Nurses' knowledge, attitude and practice in the management of acutely ill adult patients, in the general wards at Kenyatta National Hospital

Abstract

Introduction: Care of the acutely ill patient has become increasingly challenging due to demands from external sources to measure the quality and appropriateness of care provided (Ridley,1998). The more critically ill the patient is the more vulnerable and unstable he becomes, thereby requiring intense nursing care to ensure optimum c~re. Nurses' knowledge and attitude towards an acutely ill patient is generally considered to be one of the basic factors contributing to the administration of a total therapeutic nursing care. Earlier studies showed that management of acutely ill patients admitted to general wards was suboptimal (McQuillan, 1998). Other studies also suggested that doctors and nurses working in general wards may not have some of the skills required to manage patients with complex needs (Chaboyer et al, 2004). Objective: The study sought to determine nurses' knowledge and practice on the management of acutely ill adult patients and to establish the nurses' attitudes and perceptions on the management of these patients at the general wards of Kenyatta National Hospital. Methodology: This was a cross sectional descriptive study conducted at KNH general wards among nurses over a period of 6 months, from January 2010 to June 2010. Quantitative data was collected using self-administered structured questionnaires while qualitative data was obtained through a focus group discussion with the subjects. Purposive sampling was used to select fourteen medical and surgical wards. From each of the selected wards, proportional random allocation was used to select study subjects. Qualitative data obtained was coded through content analysis according to themes, and SPSS ® software used to analyse quantitative data. Results and Findings: From the study, it was noted that the respondents were not adequately knowledgeable on certain aspects of care of the acutely ill patients. A majority of the nurses had not attended any critical care course (83%). Further, 32% of nurses reported not being conversant with CPR procedures for the acutely ill patients. Of the respondents who were involved in the CPR process, 12% (n = 50) reported not being conversant with the process. Conclusion and Recommendations: It was found that majority of nurses were not adequately knowledgeable on management of acutely ill adult patients and a significant proportion were not competent in their practice. There is need for KNH management to train and periodically update staff on basic and advanced cardiac life support courses. Further, a systematic program of orientation and continuing education/refresher program should be implemented to ensure quality care provision and sustain the interest of the nursing professionals in the practice field.