Western Jamaica Research Articles

The effect of health literacy level on health outcomes in patients with diabetes at a type v health centre in Western Jamaica

ObjectiveTo identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica. MethodA correlational survey design with a random sampling technique was used. An 18-item questionnaire and the Newest Vital Sign tool were administered to 88 consenting adults with diabetes to assess their health literacy levels. Their health outcomes were evaluated with docket review. Data were analyzed using SPSS version 18. ResultsThe participants were predominantly female (77.3%), aged 51–70 years, married (44%), employed (46%), and diagnosed with diabetes > 10 years (42%). Only 13.6% of the study population was adequately health literate. The health literacy scores for gender were not significant (P = 0.84). The health literacy scores of the patients with different ages and educational levels were significant (P < 0.001). Pearson's correlations revealed no linear relationship between health literacy scores and health outcome (r = 0.185, P = 0.084). ConclusionLimited health literacy and high likelihood of limited health literacy are predominant in the study population. Age and educational level are significantly associated with health literacy levels. However, these findings suggest no association between health literacy level and diabetic health outcomes.

Anemia in pregnancy in Western Jamaica.

BackgroundAnemia is one of the most prevalent problems in pregnancy. In 2011, 29.9% of all pregnant women in Jamaica were diagnosed with anemia.ObjectiveThe objective of this study was to determine the prevalence and predictors of anemia in pregnancy in Western Jamaica.MethodsA cross-sectional study was conducted among 293 mothers attending post-natal clinics in Western Jamaica. A questionnaire was administered to the mothers, and an abstraction form was used to collect clinical data from the mothers’ records.ResultsThe prevalence of anemia among the women was 37.6%. Younger mothers (aged 18–24 years) were more likely to be anemic compared to those ≥35 years (odds ratio [OR]: 3.44, 95% CI: 1.07–11.06). Mothers who reported not always washing their hands after using the toilet were almost 10 times more likely to be anemic (OR: 9.7, 95% CI: 1.72–54.78) compared to those who reported always washing their hands. Mothers who attended a public facility for antenatal care were 2.3 times more likely to be anemic (OR: 2.31, 95% CI: 1.03–5.18) compared to those who obtained care at a private facility, and mothers who reported being told that they were anemic by a health care provider (HCP) were almost six times more likely to be anemic compared with those who were not told (OR: 5.58, 95% CI: 1.73–17.93).ConclusionThe results of the study indicate that early identification and treatment of anemia, especially among younger pregnant women, should be a priority. HCP should ensure that women understand the need to be cured of their anemia and to adhere to preventive hygienic practices.

Piloting a pediatric trauma course in Western Jamaica: Lessons learned and future directions

IntroductionPediatric injuries are a leading cause of death in low- and middle-income countries (LMICs). Despite this, there are few formal pediatric-specific trauma educational initiatives available in LMICs. While new educational tools are being developed to address this, they have not been piloted in LMICs. In Jamaica, pediatric injuries are a leading cause of hospital admission but care is limited by a lack of training in triage and stabilization. Our objective was to implement and evaluate a pediatric trauma course in Jamaica to determine the impact this may have on further course development. Materials and methodsA pediatric trauma course was conducted at the Cornwall Regional Hospital in Montego Bay, Jamaica sponsored by the Children's Medical Services International, a nonprofit organization. Participants took part in six didactic modules, an infant airway intubation skills session, and three clinical simulation scenarios. Participants completed a postcourse survey at the conclusion of the course. ResultsTwenty-five participants including surgical, pediatric, and emergency medicine residents from regional- and district-level hospitals in Jamaica participated in the course. Participants viewed the course favorably. Strengths included good review of pediatric trauma physiology, short modules, hands-on practice, and applicable clinical scenarios. Using a Likert-type rating scale of 1 to 10, with 1 being minimal and 10 being very knowledgeable, precourse knowledge was ranked as 5.9, which increased to 9.2 after the course. Using a similar scale, the precourse comfort level to run a pediatric trauma was 4.9 and increased to 8.5 following the course. DiscussionImplementation of this pilot pediatric trauma course was feasible and successful through collaboration with the hosting regional hospital. The lack of formal pediatric training can be overcome by a course such as this which includes both didactics and hands-on clinical patient simulations. Level of Evidence4.

