Nurses' Safety in Caring for Tuberculosis Patients at a Teaching Hospital in South West Nigeria

Implementation of an information system for tuberculosis in healthcare facilities in Indonesia: evaluation of its effectiveness and challenges

BACKGROUND

Tuberculosis (TB) surveillance in Indonesia is currently supported by the recording and reporting technology Tuberculosis Information System (Sistem Informasi Tuberkulosis [SITB]). SITB is used by all health workers responsible for TB programs in health facilities or hospitals throughout Indonesia. The satisfaction and ease of use of SITB affect the speed and accuracy of TB case reporting. Therefore, evaluating the information system's quality is crucial. SITB utilization is comprehensively assessed using the End-User Computing Satisfaction (EUCS) method, which considers the dimensions of content, accuracy, timeliness, and ease of use. Furthermore, the effectiveness of the user interface using heuristic evaluation methods is critical. The primary objective of this study is to conduct a comprehensive evaluation of the System for Information on Tuberculosis (SITB) focusing on its usability and user satisfaction.

METHODS

This study employed a multi-method design approach. First, a heuristic evaluation was conducted by three expert user experience designers. Second, a cross-sectional survey of 115 SITB users was carried out across all health facilities in the Special Region of Yogyakarta, Indonesia, for reporting TB cases, using the EUCS method. Finally, in-depth interviews were conducted in 10 health facilities, focusing on identifying specific attributes that needed improvement to enhance user satisfaction.

RESULTS

The evaluation indicated that user convenience and timeliness require improvement, as well as the match between the system and the real world and error prevention, as shown in the heuristic evaluation of the SITB user interface. These findings were confirmed through interviews that identified the need for user manuals, server repairs, and information and SITB forms that are suitable for TB management in the field. The overarching assessment of the SITB reveals persistent challenges in data entry, attributed to the functionality of the application, thereby potentially impacting user satisfaction.

CONCLUSIONS

SITB application requires "major" improvements to make recording, reporting, and tracing activities more efficient and precise. Moreover, the integration of existing information systems in healthcare facilities is essential to support the tuberculosis surveillance reporting system in Indonesia.

Roles and challenges of nurses in tuberculosis care in Africa: A narrative review

Nurses form the bulk of the health care workforce in Africa although their roles and challenges in tuberculosis (TB) care are not well documented. In this article we discuss roles and challenges of nurses in TB care in Africa. Nurses in Africa are key in TB prevention, diagnosis, treatment initiation, treatment monitoring, and evaluation and documentation of TB treatment outcomes. However, there is little involvement of nurses in TB-related research and policy. Challenges faced by nurses in TB care mostly relate to poor working conditions that compromise their occupational safety and mental health. There is need to expand nursing school curricula on TB to equip nurses with broad skills required for the wide repertoire of roles. Nurses should be equipped with research skills and funding opportunities for nurse-led TB research projects should be easily accessible. Occupational safety of nurses through infrastructural modification of TB units, provision of personal protective equipment and ensuring access to compensation in case a nurse develops active TB is important. Nurses also need psychosocial support given the complexity of caring for people with TB.

How clinicians manage routinely low supplies of personal protective equipment

BACKGROUND

Recommended personal protective equipment (PPE) is routinely limited or unavailable in low-income countries, but there is limited research as to how clinicians adapt to that scarcity, despite the implications for patients and workers.

METHODS

This is a qualitative secondary analysis of case study data collected in Liberia in 2019. Data from the parent study were included in this analysis if it addressed availability and use of PPE in the clinical setting. Conventional content analysis was used on data including: field notes documenting nurse practice, semi-structured interview transcripts, and photographs.

RESULTS

Data from the majority of participants (32/37) and all facilities (12/12) in the parent studies were included. Eighty-three percent of facilities reported limited PPE. Five management strategies for coping with limited PPE supplies were observed, reported, or both: rationing PPE, self-purchasing PPE, asking patients to purchase PPE, substituting PPE, and working without PPE. Approaches to rationing PPE included using PPE only for symptomatic patients or not performing physical exams. Substitutions for PPE were based on supply availability.

