgery cancellations would help in averting the conditions leading to cancellations. Proper and timely interventions could reduce the cancellation rate. The cancellation rate reduced comparatively in the post study period. Cancellation could cause wastage of valuable time, effort and energy. Moreover, financial burden to patients & hospitals. Resource wastage can be estimated based on the cancellation rate, if the hospital administrators around the world focus their attention to it. Keywords: elective surgeries; surgery cancellations; day case surgery cancellations.  
17 Assessment of Knowledge and Perception of Senior Secondary School Students Towards Nursing as a Career Choice for Men in Selected Local Government of Lagos State, Nigeria , Florence F. Folami, Iyabo Yewande Ademuyiwa, Aminat Olamide Ajibola
The number of men in nursing has remained low despite the many benefits and opportunities associated with the profession. Currently, males make up only 6.6% of the three million nursing professionals in the United States. The study assessed the knowledge and perception of secondary school students towards nursing as a career choice for men in selected Local Government of Lagos State, Nigeria. This is a descriptive cross-sectional study that was carried out on 293 respondents. A multi staged sample technique was used to select study participants. Results revealed that majority of respondents (91.4%) knew nursing as a profession and 88.9% knew that a legal certificate was required to practice nursing, Respondents generally demonstrated a good knowledge of Nursing. There was also a general positive perception towards Nursing as a career (93%). Even thou there was a positive perception towards nursing as a career choice for men generally (53%), half (50.2%) of the students in this study disagreed that nursing was a career choice for female only. Thirty-seven (37%) percent of the students stated that nursing was not a masculine type of career for males to pursue. Also, 65.6% of respondents agreed that nursing was more appropriate for females because they are more caring. There is a need for secondary school students to be aware of what nursing as a profession entails and that gender is not a determining factor of being a better nurse. Keywords: knowledge, Perception, Nursing, career choice, men.  
18 Adherence to Antiretroviral therapy among Clients Utilizing a Primary Health Care Facility Kadoma Zimbabwe (2016) , D. Chirundu, S. Tapesana, P. Magande, T. Mduluza
Introduction: The advent of antiretroviral therapy has turned Human Immunodeficiency Virus (HIV) infection into a manageable chronic condition. Maintaining ART adherence above 95% remains the benchmark for effective viral suppression. An evaluation of adherence to ART by pill count at Rimuka Integrated HIV and TB site revealed an adherence rate of 65%. We investigated factors associated with ART adherence among clients seeking care at the same facility. Method: This study design was a cross sectional study. A pretested interviewer-administered questionnaire was used for data collection. We captured and analysed the data using Epi Info 7TM statistical package. The package was used to generate, frequencies, means, and odds ratios. The strength of the association was described using odds ratios and 95% confidence interval. Results: We recruited 553 respondents. Three hundred and ninety-seven (71.79%) were females. and 156 (28.21%) were males. Eighty eight percent of the respondents had adherence rate above 95% by a composite measure. The proportion of clients taking drug holidays was low at 3.7%. In multivariate analysis, being gainfully employed aOR=1.8; getting individual health education on review visits aOR=1.5; missing ART in 4 weeks preceding the study aOR= 0.46 and being catholic aOR=0.5 remained significant factors in multivariate analysis. Conclusion: Being gainfully employed, getting individual health education are predicators of ART adherence using a composite scale. Being catholic and reporting missing any dose of ART in the previous 4 weeks were predictors of non-adherence using a composite scale. Individual health education and increasing incomes among those on ART was recommended for improved adherence. Keywords: Adherence, ART, HIV, Kadoma.  
19 Effect of Nursing Intervention on the Utilization of Antenatal Care Services: Evidence from Ogun State, Nigeria , Okueso Grace O, Folami Florence, Musah K. Toyin, Sowunmi Christiana, Kio Janet, Owopetu Adetoun
The study assessed the effect of nursing intervention on the utilization of antenatal care services (ANCS) in Ogun state, Nigeria. A total of 75 pregnant women registered for antenatal care in 4 primary health care centers were selected using the total enumeration procedure. The women were further stratified into control (40) and experimental (35) groups. Structured questionnaire was used to gather data which were analyzed using descriptive statistics and logistic regression. All analyses were measured at p≤0.05. Results showed that most of the women were between 20 and 30 years old, had up to secondary education, were in their third trimester and had made below 2 antenatal visits to the healthcare centers. Most of the women have had up to 3 children. Monthly income was generally less than N20, 000 (<$56). At baseline, the antenatal appointments were generally very poor. Parameters related to antenatal care such as checking of blood pressure, weight monitoring, malaria test and HIV counseling and testing also had low scores (<70%). However, at post-intervention, there were apparent improvements in the measured parameters in the experimental group (94%); whereas there were no changes in the control group. The overall utilization mean for the experimental group (baseline = 67%; end line = 97%) indicated that there was a considerable increase in the utilization of ANCS by pregnant women after exposure to intervention. The regression result affirmed that respondents’ participation in the intervention was significant with a positive sign at p = 0.009. This implies that, exposure of pregnant women to educational intervention will significantly increase the probability of their utilization of ANCS. The study recommends among others, that, more attention should be given to antenatal education in the study area and Nigeria at large. Keywords: Antenatal Care Services, utilization, healthcare, pregnant women, intervention, Nigeria.  
20 Family Issues and Frequency of Female Mental Illness in Federal Psychiatric Hospital, Calabar , Umoh, Edet Okon
This study was conducted to ascertain the gravity of family issues on frequency of female mental illness in Federal Psychiatric Hospital, Calabar, Cross River State, Nigeria. Five research questions were raised and one hypothesis formulated to direct the course of the study. Related literatures with Biopsychosocial model constructed by Engel, (2016) was used as a study framework. A descriptive survey design was employed and simple random sample technique was used to select the study’s participants. Data was collected using a structures questionnaire titled “Questionnaires on Family Issues and Frequency of Female Mental Illness” and analyzed with SPSS version 20. The analysed data were presented in frequency tables and simple percentages. The research hypothesis was tested using a confirmatory factor analysis based on Kaiser’s criterion (a rule of thumb) in conjunction with the scree test with a cut-off value of 0.32 for factor loadings. Findings revealed that all variables contributed to female mental illness but family pressure had very significant contribution due to pressures in aspect of childbirth, pressures from in-laws, family and societal beliefs, inability for a woman to give birth to different sex of children, inability of the spouse to provide adequate support to the family, cancellation of marital engagement and refusal by husband’s family to accept a lady as their daughter in-law. Based on these findings, the researcher recommended that women should be fully accepted, treated with values, supported and protected with laws to avoid discrimination and stigmatization. Keywords: Family issues, Mental illness, Frequency, Marital status, Substance abuse, Family mental history.  
21 The Empathy Enigma: An Empirical Study of Decline in Empathy among Undergraduate Nursing Students , Michel Vaillant Mutabazi, Amanda Schwartzentruber,  Sophonie Ndahayo
The purpose of this study was to examine changes in empathy during an academic year among undergraduate nursing students. The research followed a descriptive methodology with a sample of 214 undergraduate nursing students who completed the Jefferson Scale of Empathy at the beginning and at the end of 2006-2007 academic year. Data were collected using a questionnaire. Results showed a statistically significant decline of empathy for nursing students who were exposed more than others to patient encounters during study period (F (2, 211) = 4.2, p< 0.01). Findings were consistent with those found among medical students in that nursing students' encounters with patients, though not very clear on those who had less encounters with clients. The authors suggested that changes to the modalities of teaching may be contributing a disconnect in human connections, due to an emphasis on self-directed and simulated learning experiences. Further studies to identify whether findings of the research impacted on patient outcomes and nurse-students were recommended. Keywords: Empathy enigma, clinical experience, nurse-patient relationship, nursing students.  
22 Assessment of Menorrhagia Associated with Intra-Uterine Contraceptive Device (Cut 380a) Among Women Attending Idi-Ogungun Primary Health Care Centre, Ibadan North Local Government Area of Oyo State , Dauda Rifkatu Samaila  
There is global use of IUD among women. It is seen as the safest and reversible family planning method compared to other methods. It is a wise choice for women within the sexual active period of life that are yet to commence or complete the number of children so desired and to also prevent unwanted pregnancy and the consequences of abortion. For the married couples yet to complete number of children desired it serves as a form of child spacing method of choice with high level reliability. Despite its safety and reversibility, it uses in developing country like America is low, estimated at 2% in 2002 (Mosher, 2004). Based on 2004 United Nations data, Eastern and Western Europe represent 4-5% of global IUD use. The reason for this low practice may be associated with its possible side effects like menorrhagia. However, WHO estimates that approximately 160 million women worldwide use IUDs today. China has an estimated two-thirds of these users, or 96 million. Only a small percentage of current users are in Eastern or Western Europe or other industrialized countries (10%). The remaining 24% are in developing countries other than China, concentrated in Vietnam, Egypt, Indonesia, India, and Uzbekistan, and Turkey – those six countries alone contain half of all users in developing countries excluding China. All developing countries fall into the following clusters, which show widely different determinants of use rates. They also help to identify programmatic reasons for greater or lesser uptake, (WHO, 2007). In Nigeria according to Dinwoke V, Okafor C, Eke A, (2015) in a study conducted in an Eastern Nigerian Teaching Hospital “the IUD was the most popular, being accepted by 56.7% of all clients” of all family methods. This was attributed to some women believe that using modern methods would endanger their health and future fertility. This concede with a study carried out in Port Harcourt, south-south Nigeriaby Enyindah C, Ojule J, Bassey G, indicating IUCD users in the range of 47 to 66% of contraceptive acceptors in different family planning centers and it is used longer than other reversible contraceptive methods.  
23 Analysis of the Changing Role of Traditional Birth Attendants in Tirol West County, South Sudan , Nebiyu Lera Alaro  
Effective from May 2014, community-based traditional birth attendants (TBAs) in Yirol West County, South Sudan, were directed to start referring all women in labour to health facilities for childbirth instead of assisting them in the villages. This study aimed to understand the degree of integration of TBAs health system, to reveal the factors influencing the integration, and to explore the perceived solutions to the challenges faced by TBAs. A qualitative study utilising 11 focus group discussions with TBAs, 6 focus group discussions with women, and 18 key informant interviews with members of village health committees, staff of health facilities, and staff of the County Health Department was conducted. Data were analysed using qualitative content analysis. The study found that many TBAs were referring women to health facilities for delivery, but some were still attending to deliveries at home. Facilitators of the adoption of the new role by TBAs were: acceptance of the new TBAs’ role by the community, women and TBAs, perceptions about institutional childbirth and risks of home childbirth, personal commitment and motivation by some communication problems between TBAs and health care facilities, delays in seeking care by women, insecurity, lack of materials and supplies for TBAs, health system constraints, insufficient incentives for long distances to health facilities and transportation problems. This study has revealed encouraging developments in TBAs’ integration in the formal health system in Yirol West. However, there is need to address the challenges faced by TBAs in assuming their new role in order to sustain the integration. Keyword: TBAs Health system, TBAs In South Sudan, TBAs in Yirol, Focused antenatal care, Care of uncomplicated delivery, Emergency Obstetric and Newborn Care (HemOnc), Focused postnatal care.  
24 Knowledge of Diabetic Foot Care among Nursing Practitioners in Rivers State, Nigeria , Lilly-West B. R, Mildred E. John, Clement I  
Diabetic foot ulcers have led to countless amputations and reduced quality of life among individuals living with diabetes. Specialized diabetic foot care has been shown to reduce the risk of foot ulcers and amputation among diabetics. The study assessed the knowledge of diabetic foot care among 100 nurses in the University of Port Harcourt Teaching Hospital and the Rivers State Hospitals Management Board Hospitals (which include General Hospitals from all the local government areas) in Rivers State, Nigeria. A structured questionnaire containing questions on different aspects of diabetic foot care was interviewer-administered to the nurses and scored accordingly. The results showed that only 34 (34%) had training on diabetic foot care; and most of the nurses who had training had more than 20 years of experience. It was observed that the knowledge of diabetic foot care was significantly higher among nurses with more than 10 years of experience (p = 0.0046). Nurses with less than 10 years of experience had a significantly poor knowledge of diabetic foot care. Knowledge of footwear assessment and assessing the patient’s capacity for self-care was found to be significantly lower among nurses who had no training on diabetes foot care (p = 0.0001). The study shows the urgent need for frequently organized training on diabetic foot care for nursing practitioners to improve the quality of diabetes care in Rivers state, Nigeria. Keywords: Diabetes, Diabetic Foot, Diabetes Foot Care, Nursing Practitioners.  
25 Prevalence of Acute and Moderate Malnutrition among Under Five Children in Three Counties of Western Lakes State, South Sudan , Nebiyu Lera Alaro
The prevalence of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) of under-five children, in South Sudan is considerably high and is being aggravated by various internal conflicts and food insecurity ravaging the country. The situation has attracted the attention of various international organizations like World Food Programme (WFP), United Nations Children Emergency Fund (UNICEF), and other international Non-governmental Organizations (INGOs), for possible interventions. However, the success of the nutrition therapy programme in reducing the prevalence of SAM and MAM among under-five children, as implemented by these humanitarian organizations is hinged on many factors. A retrospective cohort study was conducted by collecting reported data from District Health Information Software (DHIS) of SAM and MAM prevalence of under-five children across three years; 2015, 2006 and 2007 for three counties, and was analysed using SPSS. Findings revealed significant differences in SAM and MAM within counties and among counties across the three years. It was further revealed that there was rising prevalence of SAM and MAM (poor impact) among the counties as the nutrition therapy programme progressed across the three years in the three counties. It was suggested, among others, that training and re-training of health and nutrition workers, timely availability of food supplements, ensuring food security, unwavering adherence to the principle of neutrality and impartiality on the part of INGOs and government, and conduct of pre and post-intervention surveys for feedbacks, may serve as the panacea towards the present unsatisfying state of the nutrition therapy programme in the war-torn Lakes State of South Sudan. Keywords: Nutrition therapy, Prevalence, Malnutrition, SAM, MAM, and South Sudan.  
26 Typhoid Fever Clusters in Kadoma City, Zimbabwe April 2014 , Z. Jakopo, D. Chirundu, D. Bangure, S. Tapesana
Background: Clusters of suspected typhoid cases were recorded in Kadoma City between February 2014 and April 2014. The clusters were at a camp for uniformed forces, a public hospital and a private hospital. Concern by Kadoma residents necessitated the need to investigate the sudden increase in suspected typhoid cases. We then set out to describe the clusters in terms of person, place and time, identify the possible causative organism and source of infection. Methods: A descriptive cross sectional study was conducted. Interviews with 34 randomly selected cases from the three clusters were done. Municipal water samples were collected for quality analysis. We collected stool specimens and hand swabs from kitchen staff at the 2 hospitals. We also collected kitchen working surface swabs and conducted a sanitary survey. Results:  Males constituted 56% of the cases. Abdominal pains (32%), diarrhoea (29%) and fever (21%) were common among cases with a positive stool culture. Loss of appetite (26%), abdominal pains (26%) and diarrhoea (24%) were common among cases confirmed by the Widal test. The water treatment plant had quality control measures in place. Two out of 8 hand swabs had E coli isolated and 1 had Salmonella typhi isolated. Four cooks were shedding Salmonella typhi in stool. No faecal coliforms were isolated in the water samples. There were numerous sewer blockages at the uniformed forces camp. Conclusion: The outbreak was propagated. Food handlers were shedding Salmonella typhi. Hand washing practices were poor. We recommended that the food handlers be removed from the kitchen and monitored. Sewer blockages in the compounds were attended to. Continued surveillance of cases and mobilization of resources in the City was also done. Keywords: Typhoid fever, Clusters, Kadoma City, Zimbabwe  
27 Awareness, Perception and Implementation of Focus Antenatal Care (FANC) among Health Care Providers Working in Mother Care Clinics and Hospitals in Benue State, Nigeria , Emmanuel O. Chukwu, Terna M. Fiase, Chinyere E. Achukwu, Terhemba P. Valentine
This non-experimental, cross-sectional descriptive study assessed the “awareness, perception and implementation of focus antenatal care (FANC) among health care providers working in mother care clinics and hospitals in Benue State, Nigeria”. The target population comprised all skilled health care providers working in all the mother care clinics and hospitals in Benue State. The sample size consisted of 195 respondents who were selected using the convenient sampling technique after stratified sampling method. The demographic data obtained from the distributed questionnaire were analyzed using pie chart, and bar graph. Data collected were presented in frequency and percentage. Mean scores were used to analyze the data. 2.50 was chosen as the bench mark (≥2.5 as criteria of acceptance). Inferential statistics (chi-square) [x2] was used to test the hypothesis at 0.05 level of significance. Findings revealed that health care providers are aware of FANC in their hospitals/clinics. Result also shows that health workers have positive perception about FANC. The health workers have tried to implement most of the activities under FANC, but some important ones such as assessment for referral, screening and some tests were not properly implemented. There were no major factors militating against the implementation of FANC in hospitals/clinics in Benue State. The hospitals/clinics do not want to implement FANC because it may deter the quantity of visits that contributes to the earning of the hospital/clinics. Hence, they are unwilling neither to implement the recommended four visits of FANC nor to educate the mothers about FANC. Based on the results, the researchers recommend that government should enforce the full implementation of FANC in all the other care hospitals/clinics in Benue State because of its significant impact on the quality care for expectant mothers. Thus, ensures a complication free pregnancy and child birth. The health care providers should implement all other activities under FANC such as assessment for referral, and some important screening and tests as these activities are also very important at ensuring complication free pregnancy and child birth. Health workers should try to educate the mothers on the importance of FANC so that they can embrace it since it has been proven to be the best approach to ANC. Keywords: Awareness, Perception, Implementation, FANC, Skilled, Healthcare, Providers, Nigeria  
28 Self-care Management and Education of Diabetic Clients , Marrie L Davis  
The roles and responsibilities of clients in managing non-communicable diseases (NCDs) remain vital. Diabetes mellitus is a chronic disease that affects people from underdeveloped, developing and developed countries despite stages of economic and social development. Diabetes self-management education (DSME) is an ongoing process of facilitating the knowledge, other skills necessary for self-care and incorporating the critical processes such as the needs affected goals and care guided by evidence-based standards. The overall goals of the article supported informed decision-making, self-care behaviors, problem-solving and collaborated with health care teams to improve clinical outcomes, enhanced health status and the quality of life living with diabetes. The self-care management model was designed to help clients living with the disease. The model provided supports and educated client on how to best adjust their lifestyle practices to sustain healthy living. The nursing process used as an assessment tool for designing the model. A client-friendly action plan and a simple take home card used to chart the way forward in managing self-care. Technology has influenced many lives, which can be motivational and allowed for more frequent contact between healthcare providers and clients and enhanced self-care management behaviors and treatment plans. The application of scientific knowledge can be broadened to clients, homes, and communities, and provided individualized care and just-in-time information. Keywords: diabetes, self-care management, diabetes self-management education, compliance, lifestyle modifications  
29 Nurses’ Role in Diabetic Foot Prevent and Care: AHealthcare Challenge , Marrie L Davis
The diabetic foot is considered one of the most devastating complications of diabetes. Diabetic foot is defined as a foot affected by ulceration. It is associated with neuropathy and or peripheral arterial disease of the lower limb. Health education is a combination of learning experiences designed to help people; by increasing their knowledge and influencing their attitudes to improve well-being. The aims of nursing interventions in diabetic foot care- to enhance patients care and services through health promotion, prevention, and patient-centered care. Nurses play vital roles in achieving these goals by providing health care, educating, consulting, being transformational leaders, researching and advocating for patients. However, this action plan focused on the roles of nurses in diabetic foot prevention and care and identified some of the challenges faced. The main goal of the article- to provide health services and to improve the physical, emotional, mental, socio-cultural and spiritual needs of clients. Education on the basics of foot care, how to perform the physical examination and educating clients on the importance of wearing the right shoes are fundamental areas. Developing educational programs for each client and their families, teaching on the importance of follow-up checks, monitoring of blood glucose at a specified interval, the primary principles of diabetic care and prevention of complications are vital roles of a nurse. On the other hand, minimizing the risk of the recurrence of the wound is vital. Therefore, by managing contributing systemic factors such as hypertension, hyperlipidemia, obesity, heart conditions or renal insufficiency is crucial. DFU are classified based on the features of the wound and tissues involvement. The study focused on the importance of complying with self-foot care the prevention of complications and the roles of the nurse in the process. Method: An evaluative study was completed using the nursing process. The monofilament test a method used for the screening process. Educational sessions were conducted and practical demonstrations on the importance of self-foot care. Cases were referred for further management based on the needs identified. Many tables were used to aid in the teaching processes. Results: All clients visited for follow-up checks were knowledgeable on the importance of compliance with care and ably demonstrated foot examination. 20% of the clients reported difficulties encountered with complying to care due to socioeconomic challenges. Notably, there were no newly diagnosed cases. Conclusion: Nurses’ roles remained the key factors in managing, caring, educating, advocating and helping clients in modifying their lifestyle practices. Keywords: Diabetic foot, diabetic foot ulcer, education, compliance.  