Epidemiology of Chikungunya fever outbreak in Western Jamaica during July-December 2014.

ObjectiveOur study describes the 2014 Chikungunya outbreak in Western Jamaica in terms of geographic distribution and trend of the outbreak over time, and evaluates clinical symptoms of the disease based on pre-existing conditions.MethodsWe conducted a retrospective, cross-sectional study of 609 clinically defined Chikungunya virus (CHIKV) fever cases that occurred in the four parishes of the Western Regional Health Authority of Jamaica from July 2014 to December 2014. Cases were not confirmed by laboratory tests but met clinical and epidemiological criteria of CHIKV fever.ResultsOur results show a propagated spread of CHIKV fever during the outbreak period with the peak at the end of October. Main urban cities, such as Montego Bay and Lucea, were identified as places that had high numbers of cases. Fever and arthralgia were the two most common clinical symptoms in CHIKV patients. Although a majority (80%) of infants aged <2 years had up to four symptoms (80%), the percentage of infants with higher numbers of symptoms (9–10) was higher than in older age groups. However, back pain was found to occur significantly more in older patients. Those with arthritis as a pre-existing condition were more likely to experience headache, asthenia, back pain, and periarticular edema.ConclusionThese findings can help public health officials develop more effective programs to prevent the spread of CHIKV outbreaks by focusing on crowded urban cities. The findings indicate that those who are likely to develop a higher number of symptoms, such as young infants and people with pre-existing conditions, such as arthritis, should be more closely monitored to better manage the disease outcome.

A Cross-Sectional Study of Antenatal Care Attendance among Pregnant Women in Western Jamaica.

Background:Pregnancy complications are preventable with appropriate antenatal care (ANC). However, ANC attendance recommendations vary.Objective:This study investigated ANC practices and predictors of ANC visits among pregnant women in western Jamaica during 2010.Methods:A cross-sectional study was conducted among 356 pregnant women. ANC visits were categorized as not meeting recommendations (<4 ANC visits), meeting WHO and the Jamaican Ministry of Health recommendations of a minimum of 4 ANC visits (4–6 ANC visits) or meeting previously standard recommendation of ≥7 visits. Differences in demographic factors, health status, ANC services received and ANC knowledge by ANC attendance were assessed and a multinomial forward-selection stepwise logistic regression model was used to identify predictors of ANC attendance.Results:Most women had an adequate number of ANC visits with 53.4% attending ≥ 7 ANC visits and 27.2% attending 4–6 visits. Despite this, 19.4% of the women had inadequate ANC care and a large portion did not receive key ANC services such as folic acid supplementation (48%), information on breastfeeding (32%) and nutrition (13%). Employment status, number of live births, distance from clinic, history of diabetes or hypertension, possession of ANC card at delivery, receiving iron supplementation and HIV counseling and testing and antenatal care knowledge were predictors of ANC visits.Conclusion:Although most women met the WHO or Jamaican ANC recommendations, many women still did not receive key ANC services. Further investigation of ANC practices and a standardized ANC curriculum may improve provision of adequate ANC services.

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A new species of Hohenbergia (Bromeliaceae) endemic to the Dolphin Head Mountains in western Jamaica

Recent botanical expeditions to the Dolphin Head Mountains in western Jamaica allowed the collection of different specimens of a new species, Hohenbergia rohan-estyi, an enigmatic plant that resembles the also Jamaican-endemic H. negrilensis. In this study, we describe H. rohan-estyi and include notes on its geographical distribution, habitat, conservation status and taxonomy. The length of the stipes and number of flowers per spike permit the differentiation of H. rohan-estyi from H. negrilensis. In addition, the geographic distributions of these two species do not overlap, as H. rohan-estyi inhabits mountainous forests of the Dolphin Head region while H. negrilensis occurs in coastal areas of western Jamaica. Finally, H. rohan-estyi is the third species of Hohenbergia reported as endemic to the Dolphin Head Mountains, indicating the importance of this area in the evolution and conservation of the genus in Jamaica and the Caribbean.

