Nigerian General Hospital Research Articles

Assessment of record keeping management in a Nigerian general hospital

Background of the study: In the context of healthcare, record keeping management specifically involves the management of patient health records, administrative documents, and other pertinent information related to healthcare delivery Purpose: This study examines the record keeping management at General Hospital, Ikot Abasi, Akwa State of Nigeria. Four (4) specific objectives guided the conduct of the study. Methods: The survey descriptive design with a qualitative approach was used. Interview was used as the method of data collection. The study included a total of 11 participants, consisting of 2 medical doctors, 5 nurses, and 4 record administrators from the General Hospital, Ikot Abasi. Thematic analysis was employed to analyze the data collected from the interviews. Findings: The study revealed a varying level of understanding among respondents regarding current record-keeping practices, with concerns raised about the accuracy and completeness of documentation. However, the study identified various challenges faced by healthcare professionals and administrators, including inconsistency in documentation practices, inadequate storage facilities, limited access to technology and resources, and compliance issues. Conclusion: The study concluded that the assessment of existing record keeping infrastructure and technology showed a positive impact, particularly with the implementation of EHR systems leading to streamlined processes and reduced reliance on paper-based documentation. The study recommends that health and other related organisations should implement standardized documentation protocols and provide regular training sessions for healthcare professionals to ensure consistency, accuracy, and completeness in record keeping.

Burnout among Nurses in a Nigerian General Hospital: Prevalence and Associated Factors.

Objective. To evaluate the prevalence and associated factors of burnout among nurses in a Nigerian general hospital. Methods. A total sampling method was utilized. Measurements. Burnout was evaluated using the Maslach Burnout Inventory; GHQ-12 was used to determine the presence of psychiatric morbidity. Results. A high level of burnout was identified in 39.1% of the respondents in the area of emotional exhaustion (EE), 29.2% in the area of depersonalization and 40.0% in the area of reduced personal accomplishment. Multivariate analysis showed that doctor/nurse conflict (OR = 3.1, 95% CI: 1.9−6.3), inadequate nursing personnel (OR = 2.6, 95% CI: 1.5–5.1), and too frequent night duties (OR = 3.1, 95% CI: 1.7–5.6) were predictors of burnout in the area of EE, doctor/nurse conflict (OR = 3.4, 95% CI: 2.2–7.6) and too frequent night duties (OR = 2.4, 95% CI 1.5–4.8) in the area of D, high nursing hierarchy (OR = 2.7, 95% CI: 1.5–4.8), poor wages (OR = 2.9, 95% CI: 1.6–5,6), and too frequent night duties (OR = 2.3, 95% CI: 2.3–4.5) in the area of RPA. Conclusions. Prevalence of burnout among these nurses was high. The government therefore needs to look into factors that will enhance nurses' recruitment and retention for effective health care delivery system.

Specific psychiatric morbidity among diabetics at a Nigerian General Hospital.

In Nigeria, with a rising incidence of diabetes mellitus (DM), there are no controlled studies of specific psychiatric morbidity among sufferers. To assess the prevalence of specific psychiatric disorders and general cognitive impairment in patients with diabetes mellitus. Using Wing's Present State Examination and the Mini-Mental State Examination, we assessed the prevalence of specific psychiatric disorders and cognitive impairment among 100 DM patients attending an out-patient clinic, in comparison with a matched non-clinic sample; and examined the relationship between psychiatric morbidity and clinical variables. They were predominantly males (66%), mean age 43.0 years, mean duration of illness, 7.7 years and in low level occupations. Only 11 of the patients had sexual dysfunction (11%) and psychiatric symptoms (31%). Psychiatric diagnosis (ICD-10) were, generalised anxiety (6%) and mild depressive disorder (4%). Two had subjective memory disturbance. Insulin-dependent patients had significantly more widespread psychiatric symptoms than the non-insulin dependent. Psychiatric symptomatology was significantly associated with low occupational status, duration of illness and sexual dysfunction. Health education, subsidizing the cost of treatment, and physicians' sensitivity to the emotional condition of patients, will help to relieve psychic distress and make for more adequate management.

