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Abstract Background Deaths can be caused by terminal illnesses, accidents, or natural disasters. However, medically, death can be hastened by healthcare providers, patients themselves, or their relatives. In advanced cancers where the patient’s quality of life is compromised, Euthanasia can be used to hasten death. Inadequate medical resources and low socioeconomic status have been cited as factors influencing Euthanasia. This study sought to explore nurses’ and midwives’ knowledge and perspectives on Euthanasia in resource-constrained health facilities. Methods A qualitative exploratory, descriptive design was used to recruit 24 nurses and midwives from three major referral hospitals, two regional hospitals, and one district hospital. Data was collected through individual in-depth face-to-face and telephone interviews. Braun and Clarke’s (2006) thematic data analysis approach was used. Findings : Three main themes and eight subthemes were generated from the data: the main themes include Knowledge of Euthanasia, health system resource constraint-driven euthanasia and family resource constraint-motivated euthanasia. The findings indicate that nurses and midwives lack understanding of some terminologies related to the act. Strict policy decisions, inadequate resources, and misunderstanding of palliative care resulted in the practice of Euthanasia. Additionally, unbearable pains and financial constraints of families of critically ill patients made them request Euthanasia in the health facilities. Conclusion The study highlights the challenges of end-of-life care in resource-constrained settings, emphasizing the need for provider training, increased healthcare capacity, and clearer national guidelines for ethical decision-making.

Abstract Introduction Cervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients’ suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes. Aim This study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana. Method In this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0. Results The challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing. Conclusion Nurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

Abstract Introduction Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient’s initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. Methods An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. Results From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one’s time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. Conclusion The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.

Introduction Migration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that have created job opportunities in high-income countries such as the USA, UK, Canada and Germany among others. Conditions of service in LMCIs are unattractive, leading to the search for better opportunities. The digital environment is becoming one of the facilitators of migration intentions due to the activities of recruitment agencies and the search for job opportunities on the World Wide Web. The digital environment creates opportunities for migration but also poses a security threat, economic loss and a brain drain to departure countries. However, there is a paucity of evidence on how the proliferation of advertisements on health workforce recruitment within social media, unsolicited emails and activities of recruitment agencies in the digital environment influence the migration of the health workforce and the implications of migration governance.Method and analysis This scoping review protocol describes a comprehensive systematic extraction and examination of existing literature to map key concepts and identify previous literature, noting the gaps in how social media and the digital environment are influencing the migration of the health workforce. We lean on Arksey and O'Malley’s scoping framework in developing this protocol. This involves the following: identifying research questions, searching for the literature, selecting articles or studies, charting the data and organising and reporting the outcome of the review. The review question is informed by the population, concept and context framework, which details the population as the health workforce (doctors, nurses, midwives and pharmacists), the key concepts as migration, social media and digital environment, and the context as LMICs. The search strategy was developed with the assistance of an experienced librarian who will work with the team to conduct a Peer Review of Electronic Search Strategies to evaluate titles, abstracts and full-text articles for inclusion from databases such as Scopus, PubMed, MEDLINE and Google Scholar. Additionally, we will search grey literature sources including online news media, social media platforms (Facebook, Instagram and Twitter), web pages of WHO, UN and migration-related agencies, and interfaces like EBSCO host. Two members of the team will screen titles and abstracts, and all team members will screen full text for data extraction. Data from grey sources will be converted to transcripts, coded and grouped into themes and subthemes consistent with thematic analysis strategies. All authors will be involved in the synthesis of the data. We intend to follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines in reporting the outcome of peer-review sources.Ethics and dissemination This is a scoping review protocol that addresses a subject of interest that poses no risk to individuals or groups. All the information will be retrieved from open sources only. The protocol was registered with the Open Science Framework registry (osf.oi/zan3q) to serve as an audit trail. Reports from the review will be published in peer-reviewed journals and presented at conferences.

