Background. Although pressure ulcer development is now generally considered as an indicator for quality of nursing care, questions and concerns about situations in which they are unavoidable remain. Awareness about the significance of the problem, positive attitude towards prevention, and an adequate level of knowledge are cornerstones to effectively prevent pressure ulcers. Objective. To assess nurses&#x2019; knowledge, attitudes, and perceived barriers to expressed pressure ulcer prevention practice in Addis Ababa government hospitals. Methods and Materials. This is a cross-sectional study by design. A total of 217 eligible nurses participated in the study and data were collected through pretested self-administered questionnaire. Results. When queried, 61.2&#x25; of the respondents had adequate knowledge on pressure ulcer prevention practices, while 68.4&#x25; had favorable attitudes towards prevention practices. Moreover, 67.3&#x25; of participants had good pressure ulcer prevention practices. Conclusion and Recommendation. More than half of the nurses were found to have adequate knowledge about pressure ulcer prevention and their attitude towards it was overall favorable. Expressed pressure ulcer prevention practice was affected by the participant&#x2019;s level of knowledge, attitude, and barriers of care. To provide effective prevention of pressure ulcer, nurses&#x2019; level of knowledge and attitude should be enhanced besides resolving these barriers.

Abebe Dilie

Daniel Mengistu

Assessment of Nurses&#x2019; Knowledge, Attitude, and Perceived Barriers to Expressed Pressure Ulcer Prevention Practice in Addis Ababa Government Hospitals, Addis Ababa, Ethiopia, 2015

Background. Registered nurses (RNs) have a role in the medication administration process (MAP) multiple times per day in a hectic hospital environment. This requires a great deal from the RNs in order to accomplish the demanding task of avoiding adverse drug events. However, the process has not been widely studied from the nurses&#x2019; perspective. Aim. The aim of this study was to describe the different stages of MAP from the RNs&#x2019; perspective. Methods. A qualitative descriptive research design, with a purposive sample involving thematic interviews of 20 RNs and questions to them in a paper form, was conducted in two medical units. Data was analyzed by using deductive content analysis. Results. The results revealed that RNs confront numerous problems such as equivocal prescriptions, problems with information technology (IT), unavailability or incompatibility of the medicines, a substantial amount of generic substitutions, and changing medicine brands. Disruptions and distraction run through each stage of the MAP, excluding prescribing. The RNs desire support in all stages of the MAP. Conclusion. There are areas to improve in each stage of the MAP from the RNs perspective. Real-time and ubiquitous documentation, along with software including the data and knowledge required in medication management, is needed.

Hanna Pirinen

Lotta Kauhanen

Riitta Danielsson-Ojala

Johan Lilius

Ilona Tuominen

Natalia D&#xed;az Rodr&#xed;guez

Sanna Salanter&#xe4;

Registered Nurses&#x2019; Experiences with the Medication Administration Process

Background. Around 50&#x2013;90&#x25; of hemodialysis patients develop pruritus. Although studies examining nonpharmacological treatments for itchy skin have been conducted, the conclusions have not been decisive. Purpose. Through a systematic review of the literature, this study aimed to understand nonpharmacological interventions carried out in clinical trials for uremic pruritus and to evaluate and consolidate the information regarding these improvements and their effectiveness. Methods. A literature search focusing on studies published between January 2004 and December 2013 was conducted from 5 electronic databases. After screening based on inclusion criteria and excluding duplicates, nonpharmacological treatments examined in randomized clinical trials were selected for further analysis and synthesis. A modified Jadad scale was used to evaluate the quality of the identified articles. Results. Seven nonpharmacological studies met the inclusion criteria. The interventions to improve uremic pruritus included using emollients, phototherapy, acupuncture, and thermal therapy. Research showed that using emollients, phototherapy, and acupuncture significantly reduces uremic pruritus. Conclusion. Nonpharmacological interventions are effective for hemodialysis patients with pruritus. Emollients were found to provide the most relief compared to the other methods and constitute a readily available and cost-effective intervention to improve pruritus symptoms.

Chiu-Feng Wu

Ya-Chu Hsiao

Pi-Chen Ko

The Effects of Nonpharmacological Treatment on Uremic Pruritus Patients: A Systematic Review

Introduction. The new demands of a fast changing world necessitate expanding the traditional concepts of nursing, extending the classical aspects to cover new areas. Purpose. Based on their professional duties, the nursing team in the pharmacy of a second-level hospital aimed to establish a theoretical and situational framework for nurses working in the central services. Material and Methods. Application of the nursing process to nursing work in an area with no direct contact with patients. Results and Discussion. The application of the NANDA diagnoses to professional practice enabled the establishment of a nursing diagnosis with the implementation of measures designed to overcome a stressful situation with a risk of becoming unmotivated. Main Conclusion. The capacity to adapt the nursing profession to undertake new roles in the field of healthcare and the power of nursing own methodological resources permit the indirect care of &#x201c;faceless&#x201d; patients to be complemented with the inclusion of nurses from other services as clients, forming the focus of care, who can thus be helped with their daily care work.