30 Beliefs About Caesarean Section amongst Women of Child Bearing Age in University of Calabar Teaching Hospital, Cross River State, Nigeria , Umoh, Edet Okon
This study was conducted to find the beliefs about caesarean section amongst women of childbearing age in UCTH Calabar, Cross River State, Nigeria. In the course of the study, five research questions and five hypotheses were formulated to direct the study. A survey method was used which is indicative in interview and discussions with people to obtain facts. The population of study was 853 pregnant women who came for antennal clinic in UCTH Calabar within the month of January 2017 with sampling size of 85 women. Accidental sampling method was used with a structured questionnaire—‘Questionnaires on beliefs about caesarean section among women of child bearing age in UCTH Calabar, Cross River State, Nigeria’. Same was administered by the researcher and his assistant and the data was analysed with mean, standard deviation, chi-square and One-way analysis of variance (ANOVA). The result revealed that there are significant influences of traditional and religious beliefs on caesarean section amongst women of childbearing age. The result further showed that there is significant difference in belief about caesarean section amongst women of childbearing age based on their educational qualifications, income status and number of children. It was recommended that there should be proper enlightenment of pregnant women over the relevance of caesarean section in the churches, communities and schools. Keywords: Caesarean section, women of child bearing age, tradition beliefs, religious beliefs.  
31 Relationship between students’ performance in aptitude test at recruitment time and actual progressive performance during training at one of the Nursing Schools in Zambia , Himoonga Mulenga
General Nursing Council recruitment and selection guidelines requires passing of an aptitude test by candidates wishing to train as nurses, a prerequisite that has been received with mixed feelings due to the high failure rate inherent with the test. The investigator therefore undertook the study to determine if there was any relationship with passing of the aptitude test and the performance of students during training. A purposive, retrospective review of records was done and IBM SPSS statistical package, version 20 was used to analyze data. The findings revealed that passing the aptitude test, was not indicative of definite subsequent passing of the nursing courses by students. In conclusion passing aptitude test was not a determinant of ability of student to pass their nursing examinations. Keywords: Aptitude, performance, nursing education, regulation.  
32 Societal Contribution to Incidence of Puerperal Psychosis in Federal Psychiatric Hospital, Calabar, Cross River State, Nigeria , Umoh, Edet Okon
The purpose of this study was to examine societal contribution in incidence of puerperal psychosis in Federal Psychiatric hospital, Calabar. In order to achieve this purpose, three research questions and three hypotheses were formulated to guide the study. The descriptive survey research design was used for the study. The population of study comprised all female psychiatric patients suffering from puerperal psychosis in Federal Psychiatric Hospital, Calabar. A convenience method of non-probability sampling was used to select sample for the study. This was made possible with in-patients’ record from female wards in the hospital revealing a total of 50 patients. Instruments used for collection of data were questionnaires and face to face interview. The reliability of the instrument was established through internal consistency technique using Cronbach Alpha Analysis. A reliability estimate of 0.867 was obtained for the instrument. Chi-square statistical analysis was used for testing the hypotheses. All the hypotheses formulated were tested at. 05 level of significance. The result of the analysis revealed that acceptability of married women by family does significantly contribute to puerperal psychosis. Again, denial of pregnancy does significantly contribute to puerperal psychosis. Finally, the result revealed that continuous delivery of same sex children does significantly contribute to puerperal psychosis. Based on this findings, it was concluded that society do contribute to incidence of puerperal psychosis in Federal Psychiatric Hospital Calabar, Nigeria. It was therefore recommended that the media, traditional leader and religious organisations should educate the citizens on the importance of family members allowing married couples to live their life without undue intervention. Lastly, Government should enforce legislation to punish any man who for one reason or the other maltreats his wife. Keywords: puerperium, psychosis, tranquilizer  
33 Knowledge and Attitudes of Nurses towards Health Care Associated Infections in Lahore, Pakistan , Muhammad Afzal, Ali Waqas, Muhammad Sabir, Shazma Ahmad Khan, Aminullah
This study assesses the knowledge & attitudes of nurses regarding standard precautions about health care associated infections (HAIs) among the different hospitals of Lahore, Pakistan. Exposure to the body fluids and blood is the main sources for HAIs to the patients. Health care associated infection is a critical issue in the health care facilities because it causes mortality and infection among the hospitalized patients and health care workers. The World Health organization reported that ninety percent of infections among health care workers (HCWs) are associated with the occupational exposure to the body fluids and blood in the developing countries (Wilburn, et al., 2013). Standard precautions are used to provide the protection to health care providers from damages and to stop spread of nosocomial infection. Standard precautions recommend the proper hand hygiene before and after the procedure while contact with the patients (Boyce, et al., 2013). The current study is of quantitative and cross-sectional design. Target population of the current study was 600 nursing staff of two hospitals of Lahore, Pakistan in which one is public hospital and other one is private hospital. The sample size of the current study was 172 which were calculated by using Slovin’s formula. SPSS 20 was used for the data analysis. The current study result shows that nurses have adequate knowledge regarding standard precautions of HAIs but lack the intention about precautions of HAIs. Thus, it is concluded that low level attitude of nursing staff regarding standards precautions about HAIs was assessed which cause infections to the health care providers and patients. Keywords: Knowledge, Attitudes, Nurses, Standard precautions and Healthcare associated infections (HAIs).  
34 Sources of Stress among the Nursing Students of Private Universities of Pakistan , Muhammad Afzal, Ali Waqas, Muhammad Hussain, Naveed Sehar
The emotional situation or demand of the work from the student may create stress among the nursing students. Stress for the students at class room is very common and altered their mental and physical health. Similarly, the tiring nature of clinical practice also reduce the performance and ability to gain the knowledge of the nursing students. Thus, aim of the current study is to investigate the sources of stress among the nursing students. The study consists of a sample of122 nursing students of the private universities of Lahore. The study results reveals that students of nursing experiences stress through the following four sources i.e. academics, clinical rotation, personal problems and environment. Furthermore, nursing students of private universities experiences more stress from the academic sources of stress than the other three categories. The study provides the recommendations and implications in the future findings. Keywords: Stress, academic sources, clinical sources, personal sources, environmental sources, nursing students.  
35 Knowledge and Practice of Telenursing among Nurses in Plateau State, Nigeria , Sunday Yohanna Dangyang  
This study was designed to study the knowledge, perception and practice of Telenursing among Nurses in Plateau State, Nigeria. It aims at the need for good policy in health care delivery and implementation of Telenursing to reduce to a greater extend the consequences associated with inadequate health care distribution. A cross sectional study involving Nurses in Plateau State, Nigeria was carried out with information on socio-demographic characteristics, knowledge of telenursing, perception towards telenursing and team work, willingness and attitude of Nurses to use telenursing and challenges affecting the implementation of telenursing in Plateau state were collected, using a semi-structured questionnaire. Data was analysed using descriptive statistical and chi-square test. The level of significance was set at p ≤ 0.05. 270 Nurses participated in the study. Majority 148 (54.8%) had not heard about telenursing though 117 (43.3%) have heard. 90.7% participants have never been engaged in telenursing, 84.4% stated inadequate resources affected telenursing practice. Majority (84.8%), 52.3% indicated interest for telenursing to be used and for improved communication and collaboration respectively between Nurses and other disciplines. Majority 66.5% agreed that telenursing is easy to use. Only 31.1% felt that telenursing may not bring any extra value to existing nursing practice when implemented. Lack of knowledge (47.4%), funding (80%), policy (15.2%), Poverty (13.3%), time/interest/will/attitude of nurses (2.6%), Shortage/lack of manpower/workload (4.8%), and Inadequate power supply (11.1), were pointed out by the participants as challenges that can affect the implementation of telenursing. Keywords: Telehealth, telenursing, information, technology, knowledge, practice.
36 Factors Associated with the Choice of Nursing Profession among First Year Students at Consolata Nkubu School of Nursing, Meru, Kenya , Catherine Joan Kawira Mundi
The study was carried out between March and August 2017.The purpose of the study was to determine factors associated with choice of nursing profession among first Year students at Consolata Nkubu School of Nursing, Meru County, Kenya. The study adopted a cross-sectional design. The target population consisted of October 2016 and April 2017 classes. The total population during the year was 263 students. Census as a sampling method was used owing to the small sample population which was only 77 respondents’. 71 Self-administered questionnaires were distributed to the respondents who met the inclusion and exclusion criteria and 4 class representatives (Key informant) were interviewed using a checklist. The study reviewed that Majority of the students who joined the training were positive about nursing. A few students did not like nursing and were forced to join the profession. The result showed many students have changed their priorities and have settled on nursing profession after the introduction to the nursing curriculum. Given a second chance most (90%) would still choose nursing as their career of choice. The researcher realized the need to sensitize the pupils and secondary school students on nursing profession through the media, career guidance and volunteer works to healthcare facilities. Generally the student nurses neither considered factors like well-paying career as the priority nor related to the occupation of the parents rather the desire to serve patients well was the greatest expectation after completing the course followed by advancing in the profession and desire to get a good job. Keywords: Nursing, Profession, nurse, career, choice, associated Factors.  
37 Nurses’ Leadership Style in Tertiary Care Hospitals , Nauman Q. Godfrey  
The present study showcases the leadership style of head nurses of Tertiary Care Hospitals in Pakistan (Lahore). Purpose is to see that what type of leadership style is mostly practiced / adapted. For data collection, quantitative methods are employed that includes a scale LPS (least preferred co-worker scale) and checklists to assess head nurses that either they are relationship motivated or task motivated. Two lists were made named as A and B for getting data about autocratic and democratic style respectively. Total sample from the populating of nurses and head nurses was 65 (n = 65) among which 18 are head nurses and 47 are charge nurses. From 18 head nurses 3 are task motivated (17% of total sample), 13 are relationship motivated (72% of total sample) and 2 are mixed of mixed leadership style (11.1% of total sample). The checklists revealed similar findings that remained consistent further strengthening the results. It was concluded that Democratic Leadership Style is most rampant in Tertiary Care Hospitals. The head nurses are very encouraging and they appreciate every creative idea from their colleagues. They promote collaborative work. They support every initiative taken for the betterment. The head nurses of Tertiary Care Hospitals share the decision making and problem-solving responsibilities with their colleagues. Charge nurses develop a greater sense of self-esteem due to importance given to their ideas and contribution. Keywords: Nurse. Tertiary Care. Hospitals. Leadership. Styles.  
38 Knowledge and Use of Standardized Nursing Languages: A Study among Nurses at the Federal Medical Centre, Owo, Ondo State, Nigeria , Abiodun-Sanni Falilat Iyabode
The Standardized Nursing Languages (SNLs) is a new innovation in nursing which is aimed at improving the standard of nursing practice and the professionalism of Nursing. This study was carried out to know the level of knowledge and utilization of Standardized Nursing languages among nurses at the Federal Medical centre Owo. It was aimed at identifying nurses familiarity with the Language, their level of knowledge, use in patient care and also to identify the possible barriers that might prevent the use of the Language in Practice. The use of SNLs is still not gaining popularity among nurses in this tertiary institution, despite its formal introduction to Nigeria since 2010, hence the need for this research work. A descriptive/correlational design was employed using a self-structured questionnaire. A sample size of 250 nurses was targeted and sampled using a non-probability technique. The data was entered using the SPSS software and analysis done using tables of frequency and percentage, mean and standard deviation, chi test, Pearson correlation where necessary. Result showed that nurses have a poor knowledge of SNLs. They are mostly familiar with NANDA. The major method of documentation was paper as they have no computer system in their unit. 54% of respondents use SNLs at work most of which are not correct based on the responses given. Correlation showed that there is no significant difference between years of experience, qualification of nurses and their knowledge of SNLs. (p>0.05). The major challenges identified by the respondents include poor knowledge of the language, lack of basic amenities, poor policy, inefficient continuous education, shortage of manpower. High quality nursing documentation promotes effective communication in the healthcare team, which facilitates continuity and individuality of care. The use of SNLs promotes quality nursing documentation and enhances the visibility of the contribution of nursing to patient care. Keywords: Standardized Nursing Languages, Knowledge, Practice, NANDA-I, NIC, NOC.  
39 Stressors and Counselling Needs of Undergraduate Nursing Students in Osogbo, Nigeria , Lilly-West, R.B
Background: Education is important in the development of any profession. It is the process of transferring knowledge from a generation of professionals to another. Stress can be beneficial in the education of a student, motivating them to reach their full potential. However, nursing education has its peculiar attendant stress that can be harmful when excessive. Majority of nursing students around the world have reported a level of stress in their academic pursuit. Objective: The study was carried out to determine the stress level of students in the various levels of the nursing education, to examine the pattern of stress amidst the students according to their sociodemographic, and to determine the relationship between the various coping mechanisms adopted and the overall stress score through a questionnaire- based study in a government school of nursing in Osun state, Nigeria. Method: A descriptive cross-sectional study was carried out at the Osun state school of nursing, Asubiaro, Osogbo, Osun state. A sample of 120 students was drawn from all the classes of the school using a multistage sampling method of proportional allocation. To achieve the objective of the study, a questionnaire was designed that contained three sections; A. Sociodemographic data, B. The perceived stress scale (PSS) and C. The brief coping orientation for problem experiences (COPE). Data were entered and analysed using the statistical package for social sciences (SPSS) version 20.0. Results: The mean age of the respondents was 22.11±4.14 years with the median and range being 21.00 and 30.00 years respectively. About 78% of the respondents are females and 70% are Christians. Using the PSS, 48.3% of the respondents sometimes become upset because of something that happened unexpectedly, 17.5% becomes upset fairly often, 12.5% almost never becomes upset among the others. Equal number of respondents (5.8%) never or almost never felt nervous or stressed in the last month, others sometimes (44.2%), fairly often (19.2%) and very often (25.0%) feel nervous or stressed. Other responses about the PSS are presented in table 2. There is a significant difference between the stress score of the respondents in between the sexes (16.70 vs 19.17; p=0.045). Also, the proportion of the females that are stressed is significantly more than the proportion of the males (66.7% vs 87.1%; p=0.018). The odds of respondents who practice behavioural disengagement to be highly stressed is 0.262 (95% CI, 0.117 – 1.483) times that of respondents who practice other coping mechanisms. Conclusion: The level of stress in the population studied is relatively low when compared with the results from other studies both locally and internationally. The various stressors identified are basically as a result of lack of control over academic events, nervousness, inability to handle personal problems, irritations, and anger. The nursing education authority should look into these stressors with the view to find ways of mitigating them, thereby providing an optimum learning environment for the students. Some of the students already practice both active and avoidant coping techniques.  
40 Attitudes of Student Nurses’ towards Adherence to Standard Precautions in the Clinical Area at a Large Teaching Hospital in Uganda , Faith R. K. Sebuliba
Standard precautions guidelines are the effective cornerstone W.H.O and CDCC measures of infection control and management used to reduce healthcare associated infections among healthcare workers and patients. However, healthcare workers especially students do not always adhere to them. The purpose of this study was to assess attitudes of student nurses and midwives towards adhering to standard precautions. A quantitative, exploratory study using a self-report questionnaire was carried out on 53 third year diploma nursing and midwifery students at a large teaching hospital in Uganda. Only 81% of the respondents scored at least 80% on the attitude scale that was measured using constructs from Rosenstock's, (1974) Health Belief Model. The construct of perceived benefits (84.9%), self-efficacy (63.5%), and perceived barriers (62.3%) rated higher than the rest. The attitudes towards adherence to standard precautions was lower than expected, revealing a gap that may lead to nonadherence to SP and continued predisposition to nosocomial infections in the hospital setting. Findings had implications for nurse educators, administrators, and practitioners to promote nurse’s attitudes towards adherence to standard precautions. Keywords: Standard precautions, universal precautions, occupational risks, nosocomial infections, compliance, adherence, health belief model, nurses, healthcare workers.  
41 Impact of Mentoring on Nursing and Midwifery Educators and Students: An Integrative , Elizabeth Namukombe Ekong, Sun J. Carolyne
Background: Academic staff shortages exist in training institutions within the developed and developing world. Mentoring is thought to enhance teachers’ competencies, strengthen social abilities, and promote learning and career development; however, not much is known about mentoring in developing countries and its impact on nursing academia. The aim of this literature review was to explore existing evidence on the impact of mentoring on nurse and midwifery teaching competencies and students’ learning and social abilities, and the pre-requisites for establishing an effective mentoring program. Methodology: A comprehensive literature search was performed using HINARI, PubMed, SAGE, WILEY, Science direct, Google scholar, and Google search. Hand searching was too done through bibliographies to identify related articles. Results were screened to select studies that reported benefits and challenges of mentoring to nurse and midwifery educators, student nurses and midwives, and successful mentoring programs. After screening, a total of 15 articles met the inclusion criteria and were reviewed and analysed. Results: Senior faculty mentoring junior faculty provides or enhances accomplishments of some nurse educator core competencies, provides opportunities to develop teaching knowledge base, and promotes exposure to required resources for growth in the teaching career. It further stimulates personal and social growth. Mentored student nurses and midwives experience reduced anxiety, and mentoring provides a supportive learning environment and increased self-awareness of one’s own values and beliefs, confidence, maturity and responsibility. Lack of time, dual responsibility, heavy workload, personality, and attitude may negatively impact the mentoring process. An effective mentoring program requires a relevant mentoring model and clear definitions of its context, structure, and goals. Conclusion: Mentoring has the potential to strengthen teaching competencies as well as students’ learning and professional growth. Keywords: Effective Mentoring program, Impact of mentoring, Midwifery educators, Nurse Educators, nursing education, social abilities, student midwives, student nurses, teaching competencies  
42 Knowledge of Bloom’s Hierarchy of Cognitive Levels of Educational Objectives and its use in Setting Examinations by Nurse Educators in Lusaka and Eastern Provinces , Patricia Mambwe
Background: The use of Bloom’s hierarchy of cognitive levels of educational objectives as a tool for classroom assessments is rapidly increasing therefore, Nurse Educators’ knowledge of the tool is vital. Objective: The first prime objective of this study was to investigate nurse educators’ knowledge of Bloom’s hierarchy of cognitive levels of educational objectives. Materials and Methods: A cross sectional study was conducted in nursing training schools of Lusaka and Eastern provinces of Zambia. The study sample comprised of 63 Nurse Educators who were selected using purposive sampling method. A self-administered questionnaire was used to collect data from the respondents. Statistical Package for Social Sciences (SPSS) version 20 was used to analyse data. The Chi Square test was used to compare the proportions. A result yielding a P value of less than 5 percent was considered to be statistically significant. Results: The findings were that 64% of nurse educators had low knowledge, 22% had moderate knowledge while 14% had high knowledge on Bloom’s hierarchy of cognitive levels of educational objectives. Results from the study indicated that 90% of nurse educators affirmed that Continuing Professional Development meetings on assessment techniques were not conducted in the schools of nursing while 10% indicated that they had them. Conclusion: Though the nurse educators undergo training on Bloom’s taxonomy, their knowledge on this topic is low and calls for Continuous Professional Development Meetings. This will improve quality and standards of examinations in nursing education which will in turn improve the performance of nurses in the clinical area. Keywords: Knowledge, use, Bloom’s hierarchy, cognitive levels, educational objectives, setting examinations, Nurse Educators  
43 Sickle Cell Disease in Pregnancy: Active Nursing Management , Anisley Fabars-Johnson
Sickle cell disease is considered as a major complication and risk factor for perinatal morbidity /mortality. Literature document that most pregnancies complicated by sickle cell are likely to result in live birth, but the consequences of influence of the disease for the pregnancy/newborn remains a significant concern for health care providers worldwide. According to the bibliography obstetrical-fetal risks are due to the metabolic demands, hypercoagulable state, and vascular stasis associated with pregnancy characterized normally for blood cells to be able to carry oxygen to the growing fetus. With sickle cell anemia, the abnormal red blood cells and anaemic characteristics of the disease physiopathology may result in lower amounts of oxygen going to the developing baby with negative outcome for the future newborn. Research review studies agreed that access of the pregnant client to a multidisciplinary care team knowledgeable about sickle cell disease and high-risk obstetrics can significantly decrease feto-maternal morbidity and mortality. Example: decreases in spontaneous miscarriage, in perinatal death rates and lowered incidence of preterm labour. Active prenatal management include: education; genetic counselling and prenatal diagnosis for couples at risk; improving nutritional status; vaccination for disease prevention, and early detection of bacterial infection. Objective of this study was to explore active nursing management of the pregnant women with sickle cell disease, including education, treatment and nursing intervention. Method: use of English Literature review current through: Jun 2017, Data were searched using MEDLINE, EMBASE, PUBMED and COCHRANE Systematic Reviews. Keywords: Sickle Cell Disease, complication, feto-maternal risk, active nursing management.  
