Journeying together: spousal experiences with prostate cancer in Ghana

Background

Prostate cancer (PCa) is a significant global health concern for men. In Sub-Saharan Africa, PCa rates witnessed a 69% increase from 1990 to 2010. Despite this, there is a dearth of literature examining the experiences of spouses of men with PCa in Africa, as the majority of studies concentrate primarily on men.

Methods

The study used a qualitative exploratory design, conducting in-depth face-to-face interviews with a semi-structured guide. Participants were selected through purposive sampling, with 35 recruited. Data was recorded, transcribed verbatim, and analysed using content analysis, resulting in 2 themes and 11 subthemes.

Results

The research revealed that spouses providing care for husbands with PCa faced notable effects on their physical and emotional well-being. Notably, they reported experiencing leg pains due to prolonged sitting by their partners, as well as disruptions in sleep and a loss of appetite triggered by the hospital smell.

Conclusion

Women encounter challenges in caring for their partners with PCa. Understanding these experiences will contribute to improving public support and assistance. Future studies should concentrate on developing interventions to help them cope with these challenges.

Midwives' experiences of providing pre-eclampsia care in a low- and middle-income country - A qualitative study

PROBLEM

Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience.

BACKGROUND

There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality.

METHODS

A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis.

FINDINGS

There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care.

CONCLUSION

To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being.

Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study

AIM

This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance.

BACKGROUND

Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources.

DESIGN

A hospital-based cross-sectional study.

SETTING

The largest tertiary hospital in Ghana.

METHODS

An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives' training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives' confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests.

RESULTS

Among the 250 midwives who responded, most possessed 1-5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08-1.47, Cohen's-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69-1.06, Cohen's-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29-0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency.

CONCLUSION

Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.

Improving success and retention of undergraduate nursing students from rural and remote Australia: A multimethod study protocol

AIM

The aim of the proposed research is to develop, pilot and evaluate a novel, bespoke intervention with in-built consideration of the factors influencing attrition and barriers to retention for rural and remote undergraduate nursing students.

BACKGROUND

There are high rates of attrition in nursing students with rural and remote backgrounds in Australia. However, there is a lack of understanding of what enables or impedes these students to progress in their studies and the strategies available to support them to become part of the nursing workforce. Addressing these gaps is critical to informing the efforts of those involved in nursing education, training and workforce planning.

DESIGN

A multi-methods study.

METHOD

A project involving a multi-methods approach will be undertaken at an Australian higher education institution. In the first exploratory study, interviews and student cohort data will be used to understand attrition and retention, influencing factors and barriers to retention among rural and remote undergraduate nursing students. Findings from this study will be used to guide the development and implementation of a novel tailored student support service targeted to increase retention for this cohort. In the final evaluation study, the attrition and retention outcomes of participating students will be examined via interviews, surveys and existing cohort retention data.

EXPECTED RESULTS

The study will provide insights into the factors that can shape the retention experiences of rural and remote undergraduate nursing students and generate much needed evidence concerning what Higher Education Institutions can do to support the retention for this specific student cohort.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital

INTRODUCTION

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare.

AIM

This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model.

METHODS

Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy.

RESULTS

Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system.

CONCLUSION

Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Exploring the challenges and roles of nurses in delivering palliative care for cancer patients and co-morbidities in Ghana

BACKGROUND

Patients suffering from chronic and life-threatening diseases receive inadequate palliative care in low-income countries, eventually leading to poor quality of life for these patients. Little is known about the experience of delivering palliative care in a low-resource country such as Ghana in comparison to higher-income countries. This study, therefore, aimed to assess the roles and challenges of nurses providing palliative care services for patients with cancer and life-limiting conditions at tertiary Hospitals in Ghana.

METHODS

Thirty oncology nurses at a tertiary Hospital in Ghana participated. All nurses were providing end-of-life care to patients with cancer. A qualitative exploratory-descriptive design and a semi-structured interview guide developed by the researchers were used. Interviews lasted on average forty minutes to 1 h were audio-recorded, and transcribed verbatim. Content analysis was carried out to generate themes and sub-themes.