Inmaculada G&#xf3;mez-Villegas

Bel&#xe9;n Ru&#xed;z-P&#xe9;rez

Dolores L&#xf3;pez-del-Pino

Francisco Garc&#xed;a-Espa&#xf1;a

Professional Nursing Duties in the Central Services: Hospital Pharmacy Nurses

Introduction. Nonexclusive breastfeeding (NEBF) is giving infants other foods or fluids in addition to the breast milk within the first six months of age. According to Ethiopian Demographic and Health Survey 2011, prevalence of NEBF was found to be 48&#x25;; this has a great impact on the health and development of the child. Objectives. To assess the prevalence and associated factors of NEBF to infants within the first six months. Methods. Community based cross-sectional study design was employed from March 1 to 31, 2014, among 828 mothers with infants 6 to 12 months old. Systematic random sampling technique was used to select study subjects. Logistic regression analysis with 95&#x25; CI was computed to identify predictor variables. Result. A total of 828 mothers with infants aged between 6 and 12 months were interviewed with 100&#x25; response rate. Prevalence of NEBF was 47.5&#x25;. Mothers who completed primary school (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2401896pt" id="M1" height="9.36053pt" version="1.1" viewBox="-0.0498162 -9.12034 65.8325 9.36053" width="65.8325pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g190-66" d="M673 0V28C608 34 594 43 563 129C499 303 432 494 370 665L339 656L132 132C98 43 84 37 20 28V0H238V28C162 35 154 45 175 108C188 150 203 192 219 237H432C454 176 474 122 487 83S491 36 428 28V0H673ZM418 280H234C265 362 296 450 328 535H330L418 280Z"/></g><g transform="matrix(.0135,0,0,-0.0135,8.981,0)"><path id="g190-80" d="M381 665C170 665 44 498 44 318C44 125 188 -15 369 -15C552 -15 703 117 703 333C703 534 550 665 381 665ZM359 629C491 629 601 517 601 306C601 114 502 21 390 21C249 21 146 158 146 346S248 629 359 629Z"/></g><g transform="matrix(.0135,0,0,-0.0135,18.979,0)"><path id="g190-83" d="M631 18C609 24 585 35 559 65C534 91 514 117 478 169C448 214 406 281 389 313C462 346 516 399 516 485C516 545 490 590 449 616C412 641 363 650 290 650H42V622C120 615 128 612 128 527V125C128 40 120 34 38 28V0H300V28C221 34 212 40 212 125V284H244C295 284 312 272 329 244C359 195 395 133 430 84C475 19 516 -3 592 -7C603 -8 615 -8 627 -8L631 18ZM212 316V563C212 591 215 602 223 607C231 613 248 617 277 617C352 617 423 577 423 469C423 415 407 375 368 345C343 324 310 316 260 316H212Z"/></g><g transform="matrix(.0135,0,0,-0.0135,31.282,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,43.02,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,49.523,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,52.612,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.0135,0,0,-0.0135,59.116,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g></svg> [95&#x25; CI: 0.30, 0.71]) were less likely practicing NEBF compared to mothers with no formal education. Governmental employees (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2401896pt" id="M2" height="9.36053pt" version="1.1" viewBox="-0.0498162 -9.12034 65.8325 9.36053" width="65.8325pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g190-66"/></g><g transform="matrix(.0135,0,0,-0.0135,8.981,0)"><use xlink:href="#g190-80"/></g><g transform="matrix(.0135,0,0,-0.0135,18.979,0)"><use xlink:href="#g190-83"/></g><g transform="matrix(.0135,0,0,-0.0135,31.282,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,43.02,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.0135,0,0,-0.0135,49.523,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,52.612,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.0135,0,0,-0.0135,59.116,0)"><use xlink:href="#g113-54"/></g></svg> [95&#x25; CI: 1.45, 4.46]) were more likely practicing NEBF. Conclusion. NEBF was practiced by 47&#x25; of mothers. Maternal educational status, occupation, and knowledge of initiation of complementary feeding were factors significantly associated with NEBF.