44 Effects of Shortage of Nurses at St. Dominic’s Mission Hospital, Ndola, Zambia , Elizabeth Njovu
The shortage of nurses is a problem that is common everywhere in the world. Nurses form the largest number in the healthcare system and play a significant role in providing direct patient care. Considering the importance of the role of nurses in the healthcare system, it is important to investigate how nursing shortage affects the quality of patient care, nurses’ job satisfaction and their work stress. Zambia is not an exception to this scourge, most hospitals face this challenge of nursing shortage. One such Hospital is St. Dominic’s Mission Hospital located in the outskirts of Ndola. There is a confirmed positive relationship between nurse shortage and workload. There is also a significant positive relationship between workload and the quality of patient care. Furthermore, a negative relationship was observed between workload and the quality of patient care. In addition, this study calculates the mean effect of emotional intelligence of these factors, and a significant correlation is found between emotional intelligence and workload as well as work stress. It can be said that in Zambia, nursing shortage Influences the workload of the employee, finally affecting the quality of patient care. In addition, the study recognized the capability of nurses to manage their emotions as well as emotions of others, which has increased their tolerance to control psychological stress in performing their duty. This study confirms that nurse’s emotional intelligence act as a partial moderating variable for job outcomes of nurses. Background: The shortage of nursing staff is a great challenge worldwide, it affects many nations in the world. With this shortage, patients are suffering because the healthcare workforce is not prepared to deal with their health needs. In each country, the shortage of nurses is as a result of a number of factors that ultimately cause a decrease in the quality of health care given. However, little is known about the global causes of a shrinking professional nurse workforce. Main objective: To assess the effects that shortage of nurses has on the care of patients and on the few nurses providing care at St. Dominic’s Mission Hospital, Zambia. Method: A cross-sectional study was conducted to assess and identify the effects of the shortage of nurses on care of the patient as well as on the few nurses providing care. Data was collected using the self-structured questionnaire with closed and open ended questions. Purposeful sample of 20 nurses participated. Results: 20 nurses participated: 15 females and 5males; aged between 21 to 50 years. Majority (90%) diploma Holders and are registered nurses. Findings reveal that (100%) are aware of the shortage of nurses at the Hospital, (89%) feel the impact of the shortage of nurses has on them. (70%) indicated that shortage of nurses compromises the quality of patients care, 55% of the participants had knowledge on the nurse-patient ratio for the general medical ward while 45% did not. 20% indicated that poor Human resource planning by administration has caused the shortage, while 75% indicated unrevised staff establishment and 5% indicated that migration of nurses is the reason for nurse shortage at the hospital. 100% expressed that shortage of staff makes them stressed and work long hours. Conclusion and recommendation: the participants’ are very much aware of the shortage of nurses not only at St. Dominic’s Mission Hospital but in other health care facility as well; they are determined to continue doing the best for the patients despite the shortage. It is therefore recommended that the administration at St. Dominic’s Mission Hospital should urgently lobby for more nursing staff from the Ministry of Health. Keywords: shortage, effects, nurses, compromised care, quality care, stressful environment, St. Dominic Mission Hospital.  
45 Consequences of Teenage Pregnancy , Catherine Malethola Lebina  
Teenage pregnancy remains a challenge requiring urgent resolution the world over (United Nations Population Fund, 2013). In 2014 the World Health Organization reported that 11% of all births were due to women aged 15- 19 years (World Health Organization, 2014). Approximately 95% of teenage pregnancies occur in developing countries with 36.4 million women becoming mothers before age 18 (United Nations Population Fund, 2013) (Mkwananzi and Odimegwu). All teen pregnancies are dangerous because every teen lacks the skills that are needs to handle oodles of stress that pregnancy brings along. All teen pregnancies are dangerous because every teen lacks the skills that are needs to handle oodles of stress that pregnancy brings along(Social Dynamics of Adolescent Fertility in Sub-Saharan Africa). Main objective: The key objective of this formative research study was to compare the response got from the target audience (youth aged 15-19 years) at St Charles catchment area and St Peter H/C catchment area on the challenges they are facing with after conceiving at an early stage of life. The study also seek to find out number of teenagers delivered at the facility with or without complications. Method: The study was quantitative descriptive cross sectional where the emphasis is on comparing groups. The study aimed to identify the relation of responses from the respondents. Data on teenage pregnancy were compiled for 2 facilities namely; St Charles Hospital and St Peter Health Centre Results: A sample of 35 questionnaires distributed at St Charles Hospital, returned 33. St. Peter H/C (25) questionnaires were distributed to the youth who came for health services. 24 were returned of which all of them were returned. For St Charles hospital, 13.64% were those 15 and 19 years, 22.73% were between 16-17 years, 27% were 18 years at the time of delivery of first kids. At St Peter H/C, 23.81% were 15 years, 14.29% were at 16 and 17 years, 19% were 18years, and 28.57% were 19 years old when they gave birth to their first kids. Conclusion: The results clearly indicate that teenage pregnancy occurs equally to married and unmarried females. The difference is one to make both parameters equal. 27% of the respondents gave birth at the age of 18 years. At the remote areas, teenage pregnancy is more prominent as the study shows that 23.81% had their first kids at the age of 15 from the catchment area of St Peter Health Centre. Teenage or adolescent pregnancy is noted as a major public health and demographic problem with medical, psychological, social and demographic implications. (Shaw and McKay; 1942). Keywords: Teenager, Pregnancy, challenges, unplanned marriage.  
46 Factors Affecting the Utilization of Family Planning among Women Attending Selected Health Centers in Ile Ife, Osun State, Nigeria , Agunbiade Funmilayo B
Many unintended pregnancies and illegal abortions contributes significantly to the high mortality rate in Nigeria, which signifies the unmet needs for family planning among women of reproductive age, which could be affected by myriads of factors. Hence, this study assesses factors influencing the utilization of family planning methods among women attending selected health centers in Ile Ife. Osun State. Nigeria. Findings showed that more than two-third (68.6%) had ever used a family planning method. Meanwhile, about two-third (60.4%) were currently using a family planning method, while 39.6% were not using any method. Majority (26.3%) rated condom as the most effective method of contraception. Factors identified as militating against the utilization of contraceptive use were; fear of side effects (80.2%), personal dislike (71.7%), opposition of spouse (63.5%) and unwelcoming attitude of health workers (61.1%) and non-effectiveness of family planning services (54.3%). Hypothesis testing revealed a strong relationship between fear of side effects and utilization of family planning services (X2 = 26.091, df = 1 and p = 0.001 at 0.05 significant value). However, there is no significant relationship between spouse opposition and utilization of family planning services (X2 = 1.171, df = 1, p = 0.279 at 0.05 significant value). In conclusion, although a good number of the respondents were using a family planning method, some of them were not still using it. Hence, the need for health care provider to educate based on isolated factors such as side effects, preference, spousal opposition that influence contraceptive use among women of child bearing age. Keywords: Factors influencing contraceptive use among Lori Ashford, Donna Clifton, and Toshiko Kaneda, The World’s Youth 2006.  
47 Role of Husband’s Age in Percentage of Eggs that get Fertilized in Invitro Fertilization Cycle , Monisayo Olayemi Komolafe, Komolafe Johnson Olusanmi  
Background: Female age is a known independent index in determining outcome of fertility treatment with ovulatory and fertility potentials declining rapidly after age 35 however it an assumed fact that men are capable of spermatogenic activity beyond age 60 with world oldest father procreating at age 97. (Myers, 1972) Objectives: Determine if age affected semen concentration and motility of male partners undergoing invitro fertilization. Determine if age of male partners had influence on percentage of oocytes that are fertilized following invitro fertilization cycles. Method: A descriptive retrospective review of data of IVF cycles performed between July 2015 and June 2017. Inclusion criteria was that age of oocytes producer must be less than 36, post sperm wash count of at least 10million per milliliters and 15% active motile sperm. Exclusion criteria were female age of oocyte producer more than 35, incomplete relevant data. Results: One hundred and twenty cycles met inclusion criteria. Mean husband age was 45.70 (±7.07). Mean percentage oocyte fertilized among the group was 51.95% (± 29.85%). Mean percentage of oocytes fertilized among husband equal to or less than 50 was 54.21% (± 28.87%) while mean percentage of oocytes fertilized among husband age 51 and above was 45.20% (± 32.20), the observed difference being statistically significant (p= 0.0000; X2 =90.133). Conclusion: There is a significant drop in ability of men above 50years to fertilize oocytes compared to men below 51years of age during invitro fertilization cycles. Keywords: In-vitro Fertilization, Intra uterine insemination.  
48 A Comparative Study to Determine the Knowledge and use of Breast Self-Examination Technic among Female Student Nurses at St. Lukes School of Nursing, Rufunsa. Zambia , Toddy Sinkamba  
Breast cancer is the second common cancer after cancer of the cervix in women in Zambia. Although screening methods for breast cancer such as mammography has been shown to reduce mortality from breast cancer in developing countries where it is commonly used, the World Health Organisation (WHO) does not recommend it for use in developing countries because of it has cost implications. Instead, WHO recommends an alternative screening method called Breast Self-Examination for all women in the reproductive age group (15-49). The purpose of the study was to compare breast cancer knowledge, attitude and use of Breast Self-Examination among female student nurses in the reproductive age group (15-49). The study site was St. lukes nursing school Rufunsa district of the Lusaka province in Zambia. A total of 50 female student nurses participated in the study. Keywords: Breast cancer, Breast Self-Examination practice, Breast cancer knowledge, student nurses in year 2 & 3, Mammography.  
49 Challenges Faced by Healthcare Providers in Providing Services to Key Population at Risks of HIV in Ethiopia , Nebiyu Lera Alaro  
As one of the main goals of the Partnership Framework (PF) between the Government of Ethiopia (GoE) and the U.S. Government (USG), Ethiopia has set a national target of reducing new HIV infections by 50% by the end of 2014 (National Target). Funded by the USG, the PF provides a five-year joint strategic plan (2010-2014) for cooperation to support Ethiopia’s national HIV/AIDS response (PEPFAR, 2010). Ethiopia has an estimated adult prevalence of 1.5% and about a million people living with HIV/AIDS (PLWHA) (ECSA & IFC, 2012), among countries most affected by the epidemic. The International Labor Organization (ILO) projection for 2015 indicates that as much as 8.5% of the Ethiopian labor force loss will be due to HIV/AIDS deaths (World Learning, 2012). On the other hand, since the PF took effect, USG funding to the program has been in constant decline. Moreover, the PF does not fully take into account context and development barriers due to the prevailing social, political, economic and development policies in the country. Participation of the private sector, independent civil societies and media in the development process has been severely curtailed. Contextual factors have been seriously challenging the prevention of mother-to-child transmissions (PMTCT) efforts. Furthermore, the country lacks a comprehensive strategy to fully address the issue of most-at-risk population (MARP) as drivers of the HIV epidemic; and the HIV/AIDS response excludes Men who have sex with Men (MSM), a “significant unacknowledged” but fast growing transmission route of HIV (Tadele, 2008). Drawing from literature review and practicum experience in Ethiopia, this paper examines the feasibility of Ethiopia’s National Target. The main problem in the HIV/AIDS discourse in Ethiopia appears to be behavioral change, but not lack of knowledge. In addition, contrary to the widespread public belief that homosexuality is not Ethiopian, there exists a flourishing underground male-sex trade in Addis Ababa.  
50 Perception of Patients about Cardiovascular Disease (CVD) and Effect of Communication by Physician and the Assisting Registered Nurse to Enhance Assessment of Risk and Bridge a Gap of Accurate Perception of their Risk of CVD , Anette Marina Rodrigues
This paper validates the level of perception of patients about Cardiovascular Disease (CVD) and effect of communication by Physician and the assisting Registered Nurse to enhance risk assessment and bridge a gap of accurate perception of their risk of CVD. Design and Procedure-A Non-experimental Descriptive study of patients visit to Out Patient Department for Physician Consultation. Non- Random selection of patients with complaints of chest pain visit from October 2016 to March 2017 over a period of 6 months. Assessment of Vital Parameters of 60 patients, Male-57 and Female 3, within age group of 30 to 40 years and ECG graphs readings were done for all. Information is collected from Health Information System Portal. Result- Communication and providing positive thought on seriousness, to prevent CVD over the future years, among 60 patients with complaints of chest pain was a challenging aspect. (n=15) were newly diagnosed with Hypertension, (n=10) were follow up patients with Hypertension and Diabetes Mellitus), and (n=25) were referred to Cardiologist with appointment fixed for further management and (n=10) ECG was normal significant of gastric pain. The Physician did initial assessment and significant symptoms on history of illness on all 60 patients. (n=44) were advised on appropriate diet and reduction of weight by balanced diet and exercise. (n=30) were advised on follow up among them (n=25) had visited the physician as follow-up. (n=10) Obese were referred to dietician with appointment fixed, and assisting nurse gave advice to (n=50). Conclusion-Patient’s perception on CVD suggests (n=50) were ignorant about risk of CVD and (n=10) had known about risk of CVD. The trustful patient relation and communication by the treating Physician and health education by Registered Nurse has direct and positive effect on outcome of the research. Patients were enthusiastic to gain more knowledge on Modifiable risk factors. The attitude and behavior of patients were significant and positive with revisit and follow up visits. Keywords: Perception, Cardiovascular Disease, Communication, Health Information System, Health education, follow up visit.  
51 Perception of Reflective Journaling during Clinical Posting among Nursing Students , Musah K. Toyin, Philip A. Ojo, Okueso Grace Ogba
The aim of the study was to find out about perception of reflective journaling among undergraduate nursing students in Babcock University, Ilisha-Remo, Ogun State, Nigeria. The objectives were to determine the students’ perception of reflective journaling and the perceived meaning of reflective journal writing. This study utilized a descriptive research design. Data was collected through self-administered questionnaire. Population of 130 students in 400 and 500 levels were used. Results of the reliability test, using Cronbach’s alpha of all the constructs measuring the perception and the explanatory variables were well above the recommended minimum of 0.70. Results revealed that, a significantly higher proportion of the participants have positive perception towards reflective journaling in the undergraduate nursing program in Babcock University. The mean score of perception of reflective journaling was 1.93205. Most of the students were able to correlate theory with practice (96.2%) with the mean of 1.9615. Data evidences also revealed that, the status of perceived meaning of reflective journaling of nursing students’ clinical learning and practice is high. This inference is evident in the fact that overall criterion weighted mean score (1.805147) is greater than the average Likert scale of 1.5. Keywords: Critical thinking, Journaling, Perception, Reflective writing, Nursing Students  
52 Knowledge, Attitude and Behavior on Overweight and Obesity, Health Consequence and Adaptation to Lifestyle Changes among Early Middle Age Medical and Non-medical Health Care Staffs of NMC Day Care Centre, Abu Dhabi, UAE , Anette Marina Rodrigues  
This non-experimental descriptive cross-sectional survey explored the knowledge, attitude and behavior (KAB Survey) related to overweight and obesity its health consequence and ways to manage ideal body image and balanced weight with diet, exercise and lifestyle modification among medical and non-medical staffs belonging to origin Indian, Nepalese, Middle east and Philippines of NMC day care center, AL wadi, Abu Dhabi, UAE. Design and procedure: A non-experimental descriptive Random cross section study was conducted among (30) medical and non-medical staffs out of 120, who have joined the team for over a period of 1.5 to 2 years since 2014.  Two months convenient sampling was done using Semi-structured questionnaire. Qualitative and quantitative data analyzed through Content analysis and Health Behavior Knowledge Scale.15 questions, including open ended Questions, choose correct answer from four options and fill in the blanks was used as method to assess Health and Behavior Knowledge. Results: The findings showed that Random Sampling of 30 Staffs, from 2014 and who stayed in UAE. 73.3% had normal BMI, 23.3% fall under Overweight, and 3.3% fall under Obesity. In 2016, the result showed 36.6% have normal, 46.6% Overweight, 10% Obese.  The results of knowledge on diet were as follows -73.3% had adequate information on diet and 26.6% lacked information on diet, whereas the attitude towards Overweight and Obesity, 66.6% were aware on negative health consequence and ways to handle them. With the knowledge on diet, 86.6% have adequate information on diet and 13.3% still have misconception on diet, whereas the attitude towards Overweight and Obesity was remarkable 100% were aware on negative health consequence and ways to handle them The vast significance which was alarming was in area of exercise.33.3% had positive attitude towards exercise and 66.6% had negative attitude towards exercise. After training on Exercise for 1 month, results are as, 83.3% have positive attitude towards exercise, 13.3% have reduced weight and gained muscle strength through exercise and 16.6% have still misunderstood about concept of exercise. The body Image Tool parameter results as follows using 9 figures, black and white of male and female, the current body image value is minimum shape of 4 (n=7), 5(n=7), 6(n=9), 7(n=3) to maximum shape 8 (n=1) and ideal body image minimum shape individuals want to attain,4(n=15), 5(n=6), to maximum shape 6(n=1), neutral (n=1) Conclusion: The study reveals that individual have interest to follow correct pattern of diet, exercise and maintain their body image and control Overweight and Obesity, with minimum exercise of 30 minutes to 1hour every three days in a week. One more point comes into consideration is How to go about to attain measurable values to ideal Body weight and Image as long term goal. Keywords: Knowledge, Attitude, Behavior, Lifestyle, Diet, Exercise, Body Image
53 Importance of Tuberculosis (TB) Infection Prevention among Nurses and Patients at St. Dominic Mission Hospital , Elizabeth Njovu
Tuberculosis infection control is the topic of great importance especially in developing countries where poor immunity, overcrowding, and some infections are a predisposing factor for Tuberculosis infection. The most common predisposing factors and measures to reduce the spread of TB infection from one person to the other are elaborated in this study. The findings reveal that even nurses taking care of the TB patients are at great risk of contracting the infection, hence strong TB infection prevention guidelines need to be strictly followed at all level of care. Main Objective: To explore the knowledge and understanding of the qualified Nurses working in the out-patient department and medical ward in relation to Tuberculosis infection control and its impact on the hospital stay and patients outcome. The method used: A cross-sectional study was conducted to identify predisposing factors to TB Infection. Data was collected by self-structured questionnaire of both closed and open-ended questions. A purposeful sample of 30 nurses from an out-patient department and male medical ward participated on a voluntary basis. I personally worked in these two departments to get the experience of what and how TB infection control is observed by nurses. Results: 30 nurses participated: 19 females and 11 males; aged 21 to 50 years. Majority (82%) diploma Holders, did registered nursing. Findings revealed that (75%) appreciates the use of protective clothing - Masks while attending to TB infected patients while 25% did not, 45% finds it important to isolate those who are suspected to have TB and those having active TB, 100% observed the guideline of keeping the doors and windows open for free movement of air. Keywords: TB infection prevention, Environment control, Protective clothing, Isolation of the infected.  
54 Common HIV/AIDS Clinical Symptoms among HIV-Positive Pregnant Women under ARV Therapy: Clinical Indicators for Non- Adherence to Treatment , Admirabilis Kalolella
The objective of this study was to assess adherence to option B+ ARV triple therapy and describe common HIV/AIDS clinical symptoms as indicators of non-adherence among women giving birth in Dar es Salaam Tanzania. We analyzed the prevalence of non- adherence through clinical assessment of common HIV/AIDS symptoms, indicators of non-adherence to treatment. The cross section method, clinical assessment and self-report interview was used to identify clinical symptoms related to HIV/AIDS. The study analyzed symptoms with higher frequency of occurrence and were termed as common HIV/AIDS clinical symptoms, and were established as indicators of non- adherence. Women with three or more of these symptoms were identified as non- adherents to ART. The study also analyzed the relationship of demographic variables and adherence. Result. Among the 105 HIV infected women under triple therapy, 63(60%) of them developed at least three HIV/AIDS related symptoms indicating that they were not adhering to the treatment, while 42(40%) adhered to the ARV therapy prescribed. The Adherence to ART Indicators tool was established presence or absence of persistent clinical symptoms of; fatigue, night sweat, muscle ache and frequently fever, extreme and unexplained tiredness, pneumonia, recurring fever, profuse night sweats, and rapid weight loss. Demographic variables were not significant related to adherence. In conclusion, the majority of HIV infected pregnant women receiving B+ ARV triple therapy developed common HIV/AIDS clinical symptoms, indicating they were not adhering to treatment. Keywords: Clinical assessment, non-adherence to ART, HIV infected pregnant women, HIV/AIDS symptoms, B+ ARV triple therapy, PMTCT.  