FINDINGS

Participants were between the ages of 25 and 40 years. A higher percentage of females (n = 17, 57%) participated in the study than males (n = 13, 43%). Two main themes were generated which were the delivery of palliative care and the provision of home care services. The current roles of nurses were centered around pain management, home care services, spiritual needs, and psychological care. Challenges that hindered the implementation of palliative care included distress over expected and unexpected patient mortality, difficulty delivering bad news to patients and families, and frustration with health system resource shortages that negatively impacted patient care.

CONCLUSION

Palliative care is one of the essential services provided for patients with life-limiting conditions, and nurses play an active role in the provision of this care. Further research is needed to determine the most effective ways to deliver this care, particularly in developing nations like Ghana.

Acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana

BACKGROUND

Almost all cases of cervical and anal cancer have been linked to the human papillomavirus (HPV). However, in addition to women who develop HPV-related cervical cancer, both men and women can also develop cancers of the anus, oral cavity, and oropharynx that are attributed to HPV. However, literature on HPV vaccination among boys globally, in Africa, and most especially in Ghana is scarce. Thus, the main objective of this study was to explore the acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana.

METHODS

In this study, a qualitative exploratory design was utilized to enlist 30 mothers who have male children aged between 9 and 12 years from the Greater Accra Region of Ghana. The recruitment of participants was carried out using a purposive sampling technique, and they were subsequently interviewed in-depth in a face-to-face setting, with the entire conversation being recorded for reference. After transcription, the recorded data were analyzed through content analysis.

FINDINGS

Upon analyzing the data, two (2) primary themes and 11 sub-themes emerged. The research showed that although the majority of the mothers were unaware of HPV in boys, they perceived it as a positive initiative and expressed a willingness to allow their sons to receive the vaccine. However, some participants mentioned certain factors that they believed could hinder the acceptance of HPV vaccination in boys among mothers. These included concerns about injection-related pain, high cost, and fears that the vaccine could make men immoral or infertile.

CONCLUSION

The study revealed poor awareness of HPV vaccination in boys among mothers, and hence, suggested the need to increase the awareness on HPV vaccination in boys among mothers as well as the public to increase its acceptance.

Experiences of women awaiting cervical CANCER screening results from selected hospitals in Accra, Ghana

Background

The rate at which cervical cancer is diagnosed among women worldwide is alarming, nevertheless, millions of women have never undergone cervical cancer screening, and many more with cervical cancer die prematurely without accessibility to quality healthcare or effective treatment. Women’s experiences following cervical cancer screening have not been extensively studied especially in advancing countries like Ghana. Hence, the researchers aim to explore the experiences of women awaiting cervical cancer results at selected hospitals in Accra.

Methods

An exploratory-descriptive qualitative design was adopted to purposively sample 48 participants engaged in face-face in-depth interviews, which were audio-taped and transcribed verbatim after. The interviews were guided by semi-structured interviews.

Findings

The findings revealed 3 themes and 10 subthemes. The themes were pre-screening experience, intra-screening experience, and post-screening experience. Participants narrated the challenges they face before the screening, during the screening, and as they waited for their results to get ready. Despite some challenges reported, most of the participants indicated that they were willing to come for a retesting if recommended.

Conclusion

In conclusion, participants who have undergone CCS have several experiences that may either motivate or discourage them from subsequent screening. Being aware of such experiences could help the nurses address them in order to increase the interest of the women in CCS.

A qualitative document analysis of policies influencing preeclampsia management by midwives in Ghana

BACKGROUND

Preeclampsia is a global issue that causes significant morbidity and mortality in low- and middle-income countries (LMICs). The care women with preeclampsia receive in LMICs is below the standard experienced by women in westernised countries due to multiple interacting factors. A review of policy factors influencing the management of preeclampsia in Ghana is needed.

AIM

This study focuses on the midwife's role and scope of practice concerning preeclampsia management. The study aimed to explore the congruence between Ghanaian preeclampsia guidelines and international best practice recommendations for midwifery practice. The study also aimed to describe how recommendations are incorporated into Ghanaian guidelines.

METHOD/DESIGN

This study was a qualitative document analysis of national and tertiary hospital policies related to midwives' scope of practice in Ghana. Altheide's five-step process (sampling, data collection, data coding and organisation, data analysis and report) was used to systematically source and analyse the content of written documents.