Obstetric mortality in a Nigerian general hospital

The aim of the study was to evaluate the progress towards achieving a 50% reduction in maternal mortality by the year 2000 at a referral hospital. A retrospective review of births and maternal deaths over an 18-year period from 1981 to 1998. There was a 30% reduction among booked women in the period 1990-1998 compared to 1981-1989 while only 8% reduction was achieved among referred women. Infection and hypertensive disorders remained the leading causes of death but the contribution of haemorrhage declined due to improved blood transfusion services. Further improvement in maternal survival can be achieved by training health personnel involved in maternity care to recognise or anticipate complications early and refer.

The Quality of Interactions between Staff and Psychiatric Inpatients in a Nigerian General Hospital

We examined the quality of the staff’s interactions with patients, and its relationship with ward structure, patients’ satisfaction and outcome. The Quality of Interactions Schedule was used to observe interactions with patients in two acute admission wards. In 40 h, 101 interactions were observed; 60.4% were of negative quality, 35.6% were positive and 3.9% were neutral. The majority (42.6%) were of the negative restrictive type, with the patients’ freedom being curtailed without explanation. Significantly more interactions occurred at the proximal sections of the wards, where most ward activities took place. There were no significant gender and interward differences. Interactions were not associated with clinical outcome. The patients were significantly not satisfied with the items that related to the curtailment of their freedom. They are sensitive to the quality of staff interactions while appreciating staff contribution to their care. Training programs should include staff attitudes for the improvement of the overall quality of care.

Specific psychiatric morbidity in liver cirrhosis in a Nigerian general hospital setting

The purpose of this investigation was to explore the psychiatric complications of liver cirrhosis in a Nigerian general hospital setting. The mental state of 31 consecutive patients with liver cirrhosis seen in a gastroenterology unit, from July 1996 to August 1998, was assessed using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE) and compared with those of 20 hypertensive patients and 20 apparently healthy controls. The socio-demographic characteristics of patients with liver cirrhosis who developed psychiatric complications were compared with those without such complications. The mental status of the cirrhosis patients in the present study was also compared with those of Chronic Obstructive Pulmonary Disease (COPD) and hemodialysis patients in earlier studies. About fifty-five percent of all the liver cirrhosis patients developed diagnosable psychiatric morbidity. This was significantly higher than that of the hypertensive patients (15%) or healthy controls (5%) ( P=0.0001). The psychiatric conditions were depressive episode, generalized anxiety disorder, delirium and adjustment disorder. No socio-demographic parameter had a significant effect on the mental state of the patients with liver cirrhosis. The same proportion (55%) of hemodialysis and a lower proportion (30%) of COPD patients compared with cirrhosis patients had psychiatric morbidity. We found a high rate of psychiatric morbidity in the patients with liver cirrhosis compared with those of hypertension and normal subjects. None of the socio-demographic variables considered was found to be associated with psychiatric complications in the liver cirrhosis patients. Poor medical conditions seem to be associated with high levels of psychiatric morbidity.

Patient and staff satisfaction with the quality of in-patient psychiatric care in a Nigerian general hospital.

Patient satisfaction has been proposed as a simple measure of the quality of care. The present study aimed to assess how satisfied the patients and staff in an acute admission psychiatric unit were with experiences in the ward, including the physical environment, freedom, comfort, attitudes of staff towards patients, access to staff, and duration of hospitalization. A descriptive study of all patients admitted for functional psychiatric disorders in a 5-month period was conducted. Patients and staff completed similar 16-item self-rated Likert-type questionnaires. Satisfaction was graded as follows: dissatisfaction < 50 % positive appreciation), bare satisfaction (50-65 %), moderate (66-74 %), and highest satisfaction (> or = 75 %). The 118 patients were dissatisfied with items that indicated curtailment of their freedom, while the 35 staff were dissatisfied with the physical facilities for care. Highest satisfaction for patients and staff were for items on staff-patient relationship. Barely satisfactory items for patients included the time spent with doctors. Patients had a higher positive appraisal of the adequacy of physical facilities than staff, while staff had a more positive appraisal of their relationship with patients. There were no significant differences in satisfaction among diagnostic groups. The logical and discriminating manner in which patients assessed satisfaction supports the impression that they can be relied upon to make objective appraisal of the process of care, and that patient satisfaction is a valid index of the quality of care.