55 The Human Immunodeficiency Virus sero-Prevalence and AIDS- Related Opportunistic Infection Patterns among Women with Retained Placenta in Eastern Tanzania ,   Admirabilis Kalolella
The objective of this study was to characterize women with Retained Placenta (RP) attending obstetric care in eastern Tanzania. We assessed the HIV sero-prevalence, then screened for medical conditions related to RP and described their AIDS related opportunistic infection patterns for the women that were HIV-sero-positive. The cross sectional study design using medical questionnaires and self-report checklist was used to collect data. The study assessed if there is any relationship between retained placenta and HIV sero-status, and if sero -status and HIV opportunistic infection patterns has relationship with pregnancy outcome and other medical conditions related to pregnancy. In our study, HIV sero-positive was detected in 105 out of 251 women (42%). HIV sero-positive women developed prolonged labor, 23(79.3%), significantly more often compared to HIV sero-negative women, 6 (20.6%), P value <0.0001. The HIV positive women are significantly more likely to develop Post- partum hemorrhage (P value= 0.0031) and to undergo Caesarian section compared to pregnant women without HIV (P value = 0.0113). The pregnant women under antenatal ARV Triple (B+) therapy are significantly more likely to end up with preterm delivery (P value= 0.0443). Women with HIV progressive symptoms of memory loss, depression, and other neurologic disorders had more underweight babies born (P- Value= 0.0316), while women with pneumonia developed vaginal tears more often during delivery (P- Value =0.0693). In conclusion, RP is common among women with HIV. The prolonged labor is the major medical condition currently faced by HIV infected pregnant women during delivery. Women with HIV progressive symptoms are at risk to give birth to underweight baby and get vaginal tear during delivery. The current B+ ARV treatment during antenatal period has positively changed some the pregnancy outcomes among HIV infected pregnant women. Keywords: Retained placenta, sero-positive, HIV sero-status, prolonged labor, HIV opportunistic infection patterns, pregnant women, Post-partum hemorrhage, B+ ARV triple therapy.  
56 Knowledge of Diabetes Management and Control among Diabetic Patients Attending Federal Polytechnic Clinic, Kaura Namoda,North West Nigeria   , Dr Abdullahi Mohammed Lawal
Diabetes is one of the chronic diseases that affect both the young and old in our society. According to World Health Organization (2006), at least 171 million people worldwide suffer from diabetes and it is more prevalent in developed countries. According to American Diabetes Association (2006), there were about 20.8 million people with diabetes in United States alone, while in developing countries, increase in prevalence is expected to occur especially in Africa, where most patients will likely be found by 2030. This increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes perhaps most importantly a “Western – Style” diet (World Health Organization, 2006). In Nigeria though no estimate of the individuals suffering from diabetes has been made, in a recent screening exercise carried out in Warri and Sapele (south east, Nigeria) where 787 people attended, 65% were diabetic and hyper-tensive (Urhobo National Association of North America, 2004). Also at University of Nigeria Teaching Hospital Enugu the number of patients that attend Wednesday diabetic clinic is alarming. Diabetes is characterized by a disorder in metabolism of carbohydrate and subsequent derangement of fat and protein metabolism. Disturbance in production and action of insulin, a hormone secreted by the islets of langerhans in the pancreas is implicated in the disease (Shafer,2000). In addition to insulin, aging, over weight and several other hormones affect blood glucose level there-by preventing glucose from entering the cells (Clavell, 2005).This leads to hyperglycemia, which may result in acute and chronic complications such as diabetic keto-acidosis, coronary artery disease, cerebrovascular disease, kidney and eye diseases, disorders of the nerves and others (Iwueze, 2007).The management of diabetes poses a challenge to medical and nursing staff as well as to the patients themselves. Since diabetes is a chronic disease, most diabetic patients need to continue their treatment for the rest of their lives. The emphasis is usually therefore, on the control of the condition through a tight schedule of blood glucose and urine sugar monitoring, medication and adjustment to dietary modification (American Diabetes Association, 2003; Iwueze, 2007). Such a chronic condition requires competent self-care, which can be developed from a thorough under-standing of the disease process and the management challenges by the patient and family members. This pre-supposes a need for some form of diabetes education and counseling for the patient and family members. According to Colbert (2007) educating and supporting diabetic patients in managing their daily lives are important goals of diabetic patients care today. Unfortunately, about a third of the people suffering from diabetes may not be aware of it early considering the insidious onset and development (Iwueze, 2007). Regrettably too, many who are diagnosed with the condition demonstrate fears about the future and a general distaste because of the predominant misconceptions about the disease. This is heightened by the superstitious explanation of causation of diseases dominant in Africa where most diseases are caused by “poison” and/or “evil spirits”. Some of these problems highlighted can be taken care of if patients and indeed the general public are exposed to diabetes education (Iwueze, 2007).
57 In-Patients’ Satisfaction with Food Served in Imo State University Teaching Hospital, Orlu , Chinelo Clare Vincent  
The study was carried out to assess in-patients satisfaction with food served at Imo State University Teaching Hospital, Orlu. The daily intake of food rich in all classes of nutrients help in promoting wound healing; decrease the occurrence of complications; as well as aiding the patient’s recovery from diseases or injuries. Three research questions gave direction to the study. Descriptive survey research design was adopted for the study. The target population for the study consisted of two hundred and thirty two (232) in-patients in different wards of Imo State University Teaching Hospital (IMSUTH). The accessible total population of in-patients as at the time of study was one hundred and fifty four (154). The main instrument for data collection was structured questionnaire. Face validation was done by a jury of Medical and Health workers in Universities, South East of Nigeria to determine the extent to which the items on the structured questionnaire are in uniformity with the stated research questions. The reliability of the instrument was done using test-retest technique (r = 0.74). The data collected were analyzed using descriptive statistics of frequency counts, percentages and charts. The result revealed that only 5.3% and 3.3% of the respondents have high and moderate levels of satisfaction respectively with the food served in their wards. Among the factors responsible for food dissatisfaction were unattractive plates and dishes “any how plate” (40.7%), foods were served cold (37.3%), appearance of food not appetizing (45.3%), unfriendly attitude of food servers (24.7%) and serving meals late (29.3%). The respondents suggested that foods should be well presented (49.3%) and that the hospital should introduce meal options (47.3%) and to serve meals warm or hot (63.3%) so as to improve their satisfaction with food served in IMSUTH wards. Based on the findings, the researcher recommended that nurses as the ward managers and patients advocates, should liaise with the appropriate health personnel such as dietician, nutritionists etc. in the food service through a periodic interactive session with a view to relaying clients’ needs and complaints to appropriate authorities. This will go a long way to encourage adequate nutrition and promote speedy recovery of the patients. Keywords: In-patients, food, food satisfaction.  
58 Societal Variables and Prevalence of Substance Abuse among Youths in Calabar, Cross River State, Nigeria , Umoh Edet Okon  
The purpose of this study was to examine societal variables and prevalence of substance abuse in Calabar, Cross River State, Nigeria. In order to achieve this purpose, four objectives, four research questions and four hypotheses were formulated to guide the study. The ex-post facto research design was used for the study. This design was considered suitable for the study because the variables under study are assumed to have occurred and could not be experimentally manipulated in the course of the study. The population of this study comprised 371,022 youths of Calabar Municipality and Calabar South Local Government Areas of Cross River State, Nigeria. The sample of this study consisted of 1000 youths. Simple random sampling technique was used for this selection. An instrument titled ‘societal variables and prevalence of substance abuse among youths Questionnaire” was used for data collection’. Simple Percentages and Pearson Product Moment Correlation Analysis were the statistical tools used for data analysis. The result of the analysis revealed that there are significant relationship between tradition, availability of substance agents, peer group as well as government security agents and the prevalence of substance abuse among youths. Based on this result, it was concluded that societal variables contributes to the prevalence of substance abuse among youths. It was recommended that government should arrests and punishes substance abusers. Keywords Societal Variables: These are various environmental factors that influence youths to substance abuse like age, sex, family background, and lack of supervision, belief system, employment, peer group, government activities, and others (Ebosele, 2010). Prevalence of substance abuse: This indicates existence and indiscriminate use of illicit and proactive substance like alcohol, Indian hemp and cocaine by majority of youths in Calabar Drug: National Institute of Drug Abuse (NIDA, (2015) said this is a chemical substance working to modify the physical and psychological status of the body. Substance Abuse: this is also referred to as drug abuse, a situation where an individual consumes the substance to the quantity and manner that it becomes injurious to him and others (Wikipedia, 2014). Substance: here they are illicit proactive drugs like tobacco, cocaine, heroin, cannabis, opiods and others (WedMD, 2016). Dependence: This is psychological and physiological reliance on a particular substance which results in habitual intake, and followed by compulsive demand.  
59 Motivation and Job Satisfaction among Hospital Nurses Working in Port-Harcourt, Rivers State , Lilly-West, R. Buloala  
Background: Employee motivation and job satisfaction has been one of the single most important factor that determine work output in any organization. This also applies to the nurses who make up the majority (58.05%) of the health care services providers in the health sector in Nigeria (Omoluabi, 2014). This suggests that a lot of healthcare outcome is dependent on their work output in the health sector. It impacts on patient safety, staff morale, productivity, and performance, quality of care, and commitment to the organisation and profession. The prevalence of dissatisfaction among nurses has been given considerable importance in recent years as it affects patient satisfaction. Lack of satisfaction with work which could be as a result of several factors could have several consequences which are negative on the health sector at large. Which has led to emigration to other countries for greener pastures, leaving the nursing profession to go to other professions entirely or working at suboptimal levels thereby providing substandard healthcare.  Objective: The objectives of the study are: to find out how motivated nurses are in hospital environment, to find out the contributing factors to the motivation and job satisfaction, and to determine what factors influence their motivation the most. This will be examined using questionnaires developed and pre-tested, to be served to nurses in hospitals in the Port Harcourt metropolis. Method: A cross-sectional study was conducted among nurses working in Port Harcourt, Rivers Hospitals. The study population consist of all the nurses that attend the mandatory continuous professional development program (MCPDP) for nurses in Port-Harcourt in March 2016. Non-probability sampling by consecutive recruitment of volunteers until all the nurses that are present at the centre are recruited. A questionnaire that was pre-tested before the study was used to obtain information on socio-demographic data and motivation variables. The data was analysed using Statistical Package for the Social Sciences (SPSS version 16.0) software. Frequencies and percentages were used to describe categorical variables. Similarly, continuous variables were described using the measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. Statistical significance of differences between means was determined using analysis of variance (ANOVA). Significant association of job satisfaction and performance with socio‑demographic, employment characteristics and leadership styles were tested using Pearson’s Coefficient of Correlation for quantitative variables. Regression analysis made done using cumulative odds ordinal logistic regression with proportional odds. Statistical significance was considered at P < 0.05. Results: the study found the level of satisfaction to be just 32.1%. This is possibly because of the high cost of living in the study location and it has been shown in earlier studies that remuneration and cost of living is most associated with motivation and job satisfaction (Cortse, 2012; Hennessy and Minnaar, 2009). It also showed that the chances of a nurse who had diploma/RN/RM to be more satisfied and motivated to work is significant, this could mean there is more enthusiasm to work among the newly employed nurse who have not had additional education, and could mean additional education makes the nurses feel less than their actual worth. This is in concert with studies made by Timilsina et al, 2015. Conclusion: The level of motivation and job satisfaction among the nurses interviewed by the questionnaire is low as compared to other studies. The government and relevant authorities should look into ensuring that all the factors associated with job motivation and satisfaction among the nurses should be looked into and optimized so as to prevent nurses leaving their profession or worst travelling out of the country in search of better opportunities. Keywords: Job satisfaction, and Motivation  
60 Factors Affecting use of E-Learning in Nursing Education: A Literature Review , Messina Sehunwe  
Purpose: The review paper presents the factors which are viewed as barriers affecting utilization of eLearning among nurse educators. Objectives: The aim of the review paper is to analyze critically available literature on use of eLearning as one of the innovative teaching stratergies in nursing education and associated challenges in its utilization by identifying factors and barriers affecting use of elearning, Identify how lack of using elearning affect quality of teaching and learning and to establish how nurse educators can be assisted to overcome the identified barriers. Rationale: The rationale for undertaking this exploration is grounded from the fact that information technology has developed and expanded. The benefits of electronic learning (e-learning) is rapidly gaining popularity and it seen as an essential tool that can enhance and facilitate lifelong learning. Methodology: Literature was retrieved using credible data bases Ebscohost, Pubmed and Google schoolar utilizing key words highlighted below and only articles which discussed the related topic were considered for the development of the paper. Results: Results revealed that there are several factors which inhibit the utilization of eLearning by nurse educators which includes, lack of faculty skills regarding ICT, lack of support, lack of funds and fear to lose control by nurse educators in learning and teaching process. Recommendations: Due to the emerging use of technology and the requirement for nurse educators to intergrate technology in teaching and learning it is recommended that Faculty ICT development programmes be a priority and strengthening of existing ICT policies in nursing education. Keywords: eLearning, eLearning models, Nursing education, Information technology, eCompetence, Barriers for eLearning.  
61 Factors affecting Compliance to Infection Prevention and Control guidelines, by Nurses at St. Dominic Mission Hospital, Ndola Copperbelt, Zambia , Elizabeth Njovu  
Background: Compliance to infection prevention and control is a major problem worldwide in Health Care Facilities and especially in developing countries, putting patients at higher risk of Health Care Associated Infections, imposing avoidable suffering, longer hospital stay, disability and death on patients; increasing extra costs on healthcare system and wider economy. Health Care Associated Infections in developing countries including St. Dominic’s mission Hospital in Zambia are at an increase. Main objective: To assess factors affecting compliance to infection prevention and control guidelines by nurses at St. Dominic’s Mission Hospital, Zambia. Method: A cross-sectional study was conducted to elicit factors affecting compliance to Infection Prevention and Control guidelines. Data collected by self-structured questionnaire of both closed and open ended questions. Purposeful sample of 30 nurses participated. Results: 30 nurses participated: 19 females and 11males; aged 21 to 50 years. Majority (82%) diploma Holders, did registered nursing. Findings revealed that (42.2%) had knowledge on use of red containers, (68.5%) used yellow containers correctly. (39.3%) indicated inadequate knowledge, concerning Infection Prevention and Control. Participants’ general information about Infection Prevention and Control guidelines availability, who was supposed to comply and when, was adequate and 99% valued the importance of Infection Prevention and Control guidelines. Factors affecting Infection Prevention and Control compliance were: Inadequate materials and equipment (76.6%), workload (47.9 %), shortage of staff and negative attitude 38.3%. Others were: Overcrowding 33%, inadequate knowledge and finance 16%, also lack of supervision and inadequate departmental meetings on Infection Prevention and Control. Conclusion and recommendation: Despite participants’ knowledge on Infection Prevention and Control guidelines, compliance needed to be encouraged through supervision and having departmental meetings. Keywords: Infection, infection control, compliance, health care-associated infections guidelines, health care providers, nurses, St. Dominic Mission Hospital, factors affecting.  
62 A Nursing Research to Investigate the “Perception of Women at MPOBI Town on Criminal Abortion and its Effect” , Adu-Nkansah Seth  
Criminal abortion is common among women despite its effects; physical psychological and physiological. This research was conducted at Mpobi community of Aboaso in the Afigya Kwabre District in the Ashanti region, of Ghana. The aim of the research was to determine the perception of women at Mpobi community on criminal abortion and its effects. A simple random technique was used to select the area from other localities. By this method each area had an equal chance of being selected. After selecting the area, an accidental method was used to select thirty women from their various homes. With this method, a data was taken from the women who were available and meet the research criteria. The target population was on women from age of 13 and above. A designed questionnaire was administered on the sample. Analysis of data was by transforming the raw data into statistical forms such as figures, tables and percentages. The findings indicated that the issue of criminal abortion was high among adolescents and married women who have too many children; however knowledge on criminal abortion among the women were adequate. The main factors accounted for the high incidence of criminal abortion in the community were, having too many children, what perception is and how does person channel it appropriately and contraceptive failure. Base on the findings some recommendations were made which included; The government should develop solid policies to restrict criminal abortions, expand and provide well equipped laboratories in most remote clinics and hospitals in communities for easy access to be checked for which family planning method is suitable for each person. The affluent, private thriving businesses and NGO's should come cooperatively to aid and make family planning methods, screening and medications free or at least cost a penny for to aid prevent criminal abortion. There is a need for proper education about the harmfulness of criminal abortion and the after effects of abortion. Proper education, awareness, training session and guidance should also be given to the people who are involved in criminal abortion about the after effects of the abortion. Family planning methods should be taught to the adolescent by their immediate parents, guardian and any other respected people in the community. The church and various Religious faith should be endowed with knowledgeable personnels who can help assimilate to the adolescent the righteous acts of not ending the life of a growing foetus on the account of unexpected results from gratifying the fleshly unsuccummable strong desire for sex. The adolescent should be raised well with proper standards to bring in consciousness that what one perception starts from the heart through the sensual gates of the body especially the eyes, so as to gain requisite knowledge, self-help and channelling the perceived thoughts with the appropriate approach. Illegal abortion cases should also be restricted by paying attention to the lifestyle of our growing female wards. The government, persons and personnel and the matured should each play his role in this regard.  
63 Acceptance and Uptake of Voluntary HIV Testing and Counselling among Nurses in Lautech Teaching Hospital Osogbo, Osun State, Nigeria , Oladejo Comfort Oyinlola, Monisayo Olayemi Komolafe
Nurses are at the front line of HIV/AIDS management, thus they have the danger of being occupationally exposed to blood borne pathogenic microbes through needle stick harm, body liquid sprinkles and so on over the span of their daily work. Numerous studies have examined acceptance and uptake of HIV screening among health workers, yet few studies are specifically on nurses' acceptance and uptake of HIV testing and counselling. This study is aimed at examining nurses’ level of acceptance and uptake of HIV testing and counselling in LAUTECH Teaching Hospital, Osogbo, Osun state, Nigeria. The study is a descriptive design which was used to examine the acceptance and uptake of voluntary HIV testing and counselling among nurses in the institution. The target population were nurses at different areas of practice in the institution. One hundred copies of a structured questionnaire were administered to participants from the target group through accidental sampling technique, they were completed, collected, processed, analysed and interpreted. Result shows that majority of the nurses in the institution had high level of knowledge about HIV/AIDS. 95% of the respondents were aware of HIV testing and counselling facilities around them and majority (94%) accepted and made themselves available for the test. 51%, a little above half of the 94%, have routine HIV test. Academic qualification was found to be a significant factor in the uptake of the test Keywords: Acceptance, Uptake, Voluntary HIV testing, Counselling, Nurses, Confidential  
64 Is Knowledge and Uptake of Hepatitis B Post Exposure Management Among Health Care Personnel Influenced by the Cadre of Work Place? , Monisayo Olayemi Komolafe, Aremu, Komolafe Johnson Olusanmi
Hepatitis B virus is recognized as important occupational risk to health care personnel. This descriptive cross-sectional study was conducted among health care personnel (HCP) in different health care facilities in Osogbo, Osun State, Nigeria to determine coverage of HBV vaccination and determine if coverage and taking of post exposure treatment was dependent on category of work place. Mean knowledge of transmission, vaccination schedules and post exposure management was good (55.8%), HCP working at teaching hospital tend to have better knowledge followed by those in primary health centre than those working in general and private hospitals. About half of the HCP (48.7%) who participated in this study felt they were at risk of exposure to HBV by virtue of their job description. Workers in primary care centers followed by those in teaching hospitals are likely to receive booster HB vaccine following exposure than workers in other health facility setting. Keywords: Hepatitis B virus, Vaccination, Immunization, Post-exposure  
65 Factors Associated with Maternal Regular Attendance and Default at Antenatal Clinic in Ile-Ife, Osun State , Odutayo, Patience Omonigho  
Background: Every year, more than 200 million women become pregnant. Pregnancy is a normal physiological process and most pregnancies end with the birth of a live baby. Pregnancy is not a disease and pregnancy-related mortality and morbidity are preventable with attainable simple and cost-effective interventions. However, all pregnancies involve some risk to the mother or infant and it is important to prevent, detect, and manage complications early before they become life-threatening emergencies and that is what Antenatal care offers. Antenatal care is considered the foundation for the normal development, adequate growth, and good health of the mother and fetus. Antenatal care is the care given to a woman during pregnancy. It is a systematic plan of preventive and therapeutic care implemented through a schedule of visits between clients and members of the health care team to enable the client (pregnant woman), the fetus and family go through the intrapartum period maximally using all resources to get the best possible outcome of pregnancy. Therefore, Antenatal care is widely used for the prevention, early diagnosis, and treatment of general medical and pregnancy-related complications. Purpose: The purpose of the study was to assess the factors associated with attendance and default/non-attendance at Antenatal clinic by pregnant women in Ile-Ife. Methodology: A descriptive research design was employed. Purposive random sampling was used to select 80 pregnant women attending the Health facilities selected for the study. A 29-item questionnaire was used to elicit information from the women. Data collected was analyzed using descriptive statistics such as frequency table and percentage. Results: Findings revealed that all the 80 (100%) respondents had heard about Antenatal care. 33 (41.3%) were defaulters and 47 (58.7%) attended their clinic regularly and up to date. Factors associated with non-attendance were lack of finance/money (21.2%), occupation/busy work schedule (30.3%), the absence of illness/healthy status (27.3%), and distance (21.2%). The main factor associated with regular attendance of antenatal clinic was good knowledge of the benefit of antenatal care. The recommendation given was that defaulters should be followed up and visited at their respective homes and education on the importance of regular attendance at ANC stressed to them. Discussion: The findings of this study highlighted the factors associated with regular maternal attendance and default at Antenatal clinic by pregnant women. All the respondents had heard about Antenatal care and were aware of it. About 79% of the respondents got information about antenatal care from neighbours, friends, and relatives who had attended antenatal clinic before. Only 21% of the respondents heard through a nurse. This implies that nurses, midwives, and the health team members need to put up strategies that will assist in reaching a large proportion of pregnant women. From the study, 41.3% of the respondents were defaulters. Some of them default because of their occupation. Those that are traders travel to buy goods or go to the market to sell when the clinic days fall on major market days. Those that are government workers default when they are not granted permission in the workplace. The farmers among them go to farm at times to get farm products for the family. Some default because of lack of money for transportation, the lack of money to buy needed materials and items/pay for services at the clinic. Some said there was no need to attend Antenatal clinic as far as they are healthy. It was also discovered that majority of those who attend ANC regularly were Primigravidae while the multigravidae and grand multigravidae were the major defaulters. The multigravidae and grand multigravidae based their reason on the fact that they have attended ANC during previous pregnancies and are healthy. Keywords: Factors, Maternal, Regular attendance, Default, Ante Natal Clinic, Ante Natal Care.  