RESULTS

The findings illustrated several recommendation shortcomings in Ghanaian documents at the national and tertiary hospital levels. The content of Ghanaian preeclampsia management guidelines was not comprehensive, contained conflicting information, and was not backed by research evidence. The standards of practice for midwives were consistent at both the national and tertiary hospital levels. Midwives had limited roles in detection, management, stabilisation, and referral of women with preeclampsia.

CONCLUSION

Uniform guidelines incorporating international recommendations are urgently needed to improve multi-professional collaboration, solidify midwives' roles, and optimise maternal and fetal outcomes.

Factors influencing postoperative pain management among nurses in selected district hospitals in Ghana

BACKGROUND

Poorly managed postoperative pain is linked to numerous postoperative complications worldwide and in Ghana. This is due to the myriad of physical and psychological problems, such as lifelong chronic pain syndromes, impaired functionality and death.

PURPOSE

The aim of this study was to assess the barriers and factors influencing postoperative pain management by Ghanaian nurses working in four hospitals.

METHODS

A quantitative descriptive cross-sectional design was employed for this study. Participants were recruited using a multistage sampling technique by which 146 returned their questionnaires out of 194 participants. The statistical analysis of data was done with the Statistical Package of Social Sciences (SPSS) 20.0 version.

RESULTS

Findings revealed that some verbal and non-verbal cues from patients such as facial grimacing, restlessness, irritability and distress, lack of concentration and moaning or crying (verbalisation) influenced how nurses controlled postoperative pain with analgesia. The participants also identified several barriers to influence postoperative pain management by nurses.

CONCLUSION

In conclusion, postoperative pain control by nurses is influenced by several factors, and hence, nurses need to manage patients' pain effectively in Ghana and abroad using multiple approaches.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

Older people's challenges and expectations of healthcare in Ghana: A qualitative study

BACKGROUND

The increase in the number of elderly persons in developing countries has not had a corresponding increase in social and health care support systems for the elderly. There is a substantial difference in the quality of healthcare received by older people in developing and developed countries. Elderly persons in developing countries including Ghana are increasingly becoming marginalised and isolated. There is, however, limited evidence of healthcare challenges and expectations by elderly persons in Ghana. This study explored healthcare challenges and expectations of elderly persons to inform policy that could lead to improved quality of life for elderly persons in Ghana.

MATERIALS AND METHODS

Qualitative exploratory descriptive study design was used in conducting this study. Semi-structured interviews were used in collecting data from 30 participants from three regions in Ghana (10 from each region). Data analysis was carried out through content analysis.

RESULTS

Four themes were extracted from data. These themes were: 1. Inadequate information from health workers regarding care of the older person. 2. Queuing frustrations. 3. Financial burden. 4. Focused elderly care demand.

CONCLUSION

The elderly in Ghana experience challenges of healthcare which include inadequate information, queuing frustrations and financial burdens. Elderly persons also have expectations of healthcare which include having dedicated professionals and units that will attend to them during their hospital visits. Academic and clinical gerontology experts could collaborate and help improve gerontology knowledge of health workers through workshops and conferences. Improving knowledge of health workers in gerontology may be a positive step towards meeting healthcare expectations of older Ghanaians.

Midwives' knowledge of pre-eclampsia management: A scoping review

BACKGROUND

Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries.

AIM

To identify what midwives' around the world know about pre-eclampsia management.

METHODS

A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes.

FINDINGS

Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia.

CONCLUSION

Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.

Clinical placement experiences by undergraduate nursing students in selected teaching hospitals in Ghana

Background

In meeting the global standard of patient safety, quality care and nursing leadership, countries are urged by the World Health Organisation to have a greater proportion of nurses educated to degree level or higher. However, some researchers have found that there are very little differences in competencies of diploma registered nurses and first degree nurses in some countries. University education in nursing remains problematic and there are many disparities in the programmes currently being offered in different parts of the world. Though teaching hospitals in Ghana are expected to assist in the training of undergraduate nursing students, there is limited scientific evidence on experiences of undergraduate nursing students in these teaching hospital environments. The purpose of this study was to explore the experiences of undergraduate nursing students in selected teaching hospitals in Ghana.