Reply to the comment of Mitchell et al. on “Geomorpho-tectonic evolution of the Jamaican restraining bend” by L. Domínguez-González, L. Andreani, K.P. Stanek and R. Gloaguen [Geomorphology, 228 (2015) 320–334

We reply to the comments of Mitchell et al. on our paper entitled “Geomorpho-tectonic evolution of the Jamaican restraining bend”. The comments contain statements about the methods that need to be balanced. We agree that the interpretation of the modeled drainage network in some karstified parts of the Jamaican island is difficult, but this does not affect the validity of our analysis elsewhere. We consider that our geomorphic analyses (which also include topographic profiles and morphometric maps) are still valid. The view expressed by Mitchell et al. that we used serially developed landscapes to ‘date’ progressive uplift is an oversimplification of our discussion. We highlighted the differences between the geomorpho-tectonic provinces of Jamaica, and we proposed to explain these differences by a model which involves (1) a westward propagation of the restraining bend and (2) a difference in tectonic styles between the different provinces of Jamaica. Our interpretation does not contradict existing models based on seismotectonic data, provenance analysis or on the origin of Jamaican bauxite. There is a disagreement between James-Williamson et al. (2014), which suggested that central Jamaica was already being uplifted by the end of the Late Miocene, and Domínguez-González et al. (2015), which proposed a Pliocene to present onset of the NE-trending compression toward the SW. However, the timing of the deformation in central and western Jamaica is still poorly constrained and, at this time, any interpretation of the uplift history of central Jamaica should be considered as hypothetical.

Lived experiences of Jamaican hospital patients with delayed wound healing

Introduction: Many individuals suffer from chronic or complex wounds that can be very difficult to heal and cause severe pain and hardship. In the absence of any evidence based local information on the topic, this study explored the lived experiences of Jamaican hospital patients with delayed wound healing using physiological, psychological, socio-cultural, developmental and spiritual perspectives. Methods: A qualitative descriptive study design with a purposive sampling method was used to select five patients, two males and three females (aged 33 years old to 56 years old) from a regional hospital in western Jamaica, who were recruited into the study. They each had a single chronic ulcer on an extremity. Following ethical approval and informed consent, individual interviews were conducted and thematic analyses were done on the data. Results: Diabetes mellitus and infection were the etiologic factors in their delayed wound healing. All of the participants experienced social isolation, low self-esteem, “frustration”, job loss/loss of man hours, financial dependence and impaired physical mobility. They desired improved communication with healthcare personnel, more supportive and caring attitudes from family and caregivers; as well as enhanced learning experiences to acquire the self-care skills needed for all aspects of diabetes control and wound care. Conclusions: The patients’ lived experiences and stated needs should be noted by all caring health professionals. Future interventions and care plans should address all the perspectives experienced and described by these patients.

The Epidemiology of Prostate Cancer in Western Jamaica: Risk Factors, Knowledge, Attitudes and Practices.

To investigate the epidemiology of prostate cancer (PCa) in western Jamaica and describe the health-seeking behaviour of at-risk men. This study contained both quantitative and qualitative components. The quantitative portion consisted of a retrospective, matched case-control study of two hundred and four men attending outpatient clinics who completed an interviewer-administered questionnaire. The qualitative component consisted of two focus group discussions designed to further investigate health-seeking behaviour and preferred educational channels regarding PCa. Four risk factors were identified: family history of PCa (OR 3.39, 95% CI 1.73, 6.66), age (OR 1.97, 95% CI 1.41, 2.74), any sexually transmitted disease (STD) history (OR 2.02, 95% CI 1.07, 3.83) and alcohol consumption (OR 1.86, 95% CI 1.00, 3.47). Knowledge of primary risk factors was low, especially for race (37%). Although 81% of controls knew tests were available, a stigma was associated with testing. The screening rate was higher than previously reported but still low (56% of controls), and PCa in the western region is discovered by symptoms 61% of the time. Focus group participants blamed a "male mentality" that is antagonistic to routine medical care and preventive testing. Family history, age, STDs and alcohol consumption were identified as risk factors for PCa in western Jamaica. Sexually transmitted disease history and alcohol consumption are interesting results that merit further investigation. Prostate cancer continues to be diagnosed primarily by symptoms, indicating that routine testing is not widespread enough to catch the disease in its early stages when treatment is most effective. A negative image of prostate screenings persists, and targeted educational interventions are needed to improve outcomes.

Prostate Cancer Knowledge, Attitudes and Screening Practices among Men in Western Jamaica.