66 A Descriptive Research on the Causes and Effect of Nursing Shortage on Some Hospitals in Enugu State, Nigeria , Okeke Ogechi Esther  
The healthcare has been on the forefront of the news and the mind of many people, therefore, the fact that we have a nursing shortage has everyone uncertain about the future of healthcare. This shortage is especially alarming as we’re faced with baby boomers who are living longer, as well as the Affordable Healthcare Act which increases the number of uninsured individuals, which leads more people in need of getting their health checked. Most importantly, patient safety is at risk resulting in medical errors that otherwise would never have happened. Nurses are also feeling dissatisfaction within their careers and many nurses across the country do not think positively about their field. It is important to control the nurses’ shortage before the negative impacts of the deficiency are too great in damage. Together, hospitals, nursing programs, and the government must all work as a team in order to overcome the nursing shortage. The shortage of qualified health sciences professionals is most often associated with the demand for nursing staff. Indeed, nurses represent hospitals’ largest labor expense, comprising the single greatest component of hospital staff. They are the primary providers of hospital patient care. “Birth and death, and all the various forms of care in between, are attended to by nurses.” There are very few other professions which allow individuals to make such a positive contribution to society. Despite the fact that nursing is meaningful work, the country is facing a nursing shortage that grows more pressing with each passing year. Given their importance in health care delivery, hospitals and other health services facilities must address the reasons behind the growing shortage of nurses. This study was restricted to only 10 hospitals in Enugu state due to time and finances but there are several hospitals suffering from the same problem in the state. This study have helped in getting the views of nurses in the state on the causes of nursing shortage and how this shortage have affected their practice. Keywords: nursing shortage, baby boomers, nursing, nurse- patient ratio, healthcare system and patient.  
67 The Socio-Cultural Factors Affecting Client Participation in Health Education Programs in Umarusandandayako General Hospital Bida , Ikeaja Nneamaka  
This study was set to examine the socio-cultural factors affecting client participating in health education programs in UmaruSandandayako general hospital Bida. The objectives of this research were to ascertain the level of participation of client in health education, to find out socio-culture factors affecting client participation in health education programs and to find out ways to improve client participating in health education in umarusandandayako general hospital Bida. The design of the research was descriptive and a sample of 50 health workers was used for the study. Simple random method was adopted in the distribution of the questionnaires which were filled and retrieved. The data collected were analyzed and preserved in simple frequency tables. Finding from the analyzed data revealed that most of the respondents were aware and knowledgeable about health education (80% strongly agreed and 20% agreed, non-disagreed or strongly disagreed) and the need for participation in health education activities. The respondents also strongly agreed (28%) and agreed (40%) that they don’t participate because they don’t understand the concepts, others said they don’t attend because illness comes from god and man made efforts are futile (36% strongly agreed and 44% agreed; only 14% disagreed and 6% disagreed). They also strongly agreed (60%) and agreed (24%) that considering their religious beliefs and giving health packets (70% strongly agreed and 16% agreed) or using interesting methods (50% strongly agreed and 30% agreed) can encourage their participation in health education. This research study can help clients participate in health education in order to better the life of the people by health prevention rather than by health curing.  
68 Incidence and Management of Low Back Pain among Nurses in Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife and Ilesa , Oyedero, Lolade Comfort
This study presents the incidence and management of low back pain among Nurses in Obafemi Awolowo University teaching Hospitals complex, Ile-Ife. (OAUTHC). The study identified the percentage of nurses with low back pain in OAUTHC. The study also identified causative factors associated with low back pain among nurses in OAUTHC, It alsoexplored the management modalities of low back pain adopted by nurses in OAUTHC. Design/Methods: A descriptive design was adopted for this study. 258 respondents were sampled using a simple random sampling technique. However 255 respondents filled the self-administered questionnaires given to them. Data was analysed using descriptive and inferential statistics and results presented in tables using frequency and percentages. Results/Findings: Findings from the study showed that 71.4% of the respondents had low back pain, among which 68.7% had a low intense pain. The study also showed that 54.1% of the respondents with low back pain got their pain from their work. The study also revealed that nursing procedures requiring lifting and bending were highly associated with low back pain. 85.5% of the respondents associated low back pain with wound dressing and bed making. The study also revealed that respondents who had pain manage their pain with, rest, massage, physical therapy and painkillers. Conclusion: The study concludes that a larger percentage of nurses have low back pain and that procedures such as wound dressing and bed making are highly associated with low back pain which makes nurses working on wards requiring these two procedures to be more prone to developing low back pain and they manage low back pain with massage, rest, physical therapy and analgesics with proven effects Keywords Low back pain: subjective experience of discomfort around the 12th rib to the gluteal folds. Back care ergonomics: special form of care directed to the spine and muscles of the back. Nursing procedures: nursing jobs in the hospital aimed at caring for the patient/client. Pain Management: measures used to control pain either medically, conservatively or alternatively. Nurses: professionals who are registered and licensed to practice nursing and are employed by OAUTHC to work as a nurse. Incidence: rate of occurrence or frequency of a case.  
69 The Opinion of Nurses on Work Related Stress and Strategies Adopted to Cope with it at Wesley Guild Hospital Ilesa , Ogundeji Margaret Omobonike
Stress has become a more recognized term over the past decade and is a major cause of concern for many nurses at work. The aim of this study is to assess the opinion on stress experienced by registered nurses working in a hospital, to identify coping strategies used, to assess the relationship between stress, coping mechanism of registered nurses and work experience, and identify decision making process towards stressful situations and possible health outcome. A descriptive correlation study was used to identify sources of stress experienced by registered nurses, stress and coping, and decision making process. Simple random sampling technique was used to select fifty (50) registered nurses, using Yemane sample size. Standardized questionnaire was distributed to them. Data generated from the study were analyzed using both descriptive (percentages, mean and standard deviation) and inferential statistics (ANOVA) at 0.05 level of significance. The findings of the study revealed that 64% of the respondents were female, while 60% working experience is between 1-5 years. The greatest perceived source of stress appears to be workload followed by emotional related issues. Registered nurses seem to be resorting to positive appraisal, and seeking social support as a coping strategies and decision making process. The most frequently reported health outcome as a result of stressful situations appears to be psychological heath implications. Keywords: opinion, work related stress, adopted strategies, coping.  
70 Promoting Health Literacy on Pre-marital Genetic Counseling and Testing of Sickle Cell Disease among Child-Bearing age Women in Nigeria , Olufunke Aduke Jimoh  
Promoting health literacy on pre-marital genetic counseling and testing of sickle cell disease among child bearing age in Nigeria has been a topic of dialogue among academics and public administration. This study showed that majority of the respondent were aware of genetic counseling and testing as well as genotype and marital genotype while some know their genotype. It was concluded that the general level of awareness of sickle cell disease and pre-genetic counseling and testing is very good although a few misconception and challenges still exist; most especially lack of enough health facilities and personnel’s to conduct the pre genetic counseling and testing activities. Therefore, it is highly recommended that the government and all authorities concerned should help curtail this problem. further awareness and success towards pre-genetic counseling and testing will occur if there is improvement in national health sector as well as entrusting dedicated centers to carry out an adequate services for pre-genetic counseling and testing all over Nigeria and beyond. Keywords: literacy, pre-marital, testing, counseling, genotype, child-bearing.  
71 Risk Perception and Impact of Ebola Virus Disease on Work and Personal Lives of Nurses / Healthcare Workers in National Hospital Abuja , Elugbaju Opeolu Emiade  
Since its importation into Nigeria through a visitor from Liberia, Ebola Virus Disease was officially documented in Nigeria. Its consequences cut across all human experiences at personal, family, institutions and national levels. The victim suffers the effects of the illness and its stigmatization. One can therefore conclude that health workers generally are at risk of contracting this disease, inferably this may affect their work and personal lives. The aim of the study is to assess the level of risk perception and impact of Ebola on the work and personal lives of health workers at the National Hospital Abuja. The study adopted use of primary and secondary data. The primary data were derived from the field of study through administration of questionnaire. The secondary data consist of facts and figures from articles and journals. Relevant descriptive and inferential statistical techniques were used in the data analysis. The research revealed that 99% of the respondents display general knowledge of Ebola virus disease and its mode of transmission. The results revealed that many of the health workers have a high risk perception on contacting Ebola due to the lack of adequate treatment and rapid spread of virus during an outbreak. The findings of the research also noticed a high impact on respondents’ work life where there is a lack of willing volunteers during outbreaks due to stigmatization. It was recommended that policies should be formulated to create quarantine centers in every state equipped to cater for prompt response during outbreak of communicable diseases. Keywords: Risk, Impact, Ebola, Nurses, Hospital, Abuja  
72 Challenges Faced by e-Learners at Ndola School of Nursing; Basis for Evaluation of e-Learning Program in Zambia , Vivian Mwiinga  
This paper explores challenges faced by e- Learning student nurses at Ndola school of nursing. E- Learning is a platform of nursing education which uses technology as the learner is in control of her studies. What problems does the e-learning students experience while in training? What support do we need to provide to e-Learners? Method: An exploratory study was conducted among all 39 second year e- learning student nurses (population study), between 14th and 18th July 2015 to determine challenges experienced by e- Learners. A Semi-structured questionnaire used. Qualitative data analyzed by content analysis, while quantitative data by Univariate and bivariate analysis. Results: 73% of respondents were females and males accounted 26.3% aged between 18-30years. Challenges experienced: problems accessing computer and skills laboratory 86.8%; understanding e – content 57%; too summarized content 22.7%. Suggestions: use of simulators and practical video lectures on e – content 31.8%; timely provision of e- content; improve accessibility  63.1%, improve internet connectivity 44.7%, ensure availability of learning materials 21%, cleaning computer laboratory 21%, Provide personal laptops/ tablets 10.5%. However, 97.3% had good perception of e-learning program. Discussion: Over 50% of the respondents had problems accessing the computer and skills laboratory, and lacked Audio-visual simulators, hence difficulties understanding the e-content. Therefore innovative approaches must be implemented. Conclusion: Challenges with e- learning program may affect effective and efficient training of these trainee nurses and must be addressed. Keywords: Challenges, e-learning Student Nurses, Ndola, Zambia  
73 Identifying Factors Leading to Poor Nursing Practices among Registered Nurses of Health Care Settings in Lahore Pakistan , Reeba Saleem  
Background: Theories of behavior change indicate that a careful analysis of different changing factors is helpful when trying to influence professional practice.1There are many such factors faced by nurses, which lead to poor practices among nurses. The aim of this study was to identify the factors that lead to poor nursing practices among Registered Nursesin Health Care setting Of Lahore Pakistan Method: A descriptive cross sectional survey was used to identify the factors that lead to poor nursing practice. To carry out this survey, a convenient sample of n=30 Registered Nurses was selected from those Registered Nurses, who are studying at College of Nursing and at the same time they are practicing too. A self-administered questionnaire consisting of 14 declarative statements was administered to the participants for the purpose of data collection. Results: A 100% response rate was achieved. The prominent factors identified, leading to poor nursing practices included shortage of staff, high work load, poor time management, poor task organization, unhealthy work environment, unavailability of proper equipment’s, lack of clinical experience, lack of professional knowledge and poor communication skills. Conclusion: It was concluded that numerous factors that lead to poor nursing practices have been identified i.e. shortage of staff, high work load, poor time management etc., also these factors should have to reduce to enhance quality of nursing care and making nursing practice more better. This study has laid the foundation for further research in to implementation of good practice by nurses in hospitals by identifying factors that lead to poor practice. Keywords: Factors Leading to Poor Nursing Practices among Registered, Different Approaches to Nursing practice, Significance of study, Ethical Consideration, Data analysis, Discussion, summary  
74 Can Health Information Technology Decrease Antibiotic Use in the Neonatal Intensive Care Unit , Natasha Wilma Remy  
Clinical signs of infection during the neonatal period are often nonspecific and non-localized. For this reason, it is extremely difficult to control antibiotic use during the neonatal period. Most times indication for antibiotics therapy in this population is based only on clinical presentation. A significant number of infants are prescribed antibiotics based on the symptom of tachypnea alone. Of these infants, a significant number of are later diagnosed with a benign condition called Transient Tachypnea of the Newborn. The purpose of the study is to evaluate whether a complete health history delivered through health Information technology can potentially decrease unnecessary antibiotic use in the neonatal intensive care unit at the Victoria Hospital in Saint Lucia. The research was conducted by interviews. Physicians mentioned that a major challengethey face in determining infant risk factors for the development of bacterial infection is the availability of critical information on the maternal history as well as the event surround the birth and delivery of the neonate. Other factors such as reliability, efficiency and availability of lab investigation as well as unit policies and guidelines were identified as influential in their decision of whether to administer treatment to the infant or not. The results of the study concluded that physician agreed that information delivered via information technology would potentially guide health care providers in the decision on antibiotics use in the neonatal unit. Keywords: Tachypnea, Transient Tachypnea of the Newborn, Antibiotics, Resistance  
75 Occupational Risk and Hazards related Nurses Working in Central Hospital Warri, Nigeria , Udogwu Felix  
Nursing is a risky and hazardous occupation in the developing countries, but little is known about the occupational risk and hazards facing the nursing work force in Nigeria. In this article, the purpose is to identify some of the work-related risk and hazards among a sample of nurses in central hospital warri. Cross-sectional data were collected through a self-administered survey in the hospital facilities. 25 questionnaires was submitted, 22 Nurses returned theirs (88%) Measures included four categories: work-related demographics, occupational risk /illness, reporting behaviour, and safety awareness. From the study, the result shows that Nurse who are not satisfy with the working conditions (working environment, safety measures, staff shortage, etc), at the Hospital has 78.9%, Over 85% are faced with extreme pressure at work, while 57.89% report any work-related health risk and hazards to the hospital authorities, 80%, of the sample of nurses experienced fatigue (temporal loss of strength and energy from hard physical/mental work. While 50% of Nurses experience low back pain and are regularly exposed to contagious pathogens/agent the results also revealed that 70% of the nurses claim they work under unclean working environments. 15% of nurses are exposed to radiation as stated in the data collected, another 20 % have been involved in electrical shock accident. 85% of Nurses understand their role in the safety and health management system, while 65% of nurses say that the management team do not regularly inspect the hospital. Future research should examine a factor which leads to risks and strengthen policies? Keywords: Risk, Nurses, hazards Ergonomics, Nigeria
76  Knowledge and Practice of Ethical and Legal issues among Doctors and Nurses in Plateau State Specialist Hospital, Jos, Nigeria , Sunday Yohanna Dangyangs, Chinenye Afonne
Background: There has been growing public concern regarding the moral behaviours of healthcare professionals. Complaints of poor ethical conduct and rise in litigation against healthcare practitioners is not uncommon. All qualified, healthcare personnel are expected to have adequate knowledge of ethical practice and legal issues (ELI). This study aims to explore the knowledge and practice of ELI among nurses and doctors of Plateau state specialist hospital, Nigeria. Method: A cross-sectional survey was conducted among eighty-nine nurses and doctors working in the study site who gave written consent. Information on socio-demographic characteristics, knowledge and practice of ethical and legal issues (ELI) and influencing factors was collected using a semi-structured, interviewer- administered questionnaire. Data was analysed using descriptive statistics and chi-square test. Level of significance was set at p ≤ 0.05. Results: The modal age group was 31-40 years (40.4%). About 15% of participants were doctors. Majority (94.4%) had heard about ELI. A greater number (78.7%) of indicated being faced with ethical problems on daily basics. Roughly 40% indicated that they have not had enough training on ELI. Lack of time (68.5%), not having mentors (82%), lack of knowledge (75.3%), lack of awareness (83.1%) and lack of motivation (82%) were major factors influencing proper ethical conduct and practice. There was no significant association between socio-demographic characteristics, knowledge and practice of the participants. Conclusion: There is need for continuing education on ELI in the study center. Medical ELI should be formulated to suit local context. Keywords: Ethical, legal issues, knowledge, practice, doctors, nurses  
77 Knowledge and Practice of Tracheostomy Care: A Case of Federal Medical Centre, Umuahia South East of Nigeria , Okam, Nwakaego  
Tracheostomy as a medical procedure is carried out to help secure airway of patients with respiratory challenge. It is not without adverse effect. When tracheostomy stays for a long time there is usually an inherent discomfort which the nurse as a care giver will help to alleviate. This study was designed to explore the knowledge and practice of tracheostomy care for the patients. The study was conducted at Fedral Medical Centre, Umuahia, Abia State of Nigeria. The hospital is the major tertiary institution that serve the communities around as well as far away neighboring states.. This study was conducted among the nurses who work in this institution. It was a descriptive cross-sectional study with quantitative methods of data collection. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 17.0. Descriptive statistics were presented in frequency distribution tables. The t-test was used to determine associations between nurse in two major wards used as regarding knowledge if indication of tracheostomy and factors that influence outcome of care. Statistical significance was determined using a cut off value of 0.05 The results study showed that 80% respondents most favoured failed intubation as indication 82.5% were of the opinion that effective mobilization of secretion is the major area of scope in management of tracheostomy. Change in respiration as an indication for initiating suctioning to clear the patient’s airway rather had low score which calls for in assessing the learning needs of the nurses. Their knowledge associated with proper techniques of suctioning is also a source of concern (21%). The nurses have high opinion about clinical outcome of tracheostomy (above 66%). The result also showed that there is significant difference between the ICU and surgical ward staff knowledge of indication for tracheostomy (. T-tab was 1.6 while t-cal was 5.04 at p-level of 0.05. the result showed a high value of t-cal of 5.04). Also, the result showed the values of mean and standard deviation which were collated and computed using t-test as; T-tab was 1.6 while t-cal was3.69 at p-level of 0.05. The result showed a high value of t-cal of 5.04 showing significant difference between the Icu and surgical ward staff knowledge of care.  