CONCLUSIONS

Strategies developed by clinicians to manage low PPE likely have negative consequences for both workers and patients; further research into the topic is important, as is better PPE provision in low-income countries.

A mixed-methods analysis of personal protective equipment used in Lassa fever treatment centres in Nigeria

Background

Lassa fever (LF) is a viral haemorrhagic fever endemic in West Africa. Lassa virus is maintained in and spread to humans from rodents, with occasional secondary human-to-human transmission. Present recommendations for personal protective equipment (PPE) for care of patients with LF generally follow those for filovirus diseases. However, the need for such high-level PPE for LF, which is thought to be considerably less transmissible between humans than filoviruses, is unclear.

Aim

In Nigerian Lassa Treatment Centres (LTCs) we aimed to describe current PPE practices, identify barriers and facilitators to implementation of existing guidance, and assess healthcare workers' understanding. This would inform the development of future PPE guidelines for LF.

Methods

We performed a mixed-methods study, including short cross-sectional surveys of PPE used in LTCs, observations of practice, and in-depth interviews with key informants. We described the quantitative data and we conducted a thematic analysis of qualitative data.

Findings

Our survey of 74 HCWs found that approximately half reported problems with recommended PPE. In three LTCs PPE was used highly variably. Full PPE, as recommended in Nigeria CDC guidelines, was used in less than a quarter (21%) of interactions. In-depth interviews suggested this was based on availability and HCWs' own risk assessments.

Conclusion

Without specific guidance on Lassa, the current approach is both resource and labour-intensive, where these are both limited. This has led to low adherence by health care workers, whose own experience indicates lower risk. The evidence-base to inform PPE required for LF must be improved to inform a more tailored approach.

Construction of an index system of core competence assessment for infectious disease specialist nurse in China: a Delphi study

Aim and objective

This study was to establish an index system for the evaluation of Chinese infectious disease specialist nurses’ core competence.

Background

The index system for the evaluation of infectious disease specialist nurses’ core competence has not been established.

Design

A two-round Delphi survey was conducted to seek opinions from experts about the index system for the evaluation of infectious disease specialist nurses’ core competence.

Methods

The study adopted several research methods, including literature retrieval, theoretical analysis and qualitative research. Based on the above method, the draft of core competence evaluation index system of infectious disease specialist nurses was constructed. A Delphi survey was used for the study of 30 infectious disease experts from 8 provinces and cities around China. A modified recommendation for the Conducting and Reporting of Delphi studies (CREDES) was also used to guide this study. A STROBE checklist was used.

Results

The Core Competence Evaluation Index System of Infectious Disease Nurses is composed of 6 primary indicators, namely, Nursing Abilities for Infectious Diseases, Infection Prevention and Control Abilities, Responsiveness to Infectious Diseases, Professional Development Abilities, Communication and Management Abilities, and Professionalism and Humanistic Accomplishment, 16 secondary indicators and 47 tertiary indicators. The authority coefficient, judgment coefficient and familiarity degree of Delphi experts were 0.923, 0.933 and 0.913 respectively.

Conclusions

The evaluation index system of core competence of diseases specialist nurses is scientific and reliable. It can be reference for future training and assessment of Chinese infectious disease specialist nurses.

Relevance to clinical practice

Infectious disease specialist nurses are the main force for infectious disease nursing. Their core competence is related to the quality of infectious disease nursing and treatment. The core competence of the nurses is important for identification of training strategies and can be regarded as reference for nurse assessment and promotion. The construction of the index system is based on the consensus of infectious disease experts, which is not only helpful to standardize the training strategies and selection standards of infectious disease specialist nurses in the future, but also meet the society’s needs in clinical infectious disease nursing.