Rwanda Journal of Medicine and Health Sciences

Abstract
Background
Nursing and midwifery students need to learn theoretical knowledge and practical skills. Students are satisfied with a clinical education program when the environment is conducive to acquiring the knowledge, skills and professional attitude essential for their career.
Objective
To assess the level of satisfaction with the clinical learning environment among nursing and midwifery students at the University of Rwanda.
Methods
A descriptive cross-sectional study design was used to assess 280 undergraduate nursing and midwifery students. The study used the instrument entitled, the ‘Clinical Learning Environment Supervision and Nurse Teacher Tool’ (CLES+T). Data analysis used descriptive statistics.
Results
The majority of participants were highly satisfied with the clinical learning environment (58%), ward atmosphere (54%), the leadership of ward manager (58%) and supervisory relationship (62%). Chi-square results showed a significant association between class level (p=0.001) and last clinical placement (p=0.000). Some students (7%) were dissatisfied with the supervisory relationship.
Conclusion
Most nursing and midwifery students were satisfied with the clinical learning environment. However, the reported levels of dissatisfaction showed that improvements are needed to attain a quality education and meet the Sustainable Development Goal (SDG) Four : to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

Abstract
Background
Chronic Kidney Disease (CKD) is a global public health burden. Most people miss the early subtle signs that can develop at any age. CKD has severe complications, including End-stage Renal Disease.
Objective
To assess the knowledge level of CKD risk factors and preventive practices among university students in Rwanda.
Methods
A cross-sectional study design was used from April to May 2017. A stratified random sampling technique was used to recruit 260 university students. A 36-item questionnaire was selfadministered. Data were analyzed using descriptive and inferential statistics.
Results
The mean age was 29 years and over half were female (53.4%). A great number (44%) had a low knowledge level of CKD and its risk factors, a third (34%) had moderate, and only (22%) had a high knowledge level of CKD risk factors. The majority (50.4%) had low level of preventive practices, nearly half (45%) had moderate and only (4.6%) had high level of preventive practice.
Conclusion
CKD knowledge and preventive practices in this study population were low. Knowledge gained and desire for healthy preventive practices may have been a benefit of the study. CKD educational programs should be further developed to prevent this significant problem affecting the Rwandese community.

Abstract
Background
Hemodialysis is the most standard method of Renal Replacement Therapy (RRT) used in Rwanda. Nephrology nursing is a new speciality, and little is known about the nurses’ work performance while caring for patients under going hemodialysis.
Objective
To explore factors influencing nurse’s work performance in the care of hemodialysis patients in four nephrology units in Rwanda.
Methods
A qualitative descriptive design used a purposive sampling strategy to recruit 12 registered nurses working on the hemodialysis unit. Data were collected through interviews using a semistructured guide. Data analysis used a thematic approach with six phases.
Results
Two themes and eight subthemes were revealed. Facilitating factors to increase work performance included the nurses’ education and speciality training, good working environment