African-Caribbean men, particularly Jamaican men, have one of the highest incidences of prostate cancer in the world. This cross-sectional study was conducted to investigate knowledge, attitudes, practices and factors associated with prostate cancer screening among men in western Jamaica. A questionnaire was administered to men 40-93 years old during May to August 2007. The outcome variable of interest was previous prostate cancer screening. Approximately 35% of men were previously screened for prostate cancer. Men > 70 years were 93% less likely to be screened compared to men 40-49 years (95% CI: 0.01, 0.56). Men living in the parish of Trelawny were 10.5 times more likely not to be screened compared to men in St James (95% CI: 2.33, 47.17) and manual labourers were 5.5 times less likely to have been screened than non-manual labourers (95% CI: 0.97, 31.68). Men who had not been advised to have prostate cancer screening were 92% less likely to be screened than those advised (95% CI: 0.02, 0.29), and men who were not sure of how frequently screening should be conducted were 6.1 times more likely not to be screened compared to those who knew that screening should be conducted annually (95% CI: 1.10, 33.35). Men who visit healthcare providers only when they feel sick were 6.4 times more likely not to be screened compared to men who visit annually (95% CI: 1.63, 25.41). A substantial proportion of Jamaican men ≥ 40 years had never been screened for prostate cancer. Interventions should be instituted to make prostate cancer screening readily available and to promote active participation of men in these programmes especially men ≥ 70 years, men with less economic resources, and men who do not routinely visit a physician or health facility.

Knowledge, Attitude, and Practices Regarding Vector-borne Diseases in Western Jamaica

BackgroundOutbreaks of vector-borne diseases (VBDs) such as dengue and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce or eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. ObjectiveThe aim of this study was to assess the knowledge, attitudes, and practices (KAPs) of residents in western Jamaica regarding control of mosquito vectors and protection from mosquito bites. MethodsA cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding VBDs. KAP scores were calculated and categorized as high or low based on the number of correct or positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. FindingsIn all, 361 (85 men and 276 women) people participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitude items. By multivariate logistic regression, housewives were 82% less likely than laborers to have high attitude scores; homeowners were 65% less likely than renters to have high attitude scores. Participants from households with 1 to 2 children were 3.4 times more likely to have high attitude scores compared with those from households with no children. Participants from households with at least 5 people were 65% less likely than those from households with fewer than 5 people to have high practice scores. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. ConclusionThe study revealed poor knowledge of VBDs and poor prevention practices among participants. It identified specific groups that can be targeted with vector control and personal protection interventions to decrease transmission of the infections.

Prostate cancer educational intervention among men in western Jamaica.

To conduct and evaluate the impact of a theory-based health education intervention on awareness of prostate cancer and intention to screen among men in Western Jamaica and determine screening rates of men participating in the intervention at 6 months post-intervention. 454 men utilizing various clinics and hospitals in Western Jamaica completed an interviewer-administered pretest survey on general prostate cancer knowledge and intention to screen. Upon completing the pretest, participants observed a prostate cancer health education intervention and immediately completed a posttest survey. Statistically significant improvements in the percentage of correct responses between the pretest and posttest were evident (p < 0.05). Additionally, screening rates increased dramatically by 6 months post-intervention with over 33% of men receiving a prostate exam after participating in the educational intervention. The theory-based educational intervention increased participants' knowledge of prostate cancer, types of screening tests, frequency of screenings and risk factors and symptoms, and was effective in increasing screening rates among the men in Western Jamaica within 6 months post-intervention. This theory-based educational intervention may be replicated to promote awareness of prostate cancer and further increase screening rates in other areas of Jamaica and other developing countries.

A theory-based intervention to improve breast cancer awareness and screening in Jamaica.

