Nurses knowledge, Challenges and Solutions on the care of premature infants: a mixed method study in the referral and tertiary hospitals in Dar es salaam

Abstract

Background: There has been an increase in preterm births of about 2% in the past 14 years (2000-2014) mainly from Asia and Sub-Saharan Africa. With prematurity on the rise so will the complications related to it both short term and long term. Nursing care is very crucial in these vulnerable babies and a lack of knowledge of health care providers is a contributing factor to morbidity and mortality. With the increase of preterm births, nurses’ knowledge adequacy, challenges and solutions on their care needs to be affirmed. Objective: Main aim of the study was to assess the nurses’ knowledge in the care of premature infants, to determine their challenges and solutions in acquiring the knowledge. Material and Methodology: A mixed method study was conducted between September 2020 to January 2021 in the neonatal units of four hospitals in Dar es Salaam. A cross sectional study was conducted to determine adequacy of nurses’ knowledge on selected domains for the care of premature infants and a phenomenological study design using focus group discussions explored on the perceived challenges and solutions in acquiring the on job training. Self-administered structured questionnaire was used and adequacy of knowledge was set at 50% or more for the three main domains 1) Essential newborn Care 2) Infection prevention and management 3) Special care and monitoring for the preterm infants. Focus group discussion were conducted using a structured interview guide focusing on challenges and solutions towards achieving knowledge on the care of preterm infants. Quantitative data were analyzed using SPSS Version 23 and qualitative data were thematically categorized using pre identified codes. Common emerging themes towards the challenges and solutions were identified in relation to the three main domains. Results: Among the 52 Neonatal Intensive Care Unit (NICU) nurses who participated in this study, 9 (17%) were from Amana regional referral hospital (RRH), 8 (15%) from Mwananyamala RRH 10 (19%) from Temeke RHH, and25 (48.1%) from Muhimbili National Hospital (MNH), Upanga. At the time of the study, almost 55.8%of the nurses had never received any on job training on care of premature infants. Adequate knowledge among thestudied nurses was found to be 94% in essential newborn care, 80.8% in infection prevention and management and 36.5% on special care and monitoring of preterm infants. Being a female nurse, being older than 41 years old and working in the neonatal unit for at least 1-3 years were more likely to determine adequacy of knowledge in infection prevention and management although not statistically significant. The main challenges in acquiring knowledge were lack of scheduled on job training for both knowledge updates and operation of equipment and work overload for nurses in the unit. Hospital and Government commitment was recommended to ensure frequent continuous medical education (CME) for all nurses and encourage mentorship within and between hospitals. Increasing number of nurses would facilitate participation in training. Conclusion: Most nurses had not attended training on the care of premature infant, and compared to other domains, special care and monitoring was poorly performed. Nurses that were female, those who were older than 41 years and those who worked for one to three years were more likely to have adequate knowledge on infection prevention and management. One of the major challenges faced by the nurses is not being able to attend training due to limited staffing and lack of scheduled on job training covering all staff. Recommendations: Continuous medical education should be emphasized specifically on special care and monitoring of premature infants. Nurses older than 41 years,Female Nurses and those with one to three years of experience should be considered when planning for mentorship program within and between hospitals. Observational studies with a larger sample size should be conducted to assess both nurse’s knowledge and skills concurrently on the care of preterm infant