Background: The growing burden of life-threatening illnesses and advancements in care interventions call for the intentional integration of palliative care services into existing care systems. The absence of active, functioning palliative care services in most hospitals in Ghana is a major concern. This study explored the factors influencing the integration of palliative care services in one of such institutions. Objectives: The aim of the study was to explore the institutional drivers of palliative care integration in a military health facility. Design: Exploratory qualitative study. Methods: We employed a qualitative exploratory study design situated within a constructivist paradigm. A purposive sampling method was used to select and interview 11 healthcare professionals. A semistructured interview was used to conduct face-to-face, in-depth interviews with participants between April and May 2022. A thematic data analysis was done based on the Braun and Clarke analysis process with the aid of QSR NVivo-12. Results: The six themes that describe the institutional driving factors for integrating palliative care services were cognitive restructuring, supportive logistics and infrastructure, staffing, healthcare professional skills, institutional policies and priorities, and utilization of focal persons. It was observed that a paradigm shift in the mindset of healthcare professionals and administrators was a major driver that would determine the integration of palliative care services. A cognitive restructuring will facilitate a more aggressive integration of palliative care services because logistics, staffing, and medication access will be prioritized. Conclusion: Institutions have the responsibility of aligning with the WHO policy on palliative care service access and must invest in training, staffing, prioritizing palliative care needs and policies, procurement of essential drugs, and the provision of logistics and supportive infrastructure to scale up the implementation of palliative care services.

Sub-Saharan African countries, including Ghana, are disproportionately affected by hepatitis B. In Ghana, the burden of hepatitis B is unevenly distributed, with the Brong Ahafo region having the highest prevalence (13.7%). Given that people with hepatitis B (PWHB) in Ghana have previously been found to have a lack of understanding of the impact of the infection, we sought to explore their health-seeking behaviour using the health belief model as an organising framework. A qualitative exploratory design was used. In total, 18 people were purposively selected for face-to-face interviews. The data was processed and analysed using QSR NVivo version 11.0 and the Braun and Clarke thematic analysis procedure. The belief that hepatitis B can cause liver cancer and death was the most important determinant of health seeking. Furthermore, access to accurate hepatitis B information, particularly information about availability of effective hepatitis B treatment, influenced a number of participants to seek formal care. However, the high cost of clinical monitoring and treatment to use herbal medicine, despite their concerns about the effectiveness of herbal medicines in managing hepatitis B. Given that hepatitis B information was a factor in health seeking, it is recommended that a hepatitis B awareness campaign focusing on the availability of hepatitis B treatment and where it can be obtained be carried out in the study area. Counselling PWHB at the point of diagnosis should highlight the relevance of life-long clinical monitoring. To remove financial barriers to hepatitis B care in Ghana, the government should include the cost of hepatitis B laboratory investigations and treatment in the health insurance scheme.

Abstract Aim The purpose of the study was to inquire into social media adoption by nurses for nursing practice. Design An exploratory descriptive qualitative design was employed in understanding social media adoption for nursing care among nurses. Method A purposive sampling technique was employed to recruit 12 participants for the study. A semi‐structured interview guide was used to conduct in‐depth interviews which were audiotaped, transcribed verbatim, coded and analysed. Thematic analysis was used to analyse the data with NVivo 12. Results The findings revealed nurses found social media to be useful for the dissemination, and reception of information, professional development and enhanced referral networks. Apart from its usefulness, participants believe that it is easy to navigate its apps, clear and understandable to use and does not involve much mental effort hence their favourable attitude towards use. Some participants also believe that inaccurate information, privacy and confidentiality concerns, distraction and addiction were some potential risks that are associated with its usage in nursing practice. Due to this, some participants developed a negative attitude towards its usage. Patient or Public Contribution Twelve nurses actively participated in the study.

Abstract Background Nurses and midwives have been stretched by the COVID-19 pandemic amidst the heroic roles they have played during the peak of the COVID-19 pandemic. Nurses stood tall among their peers in the healthcare industry saving lives. The pandemic has had a toll on nurses physically, psychologically, and socio-economically. The numerous deaths have traumatized nurses coupled with the fear of possible infection. Nurses have seen their colleagues and loved ones lose their lives to the pandemic, nevertheless, they still render care to patients no matter the circumstances. Due to that, it is imperative to ascertain the extent to which nurses who are much needed in healthcare delivery have been affected by this pandemic. This scoping review used Arksey and O’Malley’s review methodology to investigate the nature of work-related psychosocial challenges nurses encountered during the peak of the pandemic, noting the major contributors to the challenges and the coping strategies used to address them. Methods We performed a scoping review and searched for articles from five databases including PUBMED, CINAHL, SCOPUS, Google Scholar, and Grey literature from December 2019 to December 2021. A total of 7,334 articles were retrieved for the study but 45 met the inclusion criteria. Results Work-related psychosocial challenges identified included stress, burnout (emotional exhaustion and depersonalization), Post-Traumatic Stress Disorder, depression, sleeplessness, and anxiety. Factors that accounted for the challenges were inadequate personal protective equipment (PPEs), discomfort using the PPEs, extreme workload, and fatigue. Nurses experienced job insecurity, business closure, and separation from family and loved ones, and these contributed to their challenges. Strategies used to deal with the challenges centred on emotion-focused and problem-focused coping. Conclusions The study recommends regular counselling and support for all nurses working at the frontline to help them better cope with the devastating effects of the pandemic so that they could build resilience towards future pandemics.