78 The Quality Nursing Educational Innovation and Enhancement of the Decentralized Practical Model for Health Education and Training in Rural Zambia , Toddy Sinkamba  
St. Luke’s School of Nursing and Midwifery is located at a rural Mission Settlement in Mpanshya, Zambia. It opened in 2009, with just 30 students, but was recognized for its success and innovation and upgraded, now serving 210 students. 400 have successfully graduated and work across the country. To accommodate the increased intake and meet quality training standards the School pioneered a decentralized practical training model, the first of its kind in Zambia. Zambia, like many other low income countries, faces considerable challenges in providing sufficient human resources for health. It has a shortfall of 9’000 nurses (60% of its requirement). Rural hospitals suffer particularly drastic gaps between planned and actual staffing numbers, with difficulties retaining them. Zambia failed to meet MDG5 (UNDP, 2013) and still only 47% of births are attended to by skilled personnel, contributing to maternal mortality of 440 deaths in 100,000 live births. International health strategies (WHO 2008, 2010) and Zambia’s national health priorities (MoH, 2011, 2012, 2013) emphasizes training institutions need to increase their output. Keywords: Pioneering, Decentralized practicum sites, quality, practical-training, rural, Zambia  
79 Creating Environments that Heal: This Manuscript Explains the ways to Improve patient Safety Taking into Consideration of How the Environment Plays a Critical Role , Jayamargin Hemalatha  
The patient environment of care plays a vital role in the discipline of patient safety for every hospital. Demonstrating that the hospital is a safe place for patients and for those that work there should be of the utmost importance for all healthcare personnel. This article broadly describes or outlines ten important points that will improve overall patient and staff safety in any hospital or healthcare set-up to ensure safety and increase patient satisfaction.  
80 The Effect of Migration Caused by Insurgency (Boko-Haram) on Urban Town of Yola, Adamawa State, Nigeria , Donsanda Solomon Simon  
The research is on the effect of migration (caused by insurgency-Boko Haram) on Yola metropolis, Adamawa State. A case study design was adopted in this research and the target population of 202 respondents. A self-constructed questionnaire was made and an interview was conducted with the help of three assistants. The purpose of the study was to ascertain its effect on the health of children, women and the elderly. The research looked at the public health situation of the migrants; they were assessed using advanced health assessment and also had health education that centered on primary prevention, promotion of health and inhabitation (restoration) of health. Conclusively, it was found that the children, women and elderly were greatly affected by migration.  
81 Nurses’ Compliance with Medication Safety Standard in Enaya Specialized Care Centre, Doha, Qatar , Christianah Mojirade Adeola, Oyinloye  
One of the most fundamental components of health care quality is the patient safety (World Alliance for Patient Safety, 2004). Patient safety is a priority for every health care system that follows specified standards by ensuring and improving the quality of health care services as one of the main concerns of managers of health care systems (Westat, Sorra, Famolaro, et al., 2010; Stratton, Blegen, Pepper et al., 2004; Bahadori, Ravangard, Aghili et al., 2013). Patient safety is an essential and vital component of quality nursing care. However, most nations’ health care system is prone to errors, and can be detrimental to safe patient care, as a result of basic systems flaws. A variety of stakeholders (society in general; patients; individual nurses; nursing educators, administrators, and researchers; physicians; governments and legislative bodies; professional associations; and accrediting agencies) are responsible for ensuring that patient care is safely delivered and that no harm occurs to patients (Ballard, 2003). Most hospitals across the U.S. put ever-changing compliance and quality improvement standards toward the top of their list of organizational priorities. This is important for not only providing a safe environment for the delivery of patient care, but also for assuring that operations are aligned with standards set forth by the Joint Commission on Accreditation of Healthcare Organizations (TJC) and the Centers for Medicare & Medicaid Services (CMS) (Reigle, 2013).  
82 Risk Factors for Contacting HIV/AIDS among Health Care Workers in Peri Uban-Hospitals in Kumasi, Study Conducted at Suntreso Hospital , Tawiah Sampson  
Health workers are vulnerable to occupational exposure to contagious substances and stand the risk of acquiring life threatening disease. The study assessed risk factors for contracting HIV AIDS by healthcare workers in the three Peri-Urban Hospitals in Kumasi. The study was quantitative employing cross-sectional survey. Data was collected from 210 randomly selected healthcare workers from the three hospitals who were directly involved in given medical care to patients. Questionnaire and interview were the instruments employed in data gathering. The questionnaire was administered; key informant interview was conducted among healthcare practitioners. Study revealed that HIV AIDS transmission in the hospitals emanates from several factors. The major cause of HIV AIDS transmission was found to be percutaneous exposure. The items measuring percutaneous exposure all had high mean scores and relative importance indexes above 50%, indicating that they are risk factors. Injuries from needle and sharp devices contributed 80% of the risk. The study identified modifiable factors found that promotes HIV AIDS transmission in the hospitals to be, non-use of safety devices, complacency, inattentiveness, negligence, and health and safety delivery rules and policies. The study discovered that healthcare workers exposed to the risk factors receive inadequate post exposure prophylaxis. A single dose therapy regimen is administered to healthcare worker who have encountered percutaneous and mucocutaneous exposures. The study provides useful information to hospital authorities and health personnel to work in an environment risk-free. Systematic risk factors, particularly percutaneous exposure should be a prime concern to healthcare practitioners in the hospitals.  
83 Community Health Program on Increase of Male Involvement in Reproductive and Child Health Services at Haydom Lutheran Hospital Mbulu Manyara United Republic of Tanzania , Theodotha John Malissa  
Introduction: Male participation in child-bearing decisions is crucial and also has a positive impact on the acceptability of PMTCT interventions. Well-informed men will be more likely to participate positively in the decision making for the well-being of the couple There are reasons of involving men in reproductive health which are: expanding the range of contraceptive options; supporting women’s contraceptive use preventing the spread of sexually transmitted infections such as HIV/AIDS and to use the forum of reproductive health programs to promote gender equity and the transformation of men’s and women’s social roles Statement of the problem: A study done in Magu district Shinyanga region in Tanzania has showed that Male involvement in pregnancy and antenatal care in Magu district is low. Barriers for male involvement included: traditional gender roles, lack of knowledge, perceived low accessibility to join antenatal care visits and previous negative experiences in health facilities. The data obtained at Reproductive Health clinic at Haydom Lutheran Hospital shows that the number of male attended for reproductive health services for the past six months i.e. January to June 2016 is 920 (18.7%), while the targeted population at this catchment area is 9798 per year and 4899 per six months. As per this data it is obvious that male attendance is low due to either inadequate education on the importance of attending RCHC. So this program is done for the purpose of keeping aware men and the whole community about the importance of their attendance to RCHC hence good number of clinic attendance. Objectives: to increase the number of male involvement to RCH clinic services at Haydom Lutheran Hospital Program Stake holders: Health officers of all levels, Leaders and staff (HLH), division, ward and village leaders, politicians, education officers who will be involved in the program Implementation of the program: During program implementation health education was given to the community for five days with good attendance of 92 male and 420 female. Reasons for not attending to RCHS by men was obtained after interview to 20 men. The results was as follows: 12 (60%) men said that there was low attendance due to sociological factors such as believes, attitudes, communication between men and women followed by 4 (20%) who said it is due to lack of space to accommodate partners So it shows that believes, attitude and communication plays major part in the low attendance of men to RCHC.  
84  Acute Kidney Injury , Sadia Akram  
This article discusses the role of nurses in early identification of signs and symptoms of acute kidney injury (AKI) and then planning and implementing an appropriate nursing intervention. This article will give brief details about the physiology of the kidneys, risk factors, etiology, staging, clinical presentation, assessment guidelines and holistic nursing care of acute kidney injury.
85 Assessment of Weaning Practices of Mothers of Under-Five Children Attending Infant Welfare Clinic, Wesley Guild Hospital, Ilesa, Osun State , Ogunsuyi, Gladys Obiageli  
This study was conducted to assess the weaning practices of mothers of under-five children attending Infant Welfare Clinic, Wesley Guild Hospital, Ilesa, Osun State. The aim was to assess the knowledge, weaning practices, nutritional status of the under-fives and factors affecting weaning practices. Findings will help improve mothers’ weaning practices and also provide empirical evidences for nurses for health education. A descriptive survey design was adopted and samples selected though convenient sampling. 135 questionnaires were administered and filled by the participants. Findings showed that majority (92.6%) had good knowledge about weaning practices. A 55.6% initiated weaning at 4-6months of age. About two-third (65.2%) wean their babies with solid foods and larger percentage used milk substitutes for their child. Maternal smoking, lack of knowledge, lack of support, low maternal education, and low socio-economic status were factors identified influencing weaning practices of mothers. Moreover, the study determined the nutritional status of the under-five children. The findings also showed that 65.9% of the respondents’ babies had normal weight, while 28.9% had underweight. Significant association was found between maternal education, occupation and the age of initiation of weaning (P = .001) In conclusion, despite adequate knowledge of weaning and exclusive breastfeeding among mothers, only about half started weaning at 4-6month, more than a quarter of the children were under-nourished. This shows a gap between knowledge and practice. Therefore, it is recommended that nurses at all levels should educate mothers on exclusive breastfeeding and good weaning practices to promote the health of under-five. Keywords: Weaning Practices of Under-five mothers  
86 Mothers Management of Malaria Fever among Under-Five Nomadic Fulani Children of Northeastern Nigeria: Role of Nursing , Cecilia Obal Nyambi  
Malaria is a deadly disease which is spread widely in the tropical regions of the world with holoendemicity in Sub-Saharan Africa. An investigation of fever management among mothers of under-five children was carried out in nomadic Fulani settlements of Adamawa State Nigeria. Management of fever was assessed through interviews and questionnaires. Nearly half of the nomadic Fulani mothers (49.47%) did not take any action within 24 hours when their children had fever. This was not significantly different (p < 0.05) with regard to age, clan and parity of the mothers. The duration between mother’s recognition and management of fever showed that almost half (49.6%) of the mothers did not take time into consideration during intervention of fever. Mothers of under-five who acted within 24 hours of noticing of fever in their children were 30.6%, while those who acted after 24 hours were 12.0%. There was no significant difference (p < 0.05) between mothers’ recognition of fever and management based on age, clan and parity. Home management of fever by most nomadic Fulani mothers was not satisfactory. Similarly, timely intervention of fever was not considered by most nomadic Fulani mothers. There is the need for appropriate education and adoption of new strategies for timely intervention of disease causing fever among the nomadic Fulani population.  
87  Qi Gong: A physical Intervention (Complementary Therapies) , Salma Tanveer  
The word Qi means “breath of life”, Chinese explained it as life energy in human body. It has been evolved as central concept in Chinese medicine as a life force and flow on energy which is essential to sustain human health and life. Qi,’’ a person’s vital energy force that circulates in the body through channels, supposed to be produced by visualization and affirmation. Due to limitations and side effects of conventional medical treatment, patients are increasingly utilizing complementary therapies. However, evidence for the safety and efficacy of qi-gong treatments is limited. The purpose of the current review was to investigate evidence for the role of Qigong in supportive care. Literature review is conducted using the search engines, Pubmed, Google scholar, Springer Link and CINHYL. Only scientific published articles were retrieved from the year 2001-2016. The effects of qigong on physical and psychosocial outcomes were examined in 28 studies and the effects on biomedical outcomes were examined in 15 studies. RCTs with larger sample sizes reflected positive results for the role of qigong in improving mood and fatigue parameters, fibromyalgia, cancer, diabetes mellitus, Arthiritis, Parkinson’s disease and reducing inflammation. Moreover, qigong exercise in combination with conventional methods had significant improvement in immune function. Hence, Qigong has encouraging results in many of the progressive and poor prognosis diseases, hence, utilization of Qigong by the health care providers should be supported in quality improvisation.  
88 Creating a Caring Nursing Environment at the University Teaching Hospital , Himoonga Mulenga Universe  
The success of any health care delivery system depends on the value the professionals place on quality of the services given. Nursing practice is a major contributor to the success of the health care system especially if the caring concept is well defined and understood by the providers. The project that was undertaken was intended to awaken a spirit of caring in the identified ward with intentions to create a model care ward. The method included flouting the old caring strategies that nurses embraced, stimulating them to rethink and identify approaches that could enhance ‘caring’ whilst creating a vibrant working and cooperative team. A consensus building meeting was held where 20 caring behaviours and 35 uncaring behaviours were identified Keywords: Caring, nursing, professionalism, behaviours, patient.  
89 The Effect of Transformational Leadership on Nurses’ Per formance , Muhammad Afzal, Ali Waqas, Robina Kousar, Kousar Perveen, Muhammad Hussain
Background: Transformational leadership globally plays an important role in the health care system especially patient care by nurses, because performance of the staff nurses link closely to the leadership styles. Now a day’s health care organizations facing shortage of nurses for delivery of evidence base care to patient. Suitable leadership style in nurses can overcome the dearth of qualified and competent nurses as well as fulfill the health care organizations goal. Numerous researchers proven that competent leaders enhance the nurses performance during patient care. Objectives: The objective of this study was to identify the effect of transformational leadership on nurses’ performance in two tertiary care government hospitals (Jinnah and Children), Lahore Pakistan. Method:In this study quantitative non-interventional descriptive cross sectional study design was used on n =250 participants from two government hospitals Lahore Pakistan. Results: The effect of transformational leadership on nurses’ performance was identified positively. Descriptive, Correlation and Regression analysis on SPSS shows significant findings for this study. Finding of regression test shows that transformational leadership has positive effect on nurses’ performance. The values of regression test are 1 as it shows that strong relationship of transformational leadership on nurses’ performance. Conclusions:This study highlighted that transformational leadership enhance nurses performance so, it is important to prepared and trained the nurses leaders for utilization of transformational leadership style at health care setting for enhancement of nurses performance. Nurses’ knowledge and practice may be enhancingthrough workshop and seminars. Health care organizations may develop mechanism for the improvement of nurses’ performance through transformational leadership style and develop the research based culture. Keywords: Transformational leadership, Nurses, Nurses performance  
90 Underutilization of Maternity Services at Seboch e Hospital by Local Community , Lebina Malethola Catherine  
Aim: The aim of this article is to identify the risk factors associated with pregnant women from the catchment population not delivering at the facility Objectives: To reduce number of home deliveries To strengthen utilization of maternity services by catchment population To sustainably improve the health status of their populations to achieve national and global health targets. Literature review: According to WHO 2014, Lesotho has a very high maternal and neonatal death rate being 487 deaths/ 100000 and 74 deaths/1000 respectively. This maybe attributed in part to the high rate of home deliveries. The report indicated that home deliveries accounts for 40% of all births in Lesotho and rates are even higher in the rural areas. The latest WHO (2016) report Annex A, global coverage of skilled attendance at birth was estimated to have reached 73% in 2013. However, despite steady improvement globally and within regions, millions of births were not assisted by a midwife, a doctor or a trained nurse. More than 40% of births in the WHO African Region and WHO South-East Asia Region were not attended by skilled health personnel. 2014 Lesotho Demographic Health Survey shows that 8 in 10 deliveries (78%) are assisted by a skilled provider, for the most part, a nurse/midwife (61%). Unskilled persons, such as traditional healers, village health workers, and relatives/friends, assist in 21%; 1% of births receive no assistance. Skilled providers assist at nearly 100% of deliveries in health facilities, but only 7% of deliveries that take place elsewhere. Indicators related to maternal health care have improved as depicted by Lesotho Demographic Health Survey (LDHS) 2014 showing that: “Seventy-seven percent (77%) of live births in the 5 years before the survey took place in a health facility, while 23% were delivered at home. Most institutional deliveries took place at public sector health facilities (70%). Seboche Hospital catchment area was not an exception to this as it came to the facility observation that few number of local people deliver in the facility hence why the focus of the project was to increase facility based deliveries with local pregnant women. 2016 National projected catchment population for Seboche Hospital for expected deliveries is 431. Monthly the facility is expected to deliver +-36 pregnant mothers. Keywords: Underutilisation of Maternity Services, Maternal health, Midwives, contributing factors, Interventions, community involvement, Nurse patient relationship, Nurses’ attitude, women empowerment.  
91 Significance of Effective Communication During Health Education in Nursing , John Enoredia Elizabeth
This study contributes to knowledge of nurses about communication as it is very vital and the land mark of any organization. Effective communication helps to improve quality of care given to patient and makes continuity in patient care more effective and the communities at large develops confidence in the profession, make early diagnosis easy and promotes the image of the medical field. The study also emphasizes the important of effective communication between nurses, patients and other healthcare workers during health education as it is vital for client safety, disease prevention, curative and health promotion. Nurses are also employed to learn good communication skills as lack of guidelines or format may contribute to medical errors as a result of communication problems.  
92 Midwives’ Knowledge and Practices towards Primary Prevention of Premature Births in a Teaching Hospital in Uganda , Elizabeth Namukombe Ekong  
Prematurity has continued to be a threat in neonatal care for the developed and developing countries (Reedy, 2007). Complications of premature births account for 11.1% of all neonatal live births, and for one million deaths per year (Blencowe et al, 2013). In the U.S. where many infections and other causes of neonatal death have been markedly reduced, prematurity is the leading cause of neonatal mortality at 12.4% (Grady, 2009; Kent, 2009). To avoid the 116 million deaths and 99 million survivors with disability by 2035, the number of babies whoare small for gestational age (10·4 million in south Asia and sub-Saharan Africa in 2010) must be reduced (WHO, 2014). Prematurity is associated with significant costs in healthcare, even without considering the costs associated with the complications that occur later in life (Gilbert et al 2003). It places increased costs for the institution towards the care and to the affected families. There is a tremendous psychological impact on the mothers/care takers and health care providers due to increased workload especially in the era of understaffing. Generally, the consequences of prematurity have an impact on the general economy of the country. Prematurely born infants face the risk of developing complications like respiratory distress syndrome, sepsis, necrotizing enterocolitis and intraventricular haemorrhage; long term complications include bronchopulmonary dysplasia and retinopathy of prematurity (Jitta and Kyadondo, 2008; Randis, 2008). Existing literature indicate that efforts to address the problem has been put on preparing health care providers in secondary management of preterm labour and care for preterm babies after birth. A midwife being key in the care of women/mothers and their new born babies, there was need to establish the knowledge and practices towards primary prevention of premature births to determine the relevant strategies that can be used to address any gaps and contribute to the reduction of premature births and neonatal deaths in Uganda.  
93 Project on Time Motion Study of Diabetes Mellitus in Pregnancy with Emphasis on Gestational Diabetes Mellitus , Ebinyasi Virginia  
The University College Hospital was established by an Act of Parliament in 1952 in response to the need for the training of medical students following the establishment of a Faculty of Medicine at the University College, Ibadan in 1948. The physical development was commenced in 1952 and clinical facilities were formally commissioned in November 1957. The naming of the Hospital, appointment of the Chairman of the Provisional Council of the University College Ibadan as the first Chairman of the Board of Management and the provision (physical facilities for students’ from its inception, were ample proof of the functions envisaged for the hospital though primarily concerned with teaching and research with service only at a level to ensure the satisfactory performance of these basic obligations. The situation changed dramatically with the Nigerian Civil War. The well-regulated processes of referrals from General Practitioners, State Hospitals and Clinics and Selections at the General Out-Patient Clinics (GOPD) were modified with consequences for disproportionate service load. In the ensuring years, the symbolic relationship between the hospital and the University was a success story not only in the quality of Health Care available and the medical education provided, but also in its research output. By the time the University College Hospital was 30 years old, nearly 10 million patients had been treated there, while thousands of clinical student nurses and midwives, laboratory technologists, radiographers, medical record officers and several cadres of health workers have passed through its portals. At least a quarter of all doctors in practice in Nigeria today trained, researched or taught at Ibadan at one time or other. In addition to the undergraduate medical programme (based in the College of Medicine of the University of Ibadan, the UCH also provides training facilities for: Postgraduate Residency Programme in the specialties of Internal Medicine, Surgery, Obstetrics and Gynaecology, Paediatrics, Otorhniorlaryngology, Opthalmology, Anaesthesia, Laboratory Medicine, Psychiatry, Community Medicine, General Medical Practice, Radiology, Radiotherapy and Dentistry, Geriatric Centre, Palliative Care Hospice.  
94 To Determine Awareness of Leadership Roles in Nursing Management among Nurses in Consolata Hospital Nkubu , Catherine Joan Kawira Mundi.  