Correlates of psychiatric morbidity in typhoid fever in a Nigerian general hospital setting

This study explored factors associated with psychiatric morbidity in typhoid fever in a Nigerian general hospital. Information such as sociodemographic characteristics, symptom manifestations, results of investigations, neuropsychiatric symptoms, outcome and disposal were obtained from the case files of patients admitted for typhoid fever over a period of six years. The patients with psychiatric morbidity conspicuous enough to be documented by the attending physicians—mostly internists—were compared with those with no documented psychiatric morbidity on sociodemographic and clinical indices. Of the 136 cases, 26 (19.1%) had psychiatric morbidity. This included delirium (73.1%), generalized anxiety disorder (3.8%), depressive episode (3.8%), schizophrenia like disorder (3.8%) and monosymptomatic neuropychiatric manifestations such as apathy, hallucinations and irrelevant talking (15.5%). The clinical and sociodemographic indices that were significantly associated with psychiatric morbidity were diarrhea, blood biochemical imbalance and age ( P<.05). Adolescents and young adults were more predisposed to developing psychiatric complications. Some factors potentially associated with psychiatric morbidity in typhoid fever have been identified. There is the need to prospectively assess the burden from psychiatric morbidity and identify interventions that may reduce it.

Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital

Objective: The goal of this study was to explore specific psychiatric morbidity among chronic obstructive pulmonary disease (COPD) patients in Nigeria. Method: The mental status of 30 COPD patients was compared with those of 30 uncomplicated hypertensive patients and 30 apparently healthy controls using the 30-item General Health Questionnaire (GHQ-30) and Present State Examination (PSE). The sociodemographic characteristics of the three groups were also compared. Results: The COPD population was significantly least educated and predominantly subsistent farmers. Thirty percent of the COPD population, 13.3% of the hypertensive patients and 3.3% of apparently healthy controls had psychiatric morbidity ( P<.05). The COPD population, with psychiatric diagnoses consisted of 16.7% depressive episode, 10% generalized anxiety disorder and 3.3% delirium. This pattern is similar to data from industrialized countries. No sociodemographic factors were significantly associated with psychiatric morbidity. Conclusion: Improving the psychiatric knowledge of the primary physician will result in better management of the COPD patient.

Physical morbidity in a psychiatric population in Nigeria

The rate of physical morbidity amongst 191 psychiatric in-patients in a Nigerian general hospital was found to be 27.2%. Older psychiatric patients were observed to be significantly more likely to suffer from physical morbidity. Infective processes constituted 57.7% of the physical health problems identified in the study population. Organ systems most frequently involved were the central nervous system (mainly as acute organic brain syndrome from septicaemia) (28.9%), cardiovascular/haematological (19.2%), and gastrointestinal (17.3%). Over 70% of physical disorders remained undiagnosed by the referring sources. It is emphasized that adequate attention should be paid to the physical status of psychiatric patients (both new and old cases) at all levels of health care. Collaborative work between medicine and psychiatry should also be encouraged in developing countries, and this should extend beyond clinical services and training (undergraduate and postgraduate) into the areas of evaluative research.

Psychiatric morbidity in medical and surgical wards of a Nigerian general hospital

Psychological disorders among 275 medical and surgical in-patients was assessed by a two-stage screening procedure, using the GHQ-30 and the PSE. The prevalence of psychiatric disorders was 30.2% with an additional 9.8% reporting distressing psychiatric symptoms. The morbidity rates among medical (30.6%) and surgical (29.6%) patients were comparable. Older patients and females were found to be more likely to suffer from psychiatric disorders. It is suggested that the paramedical personnel in general hospital wards of developing countries could be taught psychosocial intervention techniques necessary in the management of emotional complications of physical disorders.

Management of civilian gunshot wounds in a Nigerian general hospital.

In a 3-year period (1981-1984), 52 male patients aged 10-60 years were treated for fresh gunshot wounds. The injuries varied from minor soft tissue injuries to major organ and tissue damage, and were all sustained by low-velocity missiles. Six of the patients (11.5%) died of their injuries or complications while 46 (88.46%) survived and were discharged after 1-15 weeks (a mean hospital time of 3 weeks). Some of the patients were treated before referral and for some there was a delay of more than 48 h before definitive specialist treatment. Mortality was related to the severity of wounding and the delay before treatment.