Mengistu Berhanu

Workie Zemene

Mengistu Mekonnen

Prevalence and Associated Factors of Nonexclusive Breastfeeding to Infants within the First 6 Months in Gondar Town, Northwest Ethiopia, 2014

Introduction. Diabetes mellitus is a chronic debilitating condition characterized by an increased blood glucose level and is associated with significant morbidity, mortality, and increasing health care cost. Diabetic foot ulcers and lower extremity amputations are a common, complex, costly, and disabling complication of diabetes. An estimated 15&#x25; of patients with diabetes develop a lower extremity ulcer. Objective. The aim of this study was to assess knowledge, practice, and barriers of diabetic foot self-care among diabetic patients attending Felege Hiwot Referral Hospital. Method. Institution based descriptive cross-sectional study was conducted on 313 diabetic patients using convenient sampling technique. Furthermore, descriptive statistics and binary and multivariate logistic regression were employed to assess the predicators of knowledge and practice of diabetic foot care. Result. Majority of respondents were males (64.9&#x25;). The mean age was 39.1&#x2009;&#xB1;&#x2009;16. The mean knowledge score was 7.5&#x2009;&#xB1;&#x2009;2.02 of which 56.2&#x25; and 43.8&#x25; had good and poor knowledge of foot care, respectively. The mean practice score was 25.2&#x2009;&#xB1;&#x2009;6.466 of which 53.0&#x25; had good and the remaining 47.0&#x25; had poor foot care practice. Of 162 respondents having barriers, 56.8&#x25; reported &#x201c;poor communication between patients and health care providers,&#x201d; 50.6&#x25; cited &#x201c;I did not know what to do,&#x201d; and 44.4&#x25; responded &#x201c;inconveniency for work&#x201d; as barriers of foot care. Conclusion and Recommendation. Knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, lack of adequate knowledge, and inconveniency for work were commonly cited barriers of foot care. Policy makers should initiate interventional foot care education program throughout the regional state. The study hospital should consider establishing a specialized diabetic clinic in which foot care education can easily be integrated into follow-up care.

Awole Seid

Yosief Tsige

Knowledge, Practice, and Barriers of Foot Care among Diabetic Patients Attending Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Background and Objectives. Health communication is a critical aspect of care for both providers and recipients having a direct influence on engagement and outcomes. Communicating which in this context includes talking and listening in order to share information or support young women to understand their DSD can be difficult especially since the topic area is sensitive. Methods. In this qualitative study thirteen young women (aged 14&#x2013;19 years) with a disorder of sex development who engaged with health care professionals were purposively recruited between 2011 and 2012 from three specialist centres across the United Kingdom. The young women either were interviewed or completed a diary about their experiences of communication with a range of health care professionals. An interpretative phenomenological approach was used to analyse these data. Results. By analysis of data the young women were able to clearly articulate the qualities and skills health professional needed in relation to communication. Two main categories focused on the duty in which professionals have to share information and their role in supporting young women to manage this information. Discussion and Conclusion. The study results revealed that these young women with a DSD expected to meet skilled professionals who could recognise the emotional aspects of dialogues in the short and longer term.

Caroline Sanders

Bernie Carter

A Qualitative Study of Communication between Young Women with Disorders of Sex Development and Health Professionals

Background. Musculoskeletal disorders have continued to plague nurses in hospitals and long-term care facilities. Low back and shoulder injuries are the most prevalent, frequently linked to patient handling activities. Exposure to patient handling has been predominantly quantified by subjective responses of nurses. Objective. To directly observe handling of patients and other medical equipment for nurses during a 12-hour work shift. Methods. Twenty nurses working in three different intensive care units at a Midwest teaching hospital were directly observed during 12-hour day shifts. Direct observation included documenting frequency and type of handling performed and whether lift assist devices were utilized. Two additional surveys were completed by nurses to assess current pain levels and perceptions of lifting being performed. The observed lifting was compared to the perceived lifting with simple inference statistics. Results. Nurses have a high prevalence of manually lifting patients and medical devices but limited use of lifting assist devices. Nurses handled patients 69 times per shift and medical equipment 6 times per shift, but less than 3&#x25; utilized a lift assist device. Nurses suffered from high levels of pain at the end of the shift, with the highest prevalence in the lower back, lower legs, and feet/ankles (all above 60&#x25;).

Tiffany Poole Wilson

Kermit G. Davis

Susan E. Kotowski

Nancy Daraiseh

Quantification of Patient and Equipment Handling for Nurses through Direct Observation and Subjective Perceptions

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Advances in Nursing