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Volume No. 24 2019-06-01 0

The Role of Educational Intervention in Nurses’ Competence towards Paper-Based Medical Records Documentations at four main Hospitals in Khartoum State – Sudan 2014-2015

Fadl Elmula Z. S, Bolad A. K.

Background: Paper-based medical record is a backbone of all patients’ information during admission in the hospital. Growing use of medical records system in hospitals and other medical facilities throughout the world has been driven by the concrete fact that this system can help to improve the quality of health care as medical care gets more complex.

Objectives:  To study the role of educational intervention in nurses’ competence towards paper-based medical records documentations.

Methods: This is a descriptive, interventional, analytical, hospital-based study recruited 150 nurses working at main hospitals in Khartoum State: Police Hospital in Khartoum North Province, Omdurman Teaching Hospital in Omdurman, Military Hospital in Omdurman Province and Khartoum North Teaching Hospital in Khartoum Province. The study assessed participants regarding their knowledge and performance towards paper-based medical records as well as some criteria training issues. They were subjected to pre-education assessment and post-education assessment and the study used pre-design questionnaire, then the data was analyzed by using statistical package for social sciences (SPSS, Vers. 21).

Main findings: Out of 150 nurses assessed in the current study, females were 130(86.7%) versus 20 (13.3%) males, most of them were in the age of 22-30 years who were represented by 136 (90.7%) and have more than 5 years experience and they represented 118(78.7%) while 32(21.3%) had less than 5 years. Overall scores of nurses’ knowledge towards paper-based medical records in pre- and post-intervention assessment were (29.4% and 62.2%) respectively. remarkable improvement in level of knowledge after training was found regarding their believe that, lack of time is the main reason that documentation does not get done (from 18% - 88%). Overall scores of nurses’ performance towards paper-based medical records in pre- and post-intervention assessment were (31.7% and 67.1%) respectively, they showed remarkable improvement regarding the ability to demonstrate knowledge of charting (8%-76.0%). Overall scores of nurses’ knowledge and attitude towards training issues in paper-based medical records in pre- and post-intervention assessment were (33.5%% and 62.2%) respectively.

Discussion: Our findings showed a poor level of competence towards paper-based medical records as well revealed the effective role of educational intervention in increasing competence of nurses and the analysis revealed statistically significant difference regarding the pre- and post-intervention evaluation  (P = 0.000).

Conclusion: The study concluded that, there is poor knowledge and performance among nurses towards paper-based medical records as well as it revealed that educational intervention is effective in improving competence.

Acute Scrotal Swellings In Children, Presentation & Management

Wael Mohammed Taha Mohammed Saad, Amir Abdalla Mohamadain, Aamir Abdullahi Hamza

Background: The term acute scrotum refers to acute scrotal pain. This presentation should always be treated as  an emergency because of the possibility of testicular torsion and permanent ischemic damage to the testis. It presents a major diagnostic and therapeutic challenge. Objectives: The study aimed to assess the presentation and management of acute scrotum in paediatric surgery. Methods: It is a prospective descriptive analytical study, conducted on three hospitals in the period from Mar. 2013 - Nov. 2014. It included all paediatric patients of acute scrotum younger than 13 years. Data was reviewed and analyzed using SPSS version 20. Final diagnosis was made by Doppler ultrasound ± surgical exploration in all cases. Results: the findings included epididymoorchitis (39.5%), testicular torsion (34.2%), torsion of testicular appendage (10.5%), scrotal abscess (6.6%), haematocele (5.3%) and obstructed inguinal hernia (3.9%). The common triad of symptoms was pain (100%), swelling (90.8%) and fever (46.1%), while the common triad of signs was tenderness(96.1%), erythema (82.9%) and oedema (80.3%).Surgical exploration was performed in 49 patients (64.5%), findings were testicular torsion (n=26), torsion of testicular appendage (n=8), epididymoorchitis (n=7), scrotal abscess (n=5) and obstructed inguinal  hernia (n=3). In testicular torsion group, salvage rate was 38.5% (n=10), in most of patients (90%) operated within 24 hours from symptoms onset, however, most patients underwent orchiectomy (n=15) were operated after 24 hours (P value 0.000). Conclusion: Although epididymoorchitis is the most common cause of acute scrotum in paediatric, testicular torsion is the most important differential diagnosis since delay in management leads to testicular loss. Unfortunately, testicular torsion cannot be consistently confirmed or rule out by history and clinical examination.

Keywords: Acute scrotum, Epididymoorchitis, Testicular torsion, Torsion of testicular appendage.

Determination of CD4 T cells among children infected by HIV during anti-retroviral therapy (ART)
Hosna Ibrahim Ali Omer, Ahmed Kamal Awad Alla, Mohamed Elhassan Abakar, Saeed Nasaddin

Mother-to-child transmission is by far the commonest source of HIV infection in children. Therefore, its necessary to have a policy which provides the frame work, response intervention in the prevention, care and support of these infected and affected by the epidemic and mitigation of its impact. This study is conducted on newly born babies to mothers infected with HIV/AID to determine levels of CD4 T cells in an attempt to find a correlation between these level and the Mother-to-child transmission process, so it can participate in the ongoing efforts of control using anti retroviral therapy (ART). Level of CD4 cell in infected mothers was determined by using rapid test (determine), immunocomb and PCR (DBS). The effect of ART on vertical transmission of neonates was evaluated by using CD4 and PCR, DBS. HIV analysis in mothers infected using rapid test (Determine) (RT) and immunocomb gave similar results. HIV analysis in infected mothers and their infected infants using either RT or immunocomb test revealed similar results and CD4 count was high in the majority of the study population indicating the effectiveness of ART. Our findings suggest that CD4 count following ART initiation have appreciably changed in the majority of the study population. However in few children CD4 count had not influenced by ART.