IntroductionCervical cancer has been identified as the fourth most common form of malignancy affecting and killing women globally. Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation and the burden of care. Resilience has been identified as one of the effective ways of helping nurses to cope well with the stress of oncology nursing, but this remains undetermined in Ghana.AimThis study explored personal and workplace factors influencing the resilience of nurses caring for women diagnosed with advanced cervical cancer (stage III and IV) in a resource-constrained setting in Ghana.MethodUsing a qualitative approach, we recruited twenty nurses and midwives who had worked for a year and above caring for advanced-stage cervical cancer patients at the national referral hospital in Ghana. We conducted in-depth interviews between July, 2022 to September, 2022 which were audio-taped with participants' consent. Transcription was done verbatim, and analysis conducted using thematic analysis approach with the aid of NVivo 10.0.ResultsThe results revealed experience as a safety toolkit, inherent desire to help/care for the patient, emotional numbness and maintaining professional outlook as personal factors influencing resilience among the participants. Regarding the workplace factors influencing resilience, we identified the main theme of demands of caregiving for advanced cervical cancer patients with the following sub-themes; severity of cases managed, nature of care rendered, activities of care given, reshuffling, schedules and gender mirroring as an exacerbator of psychological suffering.ConclusionResilience among nurses and midwives caring for terminally ill cervical cancer patients is influenced by longer years of service, intrinsic motivation to work as a nurse, and the defense strategy of emotional numbness and professionalism at the individual level. Also, the huge demand of caregiving serves as a major workplace factor affecting the resilience of nurses and midwives. We recommend strategies such as regular ward conferences and in-service trainings aimed at enhancing job-experience, inherent desire to render care and professionalism be adopted in resource-constrained settings to improve nurses' resilience. In addition, political actors and management of hospitals must prioritize allocation of resources for advanced cervical cancer care with particular focus on providing more specialized nurses and midwives.

Globally, the right to work is a modest human right. It is a right acknowledged under the Universal Declaration of Human Rights which delineates the various types of work. As such, each person is at liberty to take up any job granted that one has the capacity and skills. This decision must be free from stigma or discrimination. However, this is not the case with mortuary attendants in Ghana. This study explored the viewpoints of Ghanaian mortuary attendants and how society perceives their rights to work. The study used a qualitative research approach, with exploratory and descriptive designs, that sought an in-depth understanding from sampled mortuary attendants on the perception of their community members toward their work. Saturation was attained with nineteen (19) participants from nine (9) health facilities located in the three regions. Semi-structured interviews were conducted and audio recorded with concurrent data transcription and analysis using content analysis. Purposive sampling was used. The study included male or female mortuary employees with at least 1 year of working experience. The themes that emerged were as follows; self-stigma, public stigma, stigma-by-association, and structural stigma. The results were structured according to a stigma model. The study reveals high levels of stigmatization and discrimination against mortuary attendants. Researchers recommend the need for public education, and policy changes to reverse the scornful stigmatization and discrimination against death care workers and those in related profiles.

Mental health problems, particularly depression and anxiety, are common in women and young girls living with HIV/ AIDS particularly in low- and middle-income (LMICs) countries where women's vulnerability to psychiatric symptoms is heightened due to the prevalent intersectional stressors such as stigma and intimate partner violence. However, no synthesized evidence exists on the mental health burden of females living with HIV/AIDS (FLWHA) in Africa. This systematic review aimed to synthesize the current evidence on the mental health burden among FLWHA in sub-Saharan Africa. A systematic literature review of articles published from 2013-2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Five electronic databases; PubMed, MEDLINE with full text, Scopus, Academic Search Complete, and Health Source: Nursing Academic Edition were searched for articles published in English. Nineteen articles (15 quantitative, 3 qualitative, and 1 case study) from over 7 African countries met the inclusion criteria. The majority of the studies' quality was determined to be moderate. The prevalence of depression ranged from 5.9 to 61% and anxiety from 28.9 to 61%. Mental health burden was a logical outcome of HIV diagnosis. Predictors of mental health outcomes in the context of HIV/AIDS were identified as intimate partner violence (IPV), stigma, childhood traumas, sexual abuse, poverty, unemployment, and social isolation. Social support and resilience were identified as protective factors against mental illness in FLWHA. Mental illness had a deleterious effect on viral suppression rates among FLWHA, resulting in delayed initiation of antiretroviral therapy treatment and increased mortality but had no impact on immune reconstitution in the face of ART adherence. Given the high prevalence rates of depression and anxiety and their relationship with HIV progression, it is crucial that mental health care services are integrated into routine HIV care.