The purpose of the study was to determine awareness of leadership roles in nursing management among nurses of all cadres in Consolata Hospital Nkubu. The study used descriptive cross sectional design, study area being Consolata Hospital Nkubu. The target population was a total of forty seven (47) nurses working in the hospital. Forty seven nurses were interviewed. Inclusion criteria were nurses who have worked at Consolata Hospital Nkubu for more than two months irrespective of the cadre. Census was used owing to the small number of nurses. Questionnaires were use to collect data. Data analysis was through descriptive statistics such as mean, media and percentage to describe results. Presentation of findings was done in form of tables, bar graphs and pie charts. All the cadres presented including; Bachelor of Science in nursing, Registered nurses at Diploma level and enrolled nurses at the Certificate level. Majority being registered nurses at Diploma level (58%), the nurses with formal education on leadership roles in nursing were on the lower boundary (15%). On the contrary, most of the respondents stated that they had adequate knowledge on leadership roles in nursing (85%), but had inadequate time to practice due to shortage of time as presented by 79% of the respondents.In conclusion it is evident that there is deficit in the knowledge of leadership roles in Consolata Hospital Nkubu. The researcher concluded there is need for further training of the nurses on leadership roles. Keywords: Determine, awareness, leadership, roles, nursing, management  
95 Technology Assessment of Bachelor Nursing Science Staff Using the Technology Acceptance Model , Faith R. K. Sebuliba  
Institutions of higher learning continue to transition from traditional classroom to eLearning, requiring users to develop the technical skills to adapt and cope with the trend. The learning management system (LMS) provides a platform in which are embedded software or computer programs used to create, manage, and deliver education courses and training programs and learning strategies to support eLearning. However, various features of the LMS are underutilized. This capstone project carried out at a university relatively new to LMS and distance education explored the nursing faculty’s behavioral intentions to accept, adopt, and use the LMS for their courses. The project assessed the concepts that are inherent to faculty as they cope with potential changes that are related to their perception and willingness to adopt new technology such as an LMS. Concepts such as technology self-efficacy and emerging informatics, and the application of theory into practice using the technology acceptance model (TAM) were used to frame the boundaries of the project. A quantitative questionnaire guided by constructs from the TAM to assess faculty’s perceived ease of use and usefulness, attitudes towards and behavioral intentions to use, and job relevance was disseminated electronically. The overall findings suggest a positive attitude and willingness of nursing faculty to accept and adopt the LMS. The TAM proved a reliable tool to assess behavioral intentions. A follow up study will be conducted to introduce the LMS use and actual adoption by faculty. Keywords: learning management system, e-learning platform, technology acceptance model, self-efficacy, behavioral intentions.  
96 Obesity in Childhood and Interventions , Tshekoetsile keesi  
Childhood obesity is a condition where excess body fat negatively affects the child’s health and well-being. Childhood obesity has become a global issue and may results in the decrease in the life expectancy. While obesity in children is increasing across the world, minority of children living in urban areas are at higher risk of developing the condition. Due to the rise in obesity prevalence in children and its many adverse health effects it is recognized as a serious public health concern. This project consists of some short interventions aiming at reducing the obesity in children by educating the caregivers and the rest of the family. The project will be focusing on the interventions that can be implemented in the prevention of continued obesity in children. The purpose of the project is to review the pediatric obesity treatment and with the objectives of determining which treatment can be effective. Though studies I have released that psychotherapy is the primary intervention. Cardiovascular diseases and diabetes are some of hearth problems that affect children negatively, and there is evidence based intervention that can be used by the primary care givers to address the issue of obesity. Psychotherapy, diet, physical activities and pharmacotherapy are all effective interventions in treating childhood obesity. I have selected this topic from the three blocks which are health assessment, health care delivery policy and quality outcomes and leadership and communication. Keywords: Obesity, childhood, body mass index, interventions  
97 Difference in Breastfeeding Practices among Urban and Rural Mothers in Lahore, Pakistan , Amir Amin  
The objective of the study was to assess the breastfeeding practices in rural and urban nursing mothers and to evaluate the determinants of selected key indicators of breastfeeding practices in both rural and urban setting in Lahore, Pakistan. There was a need to assess the breastfeeding practices, so that the appropriate measure could be taken in order to lessen the number of the children experiencing these illnesses. A cross-sectional descriptive study was carried out on 370 mothers having up to one year old children Frequencies and percentages were computed. Exclusive breastfeeding was reported by about 40.8% of the mothers. Mostly of them were self motivated. Most of them started breastfeeding on first day. Majority of the females (59.8%) were not giving breastfeeding, mostly of them belong to urban areas and were working females. As per the analysis, it has been found that 98.6% females were from their professional and marital life. Large number of females, living in the urban areas, working for 6-8 hours a day cannot manage breastfeeding along with the work. There is a strong need for the development of policies by the government agencies to allow mothers with infants avail maternity leaves in order to provide exclusive breastfeeding to the children. Since some private organizations do not allow for long maternity leaves. Awareness campaigns should be initiated to provide necessary information about the advantages of breastfeeding and effects of not breastfeeding to the children.  
98 Influence of Knowledge, Attitude and Beliefs on Adolescent Contraceptive use in Benin City, Nigeria , Esebame Francisca
Contraceptive use by adolescents has become a critical issue of concern to parents, educators and medical practitioners in recent years because of trends towards more widespread and early sexual activity of adolescents. This leads to devastating consequences of unprotected sexual activity at an early age such as unplanned pregnancy, unsafe abortion and sexually transmitted infection. The study assessed the knowledge, attitudes, practices and beliefs about contraceptives use among secondary schools adolescents in benin city, edo state, Nigeria.. Descriptive cross sectional design using both quantitative and qualitative methods was adopted for the study. Four hundred students from seven public secondary schools categorised into urban, peri-urban and rural were randomly selected and interviewed. The result showed that contraceptives awareness level among the students was high but the use among the sexually active students was very low due to ignorance. The television was the main source of knowledge on contraceptive to adolescents. Only 23.3% of the boys and 11% of the girls of the sexually active students who claimed to use contraceptives used them consistently. The male condom was the commonest used method by both sexes. The main reasons given for non-use of contraceptives were ignorance and feeling shy buying contraceptives. There is the need for adolescents to be educated more on their sexuality to increase their awareness of the risks of pregnancy and STIs such as HIV. Keywords: Contraceptive, Adolescents, Knowledge, Attitude, Practice.  
99 Application and Documentation of Theory in Nursing Management: A Tool for Quality Care and Identification of Clear Nursing Role among the Health Care Team , Janet A. Ephraim  
This paper discusses the need to encourage the use of theory in Nursing management for quality and holistic care and documentation of such care for identification of the specific role of the nurses among the health care team that have participated in the care of such patient. Vital to the nursing professional practice is the wiliness of the nurse to document every care/activities carried out on a patient for identification of his/her role and for future record purposes/research One of the problems facing the nursing professional today in our environment is identification of our role among health care delivery team which the use of theory just like the nursing process and documentation can be used for such identification. Application of theory in nursing care management of our client/patient will enhance quality nursing care practice and give holistic care to the client/patient. Florence Nightingale the mother of modern nursing uses theory and collect data for documentation and use which help her to achieve the standard of the modern nursing we are practicing today. Keywords: Application, Theory, Nursing Management, Identification, Clear Nursing role, Health Care.  
100 The Increased Nursing Workload and its Impact on Nursing Care , Sonny Borlagdan Dechavez  
The heavy workload of hospital nurses is a major problem. Nurses are experiencing higher workloads than ever before due to some of the reasons which include increased demand for nurses, inadequate supply of nurses, reduced staffing and increased overtime, and reduction in patient length of stay. A heavy nursing workload adversely affects patient safety. This research study will seek to document the impact of nursing workload when staffing is reduced or seconded from other departments.  
101 Knowledge and Practice of Hand Hygiene and Hand Washing among Medical Students and other Health Care Professionals in Hospital Setting , Abida Parveen  
Hand washing dates back to biblical times and the early days of medicine. This simple task is the most important way to prevent infection resulting from pathogenic microorganisms found in all healthcare environments. Not only does hand washing prevent the spread of potentially deadly nosocomial infection, it also saves money. Hospital acquired infections may result in millions of dollars in costs to the healthcare (Cooper, Wisenor, & Roberts, 2005Hand washing is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of health care associated infections. Despite the relative simplicity of this procedure, compliance with hand washing among health care providers is as low as 40% (Nair, Hanumantappa, Hiremath, Siraj, & Raghunath, 2014). Health care-associated infections are a serious problem in health care services as they may cause prolonged hos­pital stays, high mortality, long-term disability, and ex­cess health care costs. Most health care-associated infec­tions can be transmitted from patient to patient via the hands of health care workers. In other words, health care workers’ hands due to poor hand washing are the most usual type of vehicle for the transmission of health care-associated infections (Nabavi, Alavi-Moghaddam, Gachkar, & Moeinian, 2015). Infection caused due to hospital acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organisms continues to cause a high nosocomial infection rate in health care settings. Nosocomial infections due to poor hand washing are a major cause of increasing morbidity, mortality and health care costs among hospitalized patients worldwide (Maheshwari, 2014). The high prevalence of these infections, as high as 19%, in developing countries poses a challenge to health care providers. Hand washing is considered the single most cost-effective public health measure for preventing health care associated infection (HCAI) (Maheshwari, 2014).  
102 Breast Cancer and Management , Ilenbarenemen Doris Omoze  
Amongst the leading cause of death for women, breast cancer is the second leading cause of death and most commonly diagnosed. But good news to the world because in the recent times or lately, death rate has decreased as a result of health education and tools put in place to detect it early. This write up will show us the preventive and therapeutic management that have given rise to an impressive figure of survivors of breast cancer in different countries most especially the USA which has a survivor of 2.5 million. Going through recent studies, the assessment carried out by the primary care provider regarding screening for breast cancer was geared towards decisions about when to initiate mammography—the process of using low energy x-ray to examine the human breast. Emphasis was made on early diagnosis as the best protection against breast cancer morbidity. However, there have been recent developments in the ability to predict and modify breast cancer risk. It is therefore important for the health care provider to be able to recognize women at higher risk for breast cancer and be familiar with issues regarding screening and reduction of risk. Recent data regarding the evaluation of breast cancer risk, newer screening strategies for high-risk women, and medical and surgical intervention to minimize breast cancer and its risk, are presented in the project. Every year 170,000 women are diagnosed with breast cancer; screening for breast cancer is one of the topics that primary care providers should address with their patients. Screening for breast cancer has been extensively endorsed and most women in the United States more than 40 years old participate in screening activities. In the community mammography remains the main screening tool. However, there have been several important developments in the ability to predict and modify breast cancer risk. Recently, data have become available regarding the evaluation of risk, screening strategies for high- risk women, and medical and surgical approaches that can decrease breast cancer risk. Women who are concerned about their risk for breast cancer and should be counseled and managed appropriately. It is important for primary care providers to be conversant with these issues. In my first three blocks which are health education, nursing informatics and ethical issues in nursing, the practice of health education, counseling, electronic health records were discovered to prevent diseases and decrease high mortality and morbidity rate. It is on this ground that I chose the topic breast cancer in women and management, sighting different methods from research by which breast cancer can be prevented, the role of the nurse in the stated aspect so that breast could be a thing of past in the nearest future. With the knowledge of nursing informatics, data analysis with tables, bar charts and pie charts were used to illustrate the results in this project.  
103 Factors Influencing the Participation of Mothers of Mothers in the Expanded Programme on Immunization, in the Nkoranza South Municipality, Ghana , Manuel Anane-Asante Junior  
The WHO, in 1974, proposed and launched the Expanded Programme on Immunization to immunize children against 6 childhood killer and other diseases, aimed at achieving and maintaining more than 90% coverage with all the vaccines. However this has not been achieved. The purpose of the study was to determine the factors influencing the participation of mothers of mothers in the Expanded Programme on Immunization, in the Nkoranza South Municipality. Study Population: The study population comprised of mothers with children less than five years who are attendants at St. Theresa’s Hospital, Nkoranza Municipality. Study Design: A descriptive study with cross-sectional design was carried out to evaluate knowledge of mothers’ on the importance It was conducted over a six weeks period. Sampling Method: Purposive sampling was used to select 150 respondents for this study. It enabled the selection of unique cases in which the result may or could be extended to the whole population. The units or respondents were intentionally picked for the study because of their characteristics or qualities which are not randomly distributed among the general population but they exhibit most of the characteristics of interest of the study. Sample Size: A sample size of 150 was chosen out of convenience from the municipality. It comprised of mothers of children less than five years. Data Collection: A questionnaire comprising both closed and open ended questions were administered to respondents. The questionnaire was pre-tested on randomly selected mothers awaiting consultation in the OPD. Both English and Twi languages were used in the administration of the questionnaire. Data Analysis: The data gathered was analyzed both manually and using Microsoft Excel and the results were expressed in percentages using charts and tables. The results obtained showed that the most popular reason for defaulting was that the mother travelled at the time the child was to be immunized (36.36%). This shows absence of knowledge that in so far as the mother is in possession of the child’s Road To Health Chart, the child will be immunized. The results also revealed that most of the mothers had heard about immunization (98%) and believed it cured disease (42.6%). The smaller proportion who knew it prevented disease (24.7%), were knowledgeable about the diseases it prevented. Just over half the children in the study were fully immunized (55.3%) and almost a quarter of the children had either defaulted or never been immunized. Presence of side effects, The mothers who said their children experienced side effects were asked to specify what kind of side effects the children had. Over half the mothers (56.25%) complained of fever, 35.4% of the mothers complained that the vaccination site got swollen. Other mothers with complaints (8.3%) complained of things like excessive crying and other non specific symptoms. This study revealed that the more than half (55.3%) of the children were fully immunized. the proportion of those who had not been fully immunized (22%) and those whose immunization was up to date (21.3%) was about the same. the lowest percentage was recorded for those who had received no vaccinations at all (1.3%). The main conclusions drawn The most common reason was that the mother travelled long distance (36.36%) at the time the child was due to receive the next vaccination and did not take the child when she returned because the time had passed. the next reason was that the child was ill (15.15%) at the time he/she was supposed to receive the vaccination and was not taken to the immunization centre upon recovery. the ill child tied with mother being too busy with work (15.15%) to take the child to the immunization point. also tying, were the mother being ill, so she was unable to take the child and postponing the immunizations for social functions etcetera with 12.12%. and also that mothers did not have sufficient knowledge about vaccine preventable diseases, also a little than half of the people surveyed had fully immunized their children. Keywords: Distance travel, sufficient knowledge, cure disease, defaulted immunization, bibliographic data, and side effects.  
104 A Comparative Study of Nurses’ Perception on Safety and injury at Work in Delta State, Nigeria , Adishi, Monday, A.C
Considering the nature of the work of nurses in the hospitals and other health-related facilities, it is pertinent to discuss workplace-induced injuries and illnesses encountered while caring for the patients and how the patients themselves are exposed to such risks while receiving treatment in the health care facilities. Needless to mention that so many workplace stressors that are capable of causing diseases and injuries are ubiquitous in the work environments. Nurses are often stressed up physically and psychologically, in addition to their constant exposure to a harsh workplace safety climate. A cross-sectional research design was used and questionnaires were distributed for data collection. The study showed that, injuries are most sustained by the nurses in the government-owned hospitals with a score of 43.5%, followed by the private hospitals maintaining her second position with a score of 31.7%, while the mission hospitals scored 24.8%. It was also found that unsafe acts are most common in general hospitals, followed by private hospitals, and with the lowest score in Mission Hospitals, because the Mission hospitals were found to be more safety conscious among the three groups of hospitals under review. In Delta State, 98% of nurses run shift in the hospital, out of which 60% admitted having some health problems whenever subjected to shift work and long work hours. 2% of nurses do straight morning duty. Mission Hospitals have the greatest challenges of managing and coping with injuries and illnesses at work (35.6%), most probably due to their lean financial resources. This study also showed that the professional nurses are significantly aware of the ways to prevent or mitigate injuries and illnesses at work. However, majority of them experience these problems because of their non-adherence to safety rules and their constant tendencies to follow short cuts  
105 Patients Safety , Snehamol Varghese  
Patient safety can define as liberty from accidental injury, focusing in the specific processes, working practices and activities in systematic manner those are able to minimize or protect the available risk of harm to patients. This particular topic has become global agenda and various countries such as England, Australia, the USA, Canada and other developed countries have established national bodies to manage and maintain patients’ safety. And they are also focusing on nursing profession for the purpose to maintain effective level of safety of patients. Nursing profession plays important role in development and maintenance of safety of patients. Therefore this coursework has conducted for the purpose to define role of nurses to increase and maintain patients’ safety in health care organizations. Role of nursing in health care organizations have defined on behalf of nursing leadership, nursing collaboration and nursing empowerment. Obtained findings have presented that nurse plays important role in the safety of patients and therefore leadership, collaboration and empowerment in the field of nursing are able to enhance safety of patients in significant manner. Leadership of nursing is able to increase patients’ safety; further nursing collaboration enhanced team work with other nurses and physicians and also avoids adverse impacts of treatments. Finally empowerment of nursing provides increased and clear information about the patients by nurse to physicians. Hence all three aspects are important to enhance safety of patients. Healthcare organizations should focus to enhance nursing leadership, collaboration and empowerment for the purpose to achieve better outcomes in health care organization in terms of increased and enhanced safety of patients.  
106 Determinants of Child Health-Care Seeking among Mothers Attending Immunization Clinic at Urban Comprehensive Health Centre, Eleyele, Ile-Ife , Victoria Adesola Ogungbemi  
Health care seeking in terms of illness behavior refers to those activities undertaken by individuals in response to symptom experience. The patriarchal nature of Nigeria family system burdens the woman with childcare in addition to other responsibilities. Maternal response to child illness often determines the survival status, but the promptness of this response is determined by several factors both at individual and household level. This study explored the knowledge and factors affecting child health care seeking behaviour among mothers attending immunization clinic at Urban Comprehensive Health Centre, Eleyele, Ile-Ife. This descriptive study selected two hundred respondents using convenience sampling technique. Structured questionnaire was used to elicit information from the respondents. Special package for social sciences was used to analyze the data collected for this study. A major striking finding reveals that majority (64.3%) of the mothers has poor knowledge and a larger proportion (82.6%) with negative attitude towards child’s health care seeking. The socio-demographic differential of mothers seeking health is also a significant finding. Majority of the mothers are on the lowest wealth quintile, earning less than 20,000 per month. This seems inadequate to seek quality health care service and might be responsible for their negative attitude. It is therefore necessary for all health-care providers to channel their effort towards increasing awareness campaign about the benefits of positive health care seeking. Women should be empowered in order to boost their economic status. Nurses should also play the advocacy role for free health services or highly subsidized health care expenses. Keywords: Child, Determinants, Mothers, Health-Care, Seeking, Behaviour.  
107 Attitude of Adults towards HIV Screening (A Case Study of Isuada Community, Owo, Ondo State, Nigeria) , Fasoranti, Abimbola Bosede  
This is a study on attitude of adults towards HIV screening. The study was carried out in Isuada community Owo, Ondo State Nigeria. The deadly nature of this disease and late presentation of clients to the hospital despite the advocacy and awareness created through the media prompted the researcher to carry out this research. The main objective of this study is to examine the knowledge of people in Isuada community about HIV Screening, to investigate possible barrier to accepting HIV screening and correct negative notion about this investigation. Data was obtained through a structured questionnaire schedule. Same was administered to adult respondents in Isuada community in Owo Local Government Area using multi-staged random sampling. Multi-staged random sampling involved selection of the sample or sampling plans where the sampling is carried out in stages using smaller and smaller sampling units at each stage from the community, wards, streets, house hold in the selected community. Sample size is 100. Data were analysed by the use of statistical tools and same presented in tables and charts, while chi- square and correlation coefficient were used to test hypothesis. The findings of study shows that 94% of the respondents are aware of this deadly disease, 85% are aware of the screening being carried out to diagnose it, but only 37% of the respondents have been screened before. Among those that have not been screened female had the highest percentage 55.6%, which shows that there is poor utilization of government hospitals by these women. Majority of those that are yet to be screen said they have not heard about HIV Screening before 23.82% and some does not see any need for it 22.22% (Table 4.12). The summary of my other findings and recommendation were made below.  
108 Critical Care Nurses Perception towards Caring for Terminal Ill Patients and Ethical Dilemmas Faced, in a Tertiary Teaching Hospital, A Case of Muhimbili National Hospital in Tanzania , Trustworthy Sithembile Majuta  
The purpose of this study was to assess the perception and to examine the ethical dilemma faced by critical care providers in a tertiary teaching hospital in Tanzania when caring for terminal patients. The study was guided by four specific objectives including, first to assess how the critical care Nurses perceive and understands end of life issues encountered during caring for terminal patients, second to explore the ethical dilemmas faced by Nurses during the course of duty in caring for terminal ill client, third to find out the psychological impact of end of life issues to critical care providers working in the ICU and lastly to determine the challenges encountered by critical care providers working in the ICU. The study was conducted from Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. The population of the study was subgroup of nurses based on qualifications, expertise and experience, working from medical ICU, surgical ICU, cardiac ICU and CCU. All the nurses who met the above criteria were included in the study. The researcher applied both structure and unstructured interview to collect data. The study results shows that, majority of nurses come across end of life issues more frequently in ICU and most of them find these issues very uncomfortable. Nurses have negative perception towards a number of end of life issues for example they don’t support the medical team to decide on withdrawing treatments. The other study result shows that nurses are psychologically and physically affected by end of life issues whereby most of them suffer from moral distress. Also, ethical dilemmas encountered by nurses in the ICU are mostly on truth telling; withdraw of treatment to vegetative patients and allocation of resources. Lastly the researcher found that, lack of adequate ICU training, lack of policies and protocol on withdraw of treatments and inadequate of equipments as the main challenges among nurses working in the ICU. The researcher suggest that the management must ensure well staffing as per universal standards, ideally nurse patient ratio in ICU should be 1:1, the procurement department must ensure the availability of equipment and consumables which all the nurses cited as one of the biggest hindrance to quality care provision and contributes to their dilemmas and stress. The hospital should do enough capacity building to cater for the size of the hospital, ideally and universal standards says, at least 10% of the total hospital bed capacity should be able to be accommodated into the ICU, hence Muhimbili hospital with a bed capacity of 1500 beds, must have at least 150 ICU beds.  
