https://kjnm.co.ke/index.php/kjnm/issue/feedKenyan Journal of Nursing & Midwifery2024-03-03T20:49:57+00:00Amos Getanda & Benson Milimobenmilimo@gmail.comOpen Journal Systemshttps://kjnm.co.ke/index.php/kjnm/article/view/248DETERMINANTS OF ABCDE BUNDLE IMPLEMENTATION BY HEALTHCARE PROVIDERS AT COAST GENERAL TEACHING AND REFERRAL HOSPITAL CRITICAL CARE UNIT, MOMBASA COUNTY KENYA.2024-03-03T20:45:47+00:00Thomas Mwalimu Kahindit.kahindi@yahoo.comGrace Githemogithemo@yahoo.comNickcy Mbuthiambuthia.nickcy@ku.ac.ke<p><strong> </strong></p><p><strong>Background. </strong>The Awakening, Breathing, Choice of analgesic and sedation, Delirium management and prevention and early Exercise/mobility (ABCDE) is evidenced based protocol associated with improved outcome of the critically ill patients. Fully implementation of this protocol optimizes the outcome of the mechanically ventilated patients.</p><p><strong>Objective. </strong>The study explored the determinants of ABCDE bundle implementation by healthcare providers Coast general teaching and referral hospital critical care unit.</p><p><strong>Methods. </strong>The study used descriptive design to explore the determinants that influence the ABCDE bundle implementation. Data collection was done through structured questionnaires in form of Likert scale. Study participants were selected using census sampling method. A total of (N=60) participants were involved in the study. Data was analysed using statistical package of social sciences (SPSS) version 25.</p><p><strong>Results. </strong>A total of 60 questionnaires were collected from the participants. The results showed that female were the majority of the participants with 68.3% (n=41). Majority of the participants were between 30-39 age group with 38.3% (n=23). The results further revealed that nursing profession contributed the majority of the participants with 75% (n=45). The results also showed that most of the participants had diploma as their level of education with 65% (n=39). Furthermore, the results revealed that majority of the participants had experience of 1-2 years. Additionally, the results revealed that implementation of the bundle varied with 71.7% (n=43) implementing SAT, 66.7% (n=40) SBT, 63.3% (n=38) pain, 75% (n=45) sedation, 75% (n=45) delirium and 76% (n=46) early exercise/mobility. Bivariate analysis of healthcare providers’ factors showed that both knowledge and experience has relationship with ABCDE bundle implementation. Similarly bivariate analysis of the healthcare system factors revealed that workload, staffing, protocol availability and training are both significantly related to the implementation of the bundle. Multivariate analysis using logistic regression revealed that knowledge predicts bundle implementation with p=0.009, experience with p=0.049, workload with p=0.021, protocol with p=0.029, training with p=0.035 and staffing with p=0.007.</p><p><strong>Conclusion. </strong>ABCDE bundle implementation is influenced by both healthcare provider factors and healthcare system factors as revealed by this study.</p><p><strong>Key words:</strong> Sedation, mechanically ventilation, spontaneous breathing trial, delirium.<strong></strong></p>2024-03-03T20:45:47+00:00Copyright (c) 2024 Thomas Mwalimu Kahindihttps://kjnm.co.ke/index.php/kjnm/article/view/246A MODEL TO PROMOTE UTILIZATION OF SKILLED HEALTH PROVIDERS AMONG WOMEN OF REPRODUCTIVE AGE IN KANDARA SUB-COUNTY, MURANG’A COUNTY - KENYA2024-03-03T20:49:57+00:00Daniel Muya Gachathidestiny.gachathi@gmail.comDrusilla Makworodmakworo@jkuat.ac.keCatherine Mwendamutungacs@gmail.com<p><strong>Background:</strong> Lack of utilization of skilled delivery services by pregnant women contributes to increased number of maternal and neo-natal morbidities and mortalities. In Kenya, skilled deliveries stand at 62% while unskilled deliveries stand at 38%.The maternal mortality ratio in Kenya is at 462 per thousand live births. In the study area, skilled deliveries stand at 65% while home deliveries are at 35%. The main aim of this study was to develop a model of care to improve utilization of skilled birth attendance in the study area.</p><p align="left"><strong>Methods:</strong> A qualitative research design was employed to gather information. Sample size: Women of Reproductive age n= 48, Community Health Volunteers (n=48), Community Extension Workers (n=10) and 7 health administrators. Data Management: Data was thematically arranged and analyzed using NVIVO software version 13.</p><p align="left"><strong>Results</strong>: The study identified key strategies, including client education, family and community involvement, and alignment with government policies, to enhance skilled delivery utilization. These findings contributed to strategies that yielded in development of a model of care for promoting skilled birth attendance and improving maternal-child health in the study area and beyond.</p><p><strong>Conclusion</strong>: Through a baseline study, the research team identified key client experiences and strategies, leading to the formulation of a model. Evaluation of the model, utilizing criteria from Parady et al. (2021), involved respondent ratings on a Likert scale. A mean score of 4 or higher was deemed acceptable for model adoption, while elements below 3 were eliminated and those at 3 were modified based on expert recommendations. The threshold for agreement, set at a mean score of 4, ensured reliability in consensus decision-making (Bascom et al, 2018 ). The validated model is now ready for testing and subsequent implementation.</p><p align="left"> <strong>Recommendation</strong>: Government policies to adopt the model's strategies and advocates for a more extensive study, possibly an RCT or meta-analysis, for a thorough understanding. Regular evaluations and critiques of the developed model, along with exploration of diverse models in future studies, are vital for evidence-based decision-making by policymakers, ensuring ongoing improvement in care quality</p>2024-03-03T20:45:47+00:00Copyright (c) 2024 daniel muya gachathi, Drusilla Makworo, Catherine Mwenda