Abstract Aim This study aims to explore the perception of nurses on the use of mobile phone SMS for managing diabetes in rural Ghana. Design Exploratory Descriptive Qualitative Design. Methods Purposive sampling was used to recruit (13) participants relative to data saturation after ethical clearance (REDACTED); using a semi‐structured interview guide. All interviews were transcribed verbatim and analysed using thematic content analysis. Results Participants believe SMS was useful in facilitating interaction between nurses, clients, family and statistically significant others; improving medication adherence and supporting blood glucose monitoring. The use of infographics was preferred to traditional SMS among digitally literate patients and voice calls for those who were illiterate. Participants had limited knowledge of downloadable diabetic applications. Participants were willing to accept and use SMS for the management of diabetes mellitus. Patient or Public Contribution Thirteen nurses actively participated in the study.

Abstract Aim The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0–14 years living with tuberculosis. Design Exploratory descriptive qualitative design. Methods Semi‐structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer‐enhanced thematic analysis. Results Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. Conclusion Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad‐based emotional and other support for these women.

Abstract Aim The purpose of this study was to explore the perceived benefits and challenges of online distance education and computer‐based testing (CBT) among registered nurses and midwives in a sample of government‐owned health facilities and health training institutions in Ghana. Design Exploratory descriptive qualitative design. Methods Individual semi‐structured interviews were conducted with 45 participants (i.e. 25 nurses and 20 midwives). The data were manually processed and analysed using Braun and Clarke’s thematic analysis approach (November 2019‐February 2020). Results Nurses and midwives prefer online distance education for three reasons: convenience, cost‐effectiveness and learning centre proximity to the workplace. The course schedule’s flexibility allowed participants to work and study simultaneously. Others acknowledged online distance education as a viable option for overcoming the challenges of obtaining study leave. However, the lack of recognition of certificates by some employers, poor Internet connectivity and perceived excessive course load were noted as deterrents. Regarding the CBT, many of the participants said that it was useful. Among the advantages of CBT are: (1) a decrease in examination malpractices, (2) a decrease in examination costs and (3) a rise in students’ interest in information, communication and technology (ICT). This finding emphasizes the necessity of integrating ICT into nursing and midwifery education and examinations, as well as maximizing its benefits.

With the increasing cancer incidence in Ghana especially breast cancer among women, its diagnosis and prognosis present enormous fear and worry for women and their families. Thus, breaking the news of breast cancer diagnosis to patients presents enormous difficulty to healthcare professionals. Aim: This study sought to explore the preferences of people living with breast cancer regarding the disclosure of their diagnosis. Methods: The study used an exploratory-descriptive qualitative design to recruit and interviewed 17 women diagnosed with breast cancer and receiving treatment in a National Radiotherapy and Nuclear Medicine Center of a major Teaching Hospital in Ghana. Data were analyzed using Braun and Clarke’s 2006 thematic analysis approach. Findings: Two major themes, six subthemes, and five sub-subthemes were generated from the data. The study found that patients preferred detailed information on the stage of their cancer diagnosis, treatment options, and the lifestyle necessary to enhance their health. The participants preferred that the news of their diagnosis be broken to them gradually in the form of a conversation with consolatory gestures, without any hidden information. From the study, clinicians do not follow any specific systematic method in the disclosure process, clinicians used a conversation approach involving consolation, encouragement, comic words, and pampering mostly in disclosing cancer diagnosis which was found relieving.In conclusion, People living with breast cancer prefer full gradual disclosure of diagnosis in a conducive environment in the presence of loved ones in a humane manner.