Subclinical Hypothyroidism-Shall we treat? Areview article
Amal Kamil M.Saeed, Ayad Mohamed, Khalid Yassin M.Ahmed

Introduction :-

Subclinical hypothyroidism (SCHT) is a commonly presenting medical condition with a prevalence of 1-10% in middle age population, with higher incidence in elderly. (1) It should be considered when a patient is found to have mildly elevated thyroid stimulating hormone (TSH), normal free thyroxin (T4) and Tri-iodothyronine (T3), and –usually - the absence of florid signs and/or symptoms of hypothyroidism.


 We conducted internet search in Medline, PubMed , e-medicine websites search more publications found in Google.

All relevant topics published during 2000-2017 were reviewed, analyzed and discussed in this review article. Those included abstracts and references, most recent and relevant case controlled studies, cohort studies, some systemic reviews and four interesting meta-analytic studies.

Keywords;- Subclinical hypothyroidism

Conclusions :-

Although subclinical hypothyroidism is the most commonly encountered thyroid function abnormality in every day clinical practice, still the data supporting the association of this thyroid dysfunction with symptoms or adverse clinical outcome, and the risks or benefits of treatment with thyroxin are few and needs further studies.

Perceived Stress among Bachelor Nursing Students in Clinical Practice in Faculties of Nursing, Khartoum State, 2018
Khalil Abdulqawi M. S. and Sara Lavinia Brair

Background: Stress has been identified as a twentieth-century disease and has been viewed as a complex and dynamic transaction between individuals and their environments. Overall students face many challenges and stressors, however, nursing students are more commonly to perceive stress than other medical students due to the transitional nature of college life and specific socio-cultural characteristics. Therefore, stress makes students to practice professional skills hardly to gain proper training. This study aimed to investigate the level of the stress among bachelor nursing students in clinical practice.

Methodology: A descriptive cross-sectional facility-based was carried out in seventeen faculties of nursing in Khartoum State. 446 nursing students were involved. A standardized structured questionnaire included; demographic information sheet and perceived stress scale (PSS) had been used. All data had been analyzed by Statistical Package of Social Sciences (SPSS). Ethical approval was obtained from Institutional Review Board at Al-Neelain and Administrative approvals were obtained from the Deans of selected faculties in this study and verbal consent was obtained from each student involved.

Results: Majority of the respondents (88.3%) were females with mean age 19 years. Overall mean level of stress was (1.52 ± 0.19). Stress from the area of practice, stress from assignments and workload, and stress from taking care of patients were the most common stressors (1.72 ± 1.01), (1.70 ± 0.88) and (1.55 ± 0.78) respectively. Factor analysis demonstrated that: stress from assignments and workload and stress from taking care of patient accounted for 62% of total variance as major source of stress.

Conclusion: Nursing students perceived intermediate to a high level of stress by more than half of the respondents, most commonly attributed to the clinical environment, assignments, workload and taking care of patients respectively.

Recommendations: familiarizing students with the clinical area by providing proper support by instructors and nursing staff, minimizing assignments and workload during clinical practice will be important to reduce stress.

Keywords: Stress, Nursing Students, Factor Analysis, and Clinical Practice.

Conflict of interest: No conflict of interest

Coping Strategies Regarding Stress among Bachelor Nursing Students in Clinical Practice, Khartoum State, 2018
Khalil Abdulqawi M. S. and Sara Lavinia Brair

Background: Nursing students experience high level of stress compared with their colleagues due to the transitional nature of college life and specific socio-cultural characteristics. In most nursing curricula, nursing students spend approximately half of their education within the clinical areas; so it is alarming that they view the clinical practice as incredibly stressful situation. A stabilizing technique that may help to maintain psychosocial adaptation during stressful events known as a coping strategies and it is very important to overcome stressful situations. Present study aimed to explore most common coping strategies practiced by Sudanese nursing students during clinical training in Khartoum State.

Methodology: This was a descriptive cross-sectional facility based study that recruited 446 bachelor nursing students enrolled in all nursing colleges in Khartoum, Sudan. A standardized administered questionnaire was used, including demographic information sheet, and coping behavior inventory (CBI). Data were analyzed by SPSS version 20. IRB approval from Al Neelain IRB, permission from the dean of faculties selected in this study and formal consent from students was obtained.

Results: 88% of participants were females under 20 years. Staying optimistic (2.76 ± 0.78), problem solving (2.71 ± 0.89) were the most coping strategies used by students. While, transference (2.34 ± 0.95) and avoidance (1.49 ± 0.79) were less commonly used. Factor analysis concluded that: staying optimistic and utilizing problem solving approach were the two main factors responsible for 66.8% of total variance and 2.67 eigenvalue of coping strategies.

Conclusion: Adapting optimism and problem solving approaches were utilized by the majority of students as a coping behavior, while avoidance and transference were less commonly used in this study.

Recommendations: It is necessary to provide at least basic education about the extent of stress and effective coping mechanisms and stress management for newly admitted nursing students, promote supervisor student interaction to allow better understanding of students, their personalities and individuality.

KEYWORDS: Coping Strategies, Stress, Nursing Students, and Clinical Practice