Despite declines in breast cancer mortality rates in developed countries, mortality rates remain high in Jamaica due to low levels of screening and lack of early detection. We hypothesized that a theory-based health educational intervention would increase awareness of breast cancer and intention to screen among women in Western Jamaica. Two hundred and forty six women attending hospitals or clinics were enrolled in an educational intervention consisting of a pretest, breast cancer presentation, and posttest if they had never been screened or had not been screened in 5 years or more. The questionnaires assessed attitudes and knowledge of risk factors and symptoms related to breast cancer. Participants were followed approximately 6 months after the intervention to determine whether they accessed breast cancer screening. There were statistically significant increases (p < 0.0001) in the percentage of correct knowledge responses and in participants' intention to screen from pretest to posttest. The greatest posttest improvements were among items measuring knowledge of breast cancer screening tests and risk factors. Of the 134 women who were reached by phone for post-intervention follow-up, 30 women (22.4 %) were screened for breast cancer and 104 women (77.6 %) had not been screened. The use of a theory-based educational intervention positively influenced knowledge of breast cancer risk factors, symptoms, and types of screening and increased screening rates in screening-naïve women. This theory-based educational intervention may be replicated to promote awareness of breast cancer and further increase screening rates in other areas of Jamaica and other developing countries.

Origins of marronage: Mitochondrial lineages of Jamaica's Accompong Town Maroons.

The Accompong Town Maroons are descendants of enslaved Africans who successfully waged war against British colonial rule and established an independent community in western Jamaica. There are discrepancies regarding Accompong Town Maroon ancestry with some scholars noting ancestry from both Africans and Taínos, Jamaica's indigenous population, while other scholars only acknowledge African ancestry. We considered the mitochondrial lineages of contemporary Accompong Town Maroons to address the question of ancestral origins. We sequenced a section of the mitochondrial DNA control region (np 16,024-16,569) and genotyped a panel of hierarchically selected haplogroup diagnostic SNPs for 50 individuals with genealogical ties to Accompong Town. Mitochondrial haplotypes were also compared with publically available Jamaican mitochondrial haplotypes using an exact test as well as haplotypes within the EMPOP public database to further access biogeographic origins. L-type mitochondrial haplogroups were observed in 96% of samples, and the remaining 4% belonged to haplogroup B2. Haplotype diversity was 0.922 (SD = 0.024) and not significantly different than the comparable Jamaican population. Of the two B2 haplotypes, one matched haplotypes throughout the Americas and East Asia and the other matched only in East Asia. These results suggest both African and indigenous American maternal ancestries within Accompong Town. Our data suggested that the maternal ancestry of contemporary Accompong Town Maroons is predominantly African and, despite claims to suggest otherwise, also indigenous American. Our study complemented Maroon oral histories, archeological data, and illuminated how colonization shaped human genetic variation within the Caribbean.

P-A9 Perinatally HIV-infected adolescents (PHIVA) in Western Jamaica –A 10 year longitudinal cohort study

P-A9 Perinatally HIV-infected adolescents (PHIVA) in Western Jamaica –A 10 year longitudinal cohort study

Gender Norms and Family Planning Practices Among Men in Western Jamaica.

The objective of this study was to identify the association between gender norms and family planning practices among men in Western Jamaica. A cross-sectional survey of 549 men aged 19 to 54 years attending or visiting four government-operated hospitals was conducted in 2011. Logistic regression models were used to identify factors associated with taking steps to prevent unwanted pregnancy, intention to have a large family size (three or more children), and fathering children with multiple women. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated from the models. Reduced odds for taking steps to prevent unwanted pregnancy among men with moderate (AOR = 0.5; 95% CI = 0.3-0.8) and high (AOR = 0.3; 95% CI = 0.1-0.6) support for inequitable gender norms was observed. Desiring large family size was associated with moderate (AOR = 2.0; 95% CI = 1.3-2.5) and high (AOR = 2.6; 95% CI = 1.5-4.3) support for macho scores. For men with two or more children (41%), there were increased odds of fathering children with multiple women among those who had moderate (AOR = 2.1; 95% CI = 1.0-4.4) and high (AOR = 2.4; 95% CI = 1.1-5.6) support for masculinity norms. Support for inequitable gender norms was associated with reduced odds of taking steps to prevent unwanted pregnancy, while support for masculinity norms was associated with desiring a large family size and fathering children with multiple women. These findings highlight the importance of including men and gender norms in family planning programs in Jamaica.