The outbreak of the COVID-19 pandemic had imposed considerable risk on public health, and had generated unprecedented levels of panic. There are increasing concerns over the possible negative impact of COVID-19 on the mental health of children/adolescents. This review was conducted to describe the impact of COVID-19 on the mental health of children and adolescents. An electronic search was conducted in PubMed, CINAHL, MEDLINE, and the WHO Global Health database on COVID-19. The 2020 updated Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline and an adapted Joanna Briggs aetiology review methodology were followed in conducting this review. A total of 21 studies from 8 different countries located on 4 continents (Asia, Europe, North America & South America), reporting on sample size of 56,368 met the inclusion criteria. Using the JBI critical appraisal tool for studies reporting on prevalence data, the quality of most of the studies was assessed to be moderate. Prevalence of depression, anxiety and stress was estimated to range from 7.2% to 78%; of anxiety, from 15% to 78%, depression, from 7.2% to 43.7% and stress, at 17.3%. Correlates for COVID −19 related mental health outcomes were identified as female gender and social isolation among others. The COVID-19 pandemic has negatively affected the mental health of children and adolescents. It is recommended that governments and health agencies prioritize mental health, especially for children and adolescents to prevent long-term effects on them.

This study aims to explore the perceptions of patients and family caregivers on the image of nurses and midwives in Ghana. The study adopted a qualitative exploratory descriptive approach. A total of 25 participants were interviewed during data collection. Content and thematic analysis were applied in the data analysis to develop themes. The findings are captured under two major themes that describe the primary influences on participant images of nurses: Thus, (1) nurses’ and midwives’ attributes with four subthemes; staff appearance, communication strategies and behaviors, work attitudes, and professional competence and (2) patients’ status and subthemes were; uneducated poor and educated rich. We conclude that patients and families in Ghana recognize the professional attributes of the nurse and midwife, which reflect in their personality, grooming, communication, competencies, and attitudes. However, low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image. A policy to perform a regular public audit on the image of the Nurse/Midwife is important for professional advancement.

Introduction The quality of life of any soldier can be affected by a simple diagnosis of Hypertension. Hypertension has not been directly linked to a single cause; however, knowing the associated risks and early diagnosis can help with its management. This study aimed to explore and describe the causes of hypertension among soldiers and its effects on their families. Objective(s) To explore and describe the causes of hypertension and its effects on soldiers and their families. Methods A qualitative technique and an exploratory descriptive design were used in this study. At saturation, a total of 10 soldiers were face-to-face interviewed and gathered data simultaneously transcribed and subjected to a content analytic method of analysis. Participants approved being audio recorded on tape with an audio recording device. Results Effects of hypertension on personal lives of soldiers, effects of hypertension on family life, and effects of hypertension on social life were identified as the causes and risk factors of hypertension among the soldiers. These themes are further expanded by their subthemes in the areas of decreased physical activity including sex life, decrease interaction with family, and isolation from friends. Conclusion This study revealed that hypertension does have effects on one's personal life, family life, and social life. Hence, it is recommended that frequent health education on hypertension and its effects should be organized in the various Garrisons by the public health department for all soldiers and their families. Screening programs should be organized for early hypertension detection. Soldiers should be educated on appropriate eating habits, weight and financial management, and reduction in tobacco and alcohol.

BackgroundDespite availability of sufficient arable land, many African countries continue to dawdle in agricultural productivity due to over-reliance on rainfall patterns. Thus, undernourishment levels are disproportionately high in Africa. Even though they play key roles in agricultural production, the food security (FS) levels of livestock dependent households are understudied. Our study assessed the FS level and its determinants in livestock farming households in Ghana.MethodsWe compared the FS levels of 287 cattle producing households in two representative agrarian districts with varying rainfall patterns in Ghana (dry vs. wet), using a cross-sectional survey. We assessed household's FS using the Food Insecurity Experience Scale. FS scores and categories were computed, and using generalized linear models, we assessed factors that explained variations in the FS levels among households.ResultsThe median herd size of households was 31 cattle (lower quartile = 24, upper quartile = 60 cattle), with a majority (91%) engaged in crop cultivation. Households reported experiencing an average of eight adverse events over a five-year recall period (2014–2018) mainly from animal diseases, cattle theft, and pasture shortages. Most households (81%) were food insecure (moderate = 40%, severe = 41%). In an adjusted model, households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 5.43, 95% CI: 1.94, 15.2] and being married (aOR = 9.48, 95% CI: 2.35, 38.3) were associated with moderate food insecurity. While households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 4.17, 95% CI: 1.44, 12.0], being married (aOR = 3.55, 95% CI: 1.03, 12.2), and increase in number of adverse events experienced (aOR = 1.53, 95% CI: 1.20, 1.96), were associated with increased odds of severe food insecurity. Household's odds of severe food insecurity decreased with each additional head of cattle in their herds (aOR = 0.97, 95% CI: 0.96, 0.99). We find no evidence of effect modification by farming district on other predictor's effect on food insecurity.ConclusionMost of the livestock dependent households are food insecure. The food insecurity levels are worse for households farming in dry areas, those married and who experience increased frequency of adverse events. Government policy interventions focusing on maintaining healthy, secure, and productive animal herds would contribute to improving the productivity of household herds, food safety and food security.