Methods

A qualitative explorative descriptive design was used in conducting the study. Purposive sampling technique was utilised in collecting data from thirty-five undergraduate nursing students placed in two teaching hospitals in Ghana. Data were collected through a semi-structured interview guide and analysed manually by the research team. A thematic content analysis was used in analysing data.

Results

Four main categories of themes were extracted from data. These themes were: 1. Feeling isolated in clinical placement. 2. Inadequate application of the nursing process. 3. Encounter with complex medical devices and complex conditions. 4. Inadequate application of physical examination by nurses.

Conclusion

There were both positive and negative experiences by undergraduate nursing students in teaching hospitals in Ghana. The opportunity to see various clinical cases and also use complex medical devices were positive experiences for students. However, the undergraduate nursing students also experienced challenges of isolation in placement, inadequate application of the nursing process, and inadequate application of physical assessment by nurses. Undergraduate nursing students require varying levels of support, supervisory commitments and logistics provisions to learn skills such as physical examination and nursing process during placement.

Electronic supplementary material

The online version of this article (10.1186/s12912-018-0325-8) contains supplementary material, which is available to authorized users.

Nurses' and Medical Officers' Knowledge, Attitude, and Preparedness Toward Potential Bioterrorism Attacks

Terrorist attacks are increasingly becoming more lethal and less discriminate. The threat of bioterrorism is increasing daily. The ease of production and the broad availability of biological agents and technical know-how have led to a further spread of biological weapons and an increased desire among nations as well as terrorists to have them. Health professionals in emergency departments are expected to play crucial roles in the management of victims of bioterrorism when bioterrorism occurs. This study explored the knowledge, attitudes, and preparedness of emergency department nurses and medical officers (MOs) toward potential bioterrorist attacks in Ghana. This qualitative study utilized focus group discussions and semistructured interviews to explore the knowledge, attitudes, and preparedness of emergency department nurses and MOs toward potential bioterrorist attacks in Ghana. Data were subjected to a qualitative content analysis in which three main thematic categories were developed. These thematic categories are as follows: (a) differences in bioterrorism knowledge between emergency department nurses and emergency department MOs, (b) unprepared emergency department nurses and MOs for care during bioterrorism attacks, and (c) positive attitudes of emergency department nurses and MOs toward bioterrorism preparedness. Although emergency MOs had better knowledge of bioterrorism than their nursing counterparts, both groups of health professionals were unprepared to respond to any form of bioterrorism. Both nurses and MOs indicated the need for staff education and infrastructure readiness to be able to respond effectively to a bioterrorist attack. A well-prepared emergency department and health professionals against bioterrorism could prevent high casualty rates in a bioterrorist attack and also serve a dual purpose of dealing with other natural disasters when they occur.

Married Men and Vasectomy: A Focused Group Study in an Urban Community in Ghana

An effective method of birth control in men yet least accepted and patronized is vasectomy. Vasectomy provides health benefits to the user, his direct family, and the entire population as it helps to control population growth. This article explored the beliefs and attitudes of commercial drivers on vasectomy in an urban community in Ghana. The study employed qualitative exploratory design using focus group discussion. Data were collected from 12 married men between the ages of 45 to 60 years who were selected through purposive sampling method. The focus group discussions were audiotaped, handwritten, and recorded. Recorded data were then transcribed verbatim, and the current version of the NVivo software for analyzing qualitative data was used to manage the data. Three major themes emerged from the study: knowledge of respondents on vasectomy, beliefs, and attitudes of married men toward vasectomy. Each of the themes had three subthemes. The study revealed that vasectomy was perceived by some of the respondents to be synonymous to castration which comes with negative effects. Inadequate knowledge, negative perceptions, future uncertainty, and the irreversible nature of vasectomy emerged as contributing to the low patronage and some of the reasons why most of the respondents had no intentions of opting for vasectomy. In view of these findings, it is imperative for all stakeholders to give urgent attention to behavior change strategies that can be put in action to ameliorate the effects of these negative attitudes and misbeliefs. Ultimately, the tide can be turned around and vasectomy will be a preferred alternative when it comes to family planning in Ghana.