Gender norms and sexual behaviours among men in western Jamaica

Objectives Gender norms, especially among men, can reduce the effectiveness of HIV prevention programs. We sought to assess the association between attitudes towards gender norms and risky sexual behaviours, and identify sociodemographic factors that predict gender-inequitable and masculinity norms among men in western Jamaica. A cross-sectional, survey of 549 men aged 19-54 years was conducted. Attitudes towards gender norms were measured using the Gender Equitable Men and Macho scales. Logistic regression and general linear models were used to assess associations between gender norms and multiple sexual partners, and to identify the associated sociodemographic factors. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) are presented. Fifty-four percent of the participants (mean age=32.4 years) reported multiple sex partners and 22% reported unprotected sex with non-regular partner in the past 12 months. Men with moderate (AOR=2.2; 95% CI=1.4-3.3) and high (AOR=4.2; 95% CI=2.0-8.5) support for inequitable gender norms, and moderate (AOR=1.7; 95% CI=1.1-2.7) and high (AOR=2.5; 95% CI=1.5-4.3) support for masculinity norms were more likely to report multiple sex partners. Similarly, men with moderate (AOR=2.4; 95% CI=1.3-4.3) and high (AOR=2.5; 95% CI=1.2-5.2) support for inequitable gender norms were more likely to report unprotected sex with a nonregular partner. A high proportion of Jamaican men engage in risky sexual behaviours. These results highlight the need for behaviour change interventions addressing gender norms targeting Jamaican men.

Causes of death in the human immunodeficiency virus population in Western Jamaica

Background: Monitoring the causes of death in patients with human immunodeficiency virus (HIV) in the era of expanding access to antiretroviral therapy in resource-limited settings has implications as more deaths are reported for reasons other than AIDS. Aims: To determine the causes of mortality in HIV-infected adults in Western Jamaica. Materials and Methods: Patients with HIV infection with a death certificate with a known cause of death between 2005 and 2010 were reviewed. Results: There were 189 patients. Co-morbidities were present in 25.3%. The mean age at death was 42.4 years. Early disease (World Health Organization [WHO] stages 1 or 2) was the presentation in 21.5% while 78.6% presented with advanced disease (WHO stages 3 or 4). The mean CD4 count at diagnosis was 95 cells/mm 3 . In patients presenting with early disease, 14.2% presented with sexually transmitted infections, 22.8% skin manifestations, and 14.2% lymphadenopathy. In patients presenting with late disease, 41.7% had Pneumocystis jirovecii pneumonia (PCP), 18.9% central nervous system (CNS) toxoplasmosis, 11.3% HIV-associated nephropathy, and 5% cryptococcal meningitis. At death, 72.6% were in WHO class 4, and 21.2% class 3. The average CD4 count at death was 75.5 cells/mm 3 . Overall, 55.2% of the patients had received highly active antiretroviral therapy. PCP accounted for 42.9% of deaths, 27.3% had CNS opportunistic infections, HIV nephropathy 16.4%, and 4.6% had malignancies. About 52.3% of patients died within 1 year of diagnosis with HIV, while 68.3% died within 2 years. Conclusion: Patients with HIV are presenting with late disease and dying of conditions that are AIDS-related. Efforts to improve early diagnosis and treatment are urgently needed in Jamaica.

Evaluation of registered nurses' knowledge and practice of documentation at a Jamaican hospital

Documentation is central to the management of patients in hospitals. Nurses are trained to follow the Ministry of Health Jamaica's policy on documentation, which is available in all public hospitals. Audit of documentation practices by registered nurses at a referral hospital. Ninety patient records from three medical wards were audited for documentation practices using an approved Jamaican Ministry of Health tool. Qualitative data regarding the nurses' experience with documentation were gathered from a focus group discussion of 12 nurses assigned to the audited wards. Most nurses (98%) followed documentation guidelines for admission by recording patients' past complaints, medical history and assessment data; used authorized abbreviations only (97%); documented nursing actions taken after identification of a problem and a provided a summary of the patients' condition at the end of the shift (98%). However, only 26% of the records had nursing diagnosis, which corresponded to the current medical diagnosis and 48% had documented evidence of discharge planning. Eighty-seven per cent had no evidence of patient teaching. The main reported factors affecting documentation practices were workload and staff/patient ratios. Participants believed that nursing documentation could be improved with better staffing, improved peer guidance and continuing education. The study showed high levels of accurate documentation by nurses at a referral hospital in Western Jamaica and the nurses appeared to be familiar with the required documentation guidelines with policy manuals available on each ward. Weaknesses in discharged planning and patient teaching were identified, which should be addressed by targeted continuing nursing.