Abstract Background The World Health Organization has admonished member countries to strive towards achieving universal health coverage (UHC) through actionable health policies and strategies. Nurses and midwives have instrumental roles in achieving UHC via health policy development and implementation. However, there is a paucity of empirical data on nurses and midwives’ participation in policy development in Ghana. The current study explored nurses and midwives’ participation in policy development, reviews and reforms in Ghana. Methods A qualitative descriptive exploratory design was adopted for this study. One-on-one individual interviews were conducted after 30 participants were purposefully selected. Data was audiotaped with permission, transcribed and analyzed inductively using the content analysis procedures. Results Two main themes emerged from the data: participation in policy development and perspectives on policy reviews and reforms. The findings showed that during health policy development and reviews, nurses in Ghana were overlooked and unacknowledged. Policy reforms regarding bridging the pre-service preparation gap, staff development and motivation mechanisms and influence on admission into nursing schools were raised. Conclusion The authors concluded that nurses and midwives are crucial members of the healthcare systems and their inputs in policy development and reviews would improve health delivery in Ghana.

Objective Eclampsia remains a public health issue, especially in low-resource countries worldwide. Midwives are the backbone of the pregnancy and delivery process. Midwives trained in the necessary knowledge and skills are more likely to notice early warning signals of preeclampsia and immediately help clients in such emergencies. This study explored midwives’ experiences in managing patients with eclampsia in Ghana. Methods This study was conducted among eight registered midwives at maternity units of two district hospitals in the Eastern Region of Ghana, using an exploratory, descriptive qualitative research design. A purposive sampling technique was adopted to select and interview participants. Interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. The right of participation and withdrawal from the study was respected. Findings The three emerged overriding themes are: 1. Midwives have knowledge (warning signs, regimens, and prevention of complications) about the management of eclampsia. 2. Challenges in managing clients included inadequate equipment, staffing, and access to drugs. 3. Strategies for mitigating barriers to care for women with eclampsia (adherence to protocols, teamwork, peer mentoring and supervision, midwives’ attitude, and client education. Conclusion Midwives working in underserved facilities have the knowledge and skill to monitor and manage pregnant women experiencing eclampsia. However, they need to be supported with appropriate resources and advanced equipment to ensure adherence to protocols on managing eclampsia promptly referred. Continuous training and workshops for midwives in the management of hypertension in pregnancy are recommended and the public educated on the dangers of eclampsia.

Managing postoperative pain require good understanding of the bio-ethical principles in order to preserve patients’ rights. Bio-ethical principles in health care include autonomy, beneficence, justice and nonmaleficence. It is important that health care professionals understand that patients in pain have the right to satisfactory management. Good insight on ethical principles and how they relate to pain management places the nurse on a better pedestal to manage postoperative pain effectively. However, there is scanty literature on the level of Ghanaian nurses’ knowledge and application of bio-ethical principles in postoperative pain management. Therefore, the study objectives were to: explore nurses’ understanding of the bio-ethical principles in postoperative pain management; explore how nurses apply bioethical principles in postoperative pain management. The study employed qualitative exploratory descriptive design. Purposive sampling technique was used to recruit participants from the surgical wards. Semi-structured interview guide was designed for data collection. Data saturation was reached at the fourteenth participant. Thematic analysis method was used and themes emerged inductively. Three main themes identified through inductive content analysis of data were: beneficence, autonomy and justice. Findings showed that nurses had some appreciable level of knowledge of the fundamental principles related to ethics and applied them in postoperative pain management. Nurses knew their duties in advocating for patients. Patients rights to refuse treatment was also appreciated by some nurses. Nurses also demonstrated humanity by helping patients financially to settle hospital debts which explicitly shows the empathetic characteristics of nurses. The study concluded that nurses are knowledgeable in bioethical principles underpinning post operative pain management and also applied these principles when caring for surgical patients.