109 Pregnant Women’s Perception Of Maternity Care Given In Ladoke Akintola University Teaching Hospital, Osogbo, Osun State, Nigeria West Africa , Clementina Obby Ezenwuba
The study was on Women's perseption of maternity care giving in Ladoke Akintola University Teaching Hospital, Osogbo, Osun State, Nigeria, West Africa. in this study, introduction was done and there was no specific objectives set to guide the work. Descriptive research study was adopted and 160 respondents were purposeively selected as sample size. Questionnaire was the instrument for data collection which was tested for validity and reliability before use. Data collected were analysed using Likert 3point scale and were presented using tables.Conclusions were made based on the findings. Recommendations and suggestions for further findings were made. KEYWORDS Pregnant, Family, Maternity, Public Health, Death, Birth  
110 Article Review On (Work Motivation Theory and Research at The Dawn of The Twenty-First Century) , Farzana Begum
This review critiques the article ‘WORK MOTIVATION THEORY AND RESEARCH AT THE DAWN OF THE TWENTY-FIRST CENTURY’ in the Journal “Annual Review of Psychology”, “Annu. Rev. Psychol. 2005. 56:485–516”. While reviewing, it will show the summary of the article. KEYWORDS Research, Motivation, Century, Analysis, Information, Psychology  
111 Achieving Healthy Weight in African-American Communities: Research Perspectives and Priorities , Bridget Onoiribholo Iweriebor
ABSTRACT The longstanding high burden of obesity in African- American women and the more recent, steeper than average rise in obesity prevalence among African-American chil- dren constitute a mandate for an increased focus on obesity prevention and treatment research in African-American communities. The African-American Collaborative Obesity Research Network  (AACORN)  was  formed  to  stimulate and  support  greater  participation  in  framing  and  im-plementing  the  obesity  research  agenda  by  investigators who have both social and cultural grounding in African- American life experiences and obesity-related scientific ex- pertise. AACORN’s examination of obesity research agenda issues began in 2003 in conjunction with the Think Tank on Enhancing Obesity Research at the National Heart, Lung, and Blood Institute (NHLBI). The assessment was subsequently expanded to take into account the overall NIH strategic plan for obesity research, literature reviews, and descriptions of ongoing studies. In identifying priorities, AACORN members considered the quality, quantity, focus, and contextual rele- vance of published research relevant to obesity prevention and treatment in African-American adults or children. Fifteen rec- ommended research priorities are presented in five categories adapted from the NHLBI Think Tank proceedings: health effects, social and environmental context, prevention and treat- ment, research methods, and research training and funding. These recommendations from an African-American perspec- tive build on and reinforce certain aspects of the NHLBI and overall NIH research agendas by providing more specific ra- tionale and directions on areas for enhancement in the type of research being done or in the conceptualization and implemen- tation of that research."   KEYWORDS Ethnic Groups, Culture, Nutrition, Physical  
112 Article Review On "A Holistic Framework for Nursing Time: Implications for Theory, Practice, and Research" , Surriya Shahnaz
This review critically reviews the article. The title is nurses’ time which they spent with patient in clinical areas for care and to see implications for theory improvement, clinical and administrative practice, and research in the Journal of Nursing Forum.  
113 Article Review On "Legal Awareness and Responsibilities of Nursing Staff in Administration of Patient Care in A Trust Hospital" , Ms. Oluwatosin Oluwaseun Olu-Abiodun
This review thoroughly and meticulously reviews the article titled ‘Legal Awareness and Responsibilities of Nursing Staff in Administration of Patient Care in A Trust Hospital’. Firstly, the details and contents of the article will be critically summarized by the review. Secondly, the validity or efficacy as regards the structure of the article will be examined by the review in order to ensure that the given information is properly organized. In addition, the review will also conduct an investigation to determine if the article can be conveniently accessed  
114 Article Review of "Empirical analysis of Nurse Retention. What keeps RNs in Nursing?" , Mr.Syeda Tasneem Kausar
This paper is atheoretical critique of a quantitative research article written by Dotson, M.J, Cazier, J.Aand Spaulding, T.J entitled: An Empirical analysis of Nurse Retention. What keeps RNs in Nursing? The article discusses the importance of nurse retention to the individual organization and the health industry as a whole. Along with, it also describe the reasons why nurses walk out of the nursing profession which include: burn out, physical stress, emotional stress, and increased work load with lack of motivation. Throughout the course, Authors interviewed online 861 RNs from Southern United states and for that they prepared a questioner. The author developed an instrument which include variables such as altruism, economic factors, and value congruence which have an impact on the staff performance, this variables were pretested to modified contradictory variable according to the study. The analysis were made by using the structural equation modeling (SEM) and with that they also use Cronbach’s alpha to measure the internal consistency and the reliability of the instrument. SEM allow the comparison of various factor which conclude that the stress and value congruence both reveal the association with behavior to leave the job but the impact of altruism on behavior to leave the job is not so evident. Author’s find the stress has the major impact to leave the job.   The purpose behind the study was to examine whether the value congruence and altruism would affectthe nurses turn over or not. The Author’s conclude that the factors which are important to retain nurses in jobs include: the stress reduction, Job satisfaction, value congruence, change the hiring process, and improve the work are of the organization to retain nurse for a long.   My evaluation/critique of this article is a holistic interpretation of the study as an example of a quantitative research project and is based on my understandings. As a Quantitative study, author’s research usesthe questioner which was assessed by a model (S.E.M) and confirmatory factor analysis which help to reduce the error in results and make it more reliable to use. The author’s also give the proper reference of the different article which were the base to initiate the research and most of them were recent. For conclusion the author did not presents the graphical presentation of data which would have given more clear impression for the quantitative results. Overall the article is a literary work in terms of it critique of current research study on the factors that contributes to the retention of RNs in Health organization and profession. KEYWORDS Empirical analysis of nurse retention; Structure equation model (S.E.M); Cronbach’s alpha; Altruism; Value congruence; Physical and emotional stress  
115 Article Review of "Empirical analysis of Nurse Retention. What keeps RNs in Nursing?" , Mr.Syeda Tasneem Kausar
This paper is atheoretical critique of a quantitative research article written by Dotson, M.J, Cazier, J.Aand Spaulding, T.J entitled: An Empirical analysis of Nurse Retention. What keeps RNs in Nursing? The article discusses the importance of nurse retention to the individual organization and the health industry as a whole. Along with, it also describe the reasons why nurses walk out of the nursing profession which include: burn out, physical stress, emotional stress, and increased work load with lack of motivation. Throughout the course, Authors interviewed online 861 RNs from Southern United states and for that they prepared a questioner. The author developed an instrument which include variables such as altruism, economic factors, and value congruence which have an impact on the staff performance, this variables were pretested to modified contradictory variable according to the study. The analysis were made by using the structural equation modeling (SEM) and with that they also use Cronbach’s alpha to measure the internal consistency and the reliability of the instrument. SEM allow the comparison of various factor which conclude that the stress and value congruence both reveal the association with behavior to leave the job but the impact of altruism on behavior to leave the job is not so evident. Author’s find the stress has the major impact to leave the job.   The purpose behind the study was to examine whether the value congruence and altruism would affectthe nurses turn over or not. The Author’s conclude that the factors which are important to retain nurses in jobs include: the stress reduction, Job satisfaction, value congruence, change the hiring process, and improve the work are of the organization to retain nurse for a long.   My evaluation/critique of this article is a holistic interpretation of the study as an example of a quantitative research project and is based on my understandings. As a Quantitative study, author’s research usesthe questioner which was assessed by a model (S.E.M) and confirmatory factor analysis which help to reduce the error in results and make it more reliable to use. The author’s also give the proper reference of the different article which were the base to initiate the research and most of them were recent. For conclusion the author did not presents the graphical presentation of data which would have given more clear impression for the quantitative results. Overall the article is a literary work in terms of it critique of current research study on the factors that contributes to the retention of RNs in Health organization and profession. KEYWORDS Empirical analysis of nurse retention; Structure equation model (S.E.M); Cronbach’s alpha; Altruism; Value congruence; Physical and emotional stress  
116 An Encounter Of Pregnant Women With Ultrsound Scan In Ghana , Thomas Zieme
A critical review of an article on that sought evaluate the experience and perception of Ghanaian women in the use of ultrasound scan in antenatal care. A cross–sectional survey of three public hospitals in Ghana. The study used the random sampling method to select a total of 337 participants .The review a purposive sampling because the participants were chosen based on the researchers judgment of the qualifications of the respondents who undergone ultrasound scan during pregnancy and had delivered successfully, to take part in the study. The study revealed that a good percentage of pregnant women were not given any information about ultrasound scan by health workers though most of these clients perceive the usefulness of ultrasound as a tool. The study recommended the need for health workers ,midwives, sonographers and obstetricians  to give information about ultrasound scan to clients before and after the interventions. KEYWORDS Women, Ultrasound, Antenatal, Ghana, Medicine  
117 Total Quality Management (TQM) Strategy and Organizational Characteristics: Evidence from A Recent WTO Member , Rukhsana Kousar
This paper presents a comparative study on the relationship between implementing total quality management (TQM) and organisational characteristics (size, type of industry, type of ownership, and degree of innovation) in a newly industrialised country in South East Asia. Vietnam has become the 150th member of the World.Trade Organisation (WTO) since January 2007, and this is the first empirical studyto examine TQM practices in Vietnam. Analysis through Structural Equation Modelling, t-test and MANOVA of survey data from 222 manufacturing and service companies produced three major findings. First, this study supports previous research findings that TQM can be considered as set of practices. Second, industries in Vietnam have deployed certain TQM practices (customer focus and top management commitment) at much higher levels than others, namely information and analysis system, education and training, employee empowerment, and process management. Finally, MANOVA shows a clear difference in TQM practices by company size, industry type, and degree of innovation. Large companies had higher implementation levels across almost all practices except for teamwork and open organisation when compared to small- and medium-sized companies. TQM practices were statistically more significant in manufacturing companies compared to service companies,and firms having a higher degree of innovation also showed higher levels of TQM practice implementation.In particular, the low deployment of TQM practices in service industries,where TQM has been considered as orderqualifier,highlights the challenges for Vietnam’s service industries that pursue TQMto successfully compete in the global marketplace. KEYWORDS total quality management; organizational characteristics; Vietnam; WTO;MANOVA; empirical research; Structural Equation Modeling; manufacturing/service Company  
118 Nurse Managers Leadership Style in Finland , Salma Parveen
This paper presents a Nurse Manager (NM) who can observe their own behavior and its possessions on employees can regulate which enhanced leadership styles. The purpose of the study was to explore nurses’ and supervision insight about Nurse Manager Leadership Styles (NMLS).  Open- ended interviews were carried out by eleven registered nurses and ten superiors including nurse supervisors and nurse managers. The data were analysed by content analysis.  In the study, Six leadership styles were classified: visionary, coaching, affiliate,   democratic, commanding and isolating. Job satisfaction, commitment to development work, cooperation, and institutional environment in the working department were the factors affected by Leadership styles (LS). The Nurse Manager should think about leadership styles when interact with employees as well as situational factors and objectives of the institution. In Leadership Styles, a participatory leadership style was more common among employees because in such style employee performance is active. Globally participatory (democratic) style also use in various institutions  KEY WORDS Nurse, Nurse Manager, Leadership Styles  
119 Nurses Moving Abroad , Muhammad Hussain, Muhammad Afzal
Background: Pakistan as like developing countries has trained nurses for to meet their health care needs and achieve the Millennium Development Goals (MDGs). Unfortunately these nurses are leaving the country for better opportunities to developed countries. Objective: The study aims to identify the factors involved in Pakistani nurses moving abroad and to draw together recommendations to retain nurses from the respondents through a questionnaire- based study in a selected government and private tertiary care hospital in Karachi, Pakistan Procedure: Descriptive survey study was conducted in six tertiary care teaching hospitals of Karachi Pakistan. A sample of 307 nurses was taken randomly by lottery technique in six selected government and private hospitals which were demographically situated in different places in Karachi and serves a diversity of population. Results: The results showed that low salary package, poor image of the nurse, and poor working conditions were the major reasons why nurses would like to leave the country and work or migrate abroad. The United Kingdom, Canada, and the United States of America are the most popular countries where Pakistani nurses would like to work and migrate. Conclusion: The reasons for Pakistani nurses moving abroad are linked to the fulfillment of basic human needs, self esteem, safety and security needs. These issues are similar to the reasons of nurses in other source countries. Keywords: Abroad, Infant mortality rate (IMR), Migration, Millennium Development Goals (MDGs),  
120 Health Care Delivery System in Developed Countries, Developing Countries, and Undeveloped Countries , Marrie Davis
Open innovation takes many forms from crowdsourcing to structures, organizational alliances, and strategic co-ventures. Open innovation strategies acknowledged good ideas from anywhere “the outside-in approach or Intellectual property” (IP), created added value due to its licensing arrangement, joint ventures, and other strategic collaborations. The combination of internal and external ideas and paths to market to make advances in processes or technologies, a striking model for structuring collaborations between developed and developing countries. The crafty approach designed new ways of working. Innovation “use of purposive inflows and outflows of knowledge to accelerate internal advances and expand the markets for external use of modernization” defined innovation (Chesbrough, 2006). The definition emphasized, importance of organizations putting greater emphasis on collaboration and networking (Vanhaverbeke, 2006). A well-structured article, goals clearly stated and a recently published editorial. Findings displayed in the form of figure and discussion. The use of the point method approach carefully analyzed the commentary. The usage of the open innovation model highlighted the relevance of recent research on the topic.  
121 Public Health Nurses’ Knowledge and Use of Nursing Process for Documentation of Care in Southwest, Nigeria , Odutayo Patience Omonigho
The use of Nursing process (NP) in documenting care has improved image of the Nursing Profession in developed nations. This study was therefore conducted to assess the knowledge and use of Nursing process for documentation of care among Public Health Nurses (PHNs). A descriptive design was adopted in carrying out the study. Purposive sampling technique was used to select 40 PHNs. A questionnaire on Nursing Process was used to collect data. Data was analyzed using descriptive statistics. Seventy percent of the participants have heard of NP. Major source of information was their schools of training. Sixty percent have had practical training on NP in schools. Only 10% have attended recent workshops on NP. All participants do not use NP in care of clients. Ninety- five percent had poor knowledge of the NP. Factors hindering the participants from using the NP were Non availability of NP forms, lack of proper training on the use of NP, busy schedule, shortage of staff and not mandated to use NP. From the findings, it is clear that PHNs need more training, seminars / workshops on the use of NP. There is also need for more staffing, close supervision and provision of NP forms. Keywords: Public Health Nurses, Knowledge, Nursing Process, Documentation  
122 A Practical Guide in Health-Care Organizations in Nigeria Today , Florence U. Oparanma
Perhaps the two most often studied and empirically supported organizational factors that can promote the acceptance of technology by the end users are training and participation. The science of training is well established. Not surprisingly, well designed training programs have been shown to promote end user acceptance of technology. The key is to design the training program according to the scientific evidence. Well designed training not only transfers knowledge and skills about the technology, but it can also bring understanding of the technology through education and can create feelings of involvement in decisions. In addition, training can lead to several other important variables for the acceptance of technology including self-efficacy and intrinsic motivation. This paper reviews the theoretical knowledge on what leads to successful technology implementation and how this can be translated into specifically designed processes for successful technology change in Nigerian health-care organizations. Key words: Safety, information technology, patients, and health-care.
123 Employment Status and Mental Illness in Federal Psychiatric Hospital, Calabar , Umoh, Edet Okon
The purpose of this study was to examine employment status and mental illness among psychiatric patience of Federal Psychiatric Hospital Calabar, Nigeria. The ex-post facto research design was used for the study. The population of this study comprised all the in-patients in the hospital. The sample of this study comprised of 50 patients who were randomly picked from acute wards of the hospital. Four research questions and hypotheses were formulated to guide the study. Instrument titled “employment status and mental illness questionnaire” was used for the study. The validity of the instrument was established using face validation method. The data obtained were analysed using Chi- square test. Each of the hypotheses was tested at 0.05 level of significance. The result of the analysis revealed that the rate of mental illness, recovery and relapse differ significantly between the employed and the unemployed. The result further revealed that societal regards for the employed and the unemployed do significantly differ. Based on this findings, it was concluded that employment status do influence mental illness in Federal Psychiatric Hospital Calabar, Nigeria. It was recommended that Government should create more job opportunities for the unemployed so as to get them occupied, which in turn will help in taking away the time they would have engaged in anti social activities. Key Words Employment: A state of functionality of an employee under agreement with his employer.  
124 Assessment of Practice of Exclusive Breast Feeding Among Postnatal Mothers in NKST Hospital Mkar, Gboko, North Central Nigeria , Emmanuel O. Chukwu
The research is a cross-sectional descriptive survey conducted at NKST hospital Mkar, Gboko, North Central Nigeria to assess practice of exclusive breastfeeding (EBF) among postnatal mothers. The specific objectives were; to assess the knowledge of postnatal mothers on EBF, to determine the level of understanding of postnatal mothers on importance of EBF, to ascertain if postnatal mothers adopt good attachment while breastfeeding , and to assess factors militating against EBF by the postnatal mothers. Convenient sampling technique was used in selection of samples used for the study. Data were collected from the respondents through self-structured and validated questionnaire. Data obtained were analyzed and presented using frequency distribution table. Based on the findings; the knowledge of postnatal mothers on EBF was very adequate and good, also, the postnatal mothers have good understanding of the importance of EBF, however only very few of the mothers practices EBF. The finding also revealed that majority of mothers does not really know what are indications for good baby attachment to the breast. In addition, the finding show that the major factors militating against EBF includes misconception that crying baby is an indication that the breast was not enough for the baby, hence needed more supplement; nature of their work not permitting them to practice EBF; misconception that EBF makes their breast to sag quick among other factors. The researcher made the following recommendations; health workers especially should put all hands on deck to ensure more implementation of practices of EBF by lactating mothers through adequate dismissal of all misconceptions militating against EBF, and that government should come up with good motivational material incentives for mothers who successfully breast feed their babies exclusively such as giving out wrappers to the mothers, giving such child free primary and secondary education, giving the mothers some reasonable amount of money etc. Key Words: Assessment, Practice, Exclusive Breast Feeding, Postnatal Mothers.  
125 Is Aversion to Caesarean Section Justified in Africa? , Monisayo O. Komolafe, Johnson O. Komolafe, Olayemi O. Ademakinwa, Ayobami M. Owolabi
Caesarean section (CS) is still relatively not well accepted in Africa when compared to Western countries. Morbidity following CS especially inability to do things by oneself is a major deterrent to accepting CS. This study reviewed morbidity following CS & retrieve feedback on CS from clients. A retrospective three year review of all CS done in an obstetric specialist unit was conducted. A cross sectional study was carried out using self-administered questionnaire to retrieve feedbacks from clients who have had CS done on them. Caesarean section rate was 68.59%. Mean time to ambulation, taking of oral sips, commencement of breastfeeding was 24 hours while mean time to discharge was 71.7hours. 70% of the women had no regrets doing CS. About 50% would want some improvement in the process of CS especially the spinal anaesthesia. Morbidity following CS occurred in less than 20%. Keywords: aversion, caesarean section, postoperative, morbidity  
126 Student Nurse’s Clinical Learning Environment: Clinical Teachers’ Perspective , Benuis Kaliyangile, Catherine M Ngoma
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.  
127 Effects of Postoperative Care Program on Leg Pain and Functional Performance after Lumbar Spine Surgery , Amornrat Sangsaikaew, Wanwisa Samrannet, Apinya koontaley
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. Keywords: Postoperative care program, Leg pain, Postoperative functional performance, Lumbar spine surgery.  
128 Knowledge of Nurses in Holistic Care of a Child with Delayed Developmental Milestone and Cerebral Palsy , Gloria Tonye Dikibo
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.  
129 Health Disparities among Lesbian, Gay, Bisexual, and Transgender Population in Ghana , Nathaniel Acolatse
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.