Two-Stage Scintiscanning in the Differential Diagnosis of Vascularized and Non-Vascularized Intrahepatic Space-Occupying Lesions

A two-stage scanning procedure is described which is used to differentiate vascular from non-vascular localized intrahepatic lesions. The first examination is preferably performed with 99mTc colloid or 113mIn, pH 7, as the first step in discovering and characterizing the space-occupying lesion. The second scan is preferentially performed by the intravenous injection of 113mIn, pH 1.7, when there is no longer any activity left from the first examination. This second scan provides information about the blood content of the previously recognized lesion.

There was good correlation between the results of two-stage scanning, coeliac angiography and the final clinical and/or pathological findings.

Knowledge, Attitudes, and Practices of Postoperative Pain Management by Nurses in Selected District Hospitals in Ghana

INTRODUCTION

There is documented evidence pointing to the fact that there are numerous challenges with postoperative pain (POP) management globally. However, these challenges with POP management are more profound in developing countries.

PURPOSE

The purpose of this study is to examine the knowledge, attitude, and practices of nurses concerning POP management in four selected district hospitals in Ghana.

METHODOLOGY

A descriptive, cross-sectional survey was employed to evaluate nurse's knowledge, attitude, and practices pertaining to POP management. Multistaged sampling was used to draw the respondents. An adapted version of the Nurses Knowledge and Attitudes Survey Regarding Pain instrument was used to test the knowledge, attitude, and practices of nurses and midwives. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study.

RESULTS

This study showed that nurses in the four district hospitals had knowledge deficits regarding POP management. Eighty-one representing 48% of nurses had low knowledge on POP management. An overwhelming majority of nurses (97.6%) relied on routinely rendered basic nursing skills to relieve POP and a few used pharmacological interventions. However, nurses had good attitudes toward POP management.

CONCLUSIONS

POP is ineffectively managed by nurses in district hospitals in Ghana. Nurses and midwives in Ghana need to adhere to best practices in POP management by increasing their theoretical and practical knowledge, so that there will be tangible positive change in POP management in Ghana.

RECOMMENDATIONS

Nurses must be empowered through continuous development programs to keep abreast with changing trends that pertain to POP management.

Evaluation of renal angiomyolipoma by traditional and modern imaging in a case of tuberous sclerosis

Renal angiomyolipoma is known to affect mainly patients with tuberous sclerosis, although it can be found in a significant number of otherwise normal individuals. Few cases have been published in which angiomyolipoma and renal cell carcinoma occurred in the same kidney. In such cases the radiologist may be asked if it is possible to distinguish between the two tumors in the same kidney. The present case report describes systemic traditional and modern imaging of huge bilateral angiomyolipoma in tuberous sclerosis. The analysis of the data implies that, although the diagnosis of angiomyolipoma can be established with noninvasive techniques only, it is impossible to distinguish between the two mentioned tumors if they coexist in the same kidney, even if all available imaging techniques are used.

Common origin of inferior mesenteric and main renal artery

The first case of a common origin of both the inferior mesenteric and single main renal artery, angiographically documented in a patient with primary ipsilateral ectopic kidney, is reported. Embryologic as well as surgical aspects are mentioned.

Site of entry of single main renal artery. Angiographic study

In an effort to determine the frequency of extrahilar entry of the single main renal artery, renal angiographies of 124 left and 124 right kidneys were examined and the findings reviewed. Extrahilar entry of the main renal artery was found in 33 per cent of the kidneys. In 81.7 per cent of the kidneys with extrahilar entry, the artery penetrated the kidney through the upper zones (above the normal hilus). Apical entry of the renal artery was found in 1.6 per cent of the 248 kidneys. There was no entry of the single main renal artery below the hilus of the right kidney. An embryologic explanation of these findings is suggested, and some practical aspects are mentioned.

Apical entry of single main renal artery

Two cases of extrahilar entry of a single main renal artery are described. Selective renal angiography demonstrated arterial entry through the upper pole of the kidney and venous exit, adjacent to the arterial entry. Embryologic as well as some surgical aspects are presented. To our knowledge only one similar variation of arterial supply to the kidney has been reported previously.

Ectopic origin of main renal artery

Two cases with an unusually high origin of a single main left renal artery, angiographically investigated, are presented. In the first case the artery originates as the most cephalad branch of the abdominal aorta above the celiac artery. In the second case its origin is from the celiac axis. Embryologic as well as some practical aspects are mentioned.