Background Hospital beds are of great assistance to both clients and caregivers as they give lots of choices to the users. More often, clients have difficulty getting in and out of beds, but the adjustable features of the beds make it possible for them to be comfortable, regardless of their condition. This situation may not be the same if nonadjustable delivery beds (NADBs) are used in conducting deliveries at health care facilities. This study explored the experiences of midwives using NADBs in selected Christian Health Association of Ghana (CHAG) hospitals in the Volta Region of Ghana. Methods The study employed an exploratory qualitative research design with purposive sampling. Semistructured interview data were audio recorded. The inclusion criteria were professional midwives with at least 1 year of working skills and the midwives should have conducted deliveries using NADBs during their practice. Data were collected concurrently with data transcription and analyzed using content analysis. Saturation was reached after the 20th interview. Results Three themes emerged from the study: NADBs not comfortable to work with, assumption of awkward postures, and the nature of the delivery beds. Conclusion The findings of the study show that midwives experience several setbacks in the use of NADBs in conducting deliveries as they sacrifice their health for work.

Adherence to antiretroviral therapy (ART) is essential to achieving an improved cluster of differentiation-4 (CD4) count, viral load, and quality of life while preventing drug resistance. Medication adherence among people living with Human Immunodeficiency Virus (HIV) is influenced by different factors. Several studies have identified adherence promoters and inhibitors that emanate from the internal and external environment. We conducted six (6) individual in-depth interviews and three (3) focus group discussions to explore adherence behaviour among patients diagnosed with HIV in a teaching hospital in Accra, Ghana. Participants were drawn from the intervention arm of a mobile phone adherence intervention program. They had been enrolled in the study for at least six (6) months before the interviews are conducted. Results revealed that participants adhered to treatment irrespective of prompts from significant others. Adherence promoters included perception of ART as part of daily routines, benefits of the ART, awareness of regimen, access to food, and transparency. Adherence inhibitors were forgetfulness, secrecy, waiting time, religious beliefs, and sleep. People living with HIV (PLWHIV) have the personal motivation to take medication; however, negative perceptions about HIV must be addressed to ensure optimum adherence behaviour.

Background: Graduating student nurses as the future workforce are expected to possess the requisite skill-competence to care for TB/HIV coinfected patients. However, few studies have investigated the self-assessed TB/HIV coinfection care skill-competence of graduating student nurses and its determinants in Accra, Ghana. Purpose: This study investigated final year student nurses’ self-assessed TB/HIV coinfection care skill-competence and its determinants. Methods: This was a descriptive cross-sectional survey among Bachelor of Science in nursing (n = 112) and Diploma in nursing (n = 236) students in their final year of training in four (4) nursing training institutions using convenience sampling technique. Descriptive, independent t and Kruskal Wallis mean rank statistical tests were conducted to identify determinants. Results: TB/HIV coinfection care skill-competencies were low. Determinants of TB/HIV coinfection care skill-competence were age (r = 0.110, p = .048), duration of managing patients (r = 0.219, p = .005) and ownership of nursing training institution (p = .005). Other factors included student nurses’ previous experience working in a TB health facility (p

Postoperative pain remains a challenge in many healthcare settings. It is unethical if pain is not managed adequately. However, there is inadequate literature on nurses’ ethical decision making on pain management. Thus, this study aimed at exploring the factors influencing ethical decision making for postoperative pain management among nurses in Ghana. Qualitative exploratory descriptive design was used and participants were purposively sampled from the surgical wards of the study hospital. Semi-structured interview guide was used for data collection and saturation was reached at the 14th participant. Thematic analysis was done and three themes emerged: Institutional factors influencing ethical decision making, leadership roles in nurses’ ethical decision making, and inter-professional relationships influencing ethical decision making. Lack of protocols on pain management, no disciplinary and ethics committees, and unavailability of analgesics were perceived to negatively influence ethical decision-making for postoperative pain management. Nurses stated that establishing ethics committee would address ethical issues on pain management. Constructive feedback from clinical unit leaders was also perceived to influence decision making for postoperative pain management positively. The study concluded that, there is need for the nurse to place emphasis on ethically sound decisions when managing postoperative pain since it is a fundamental human right for patients to have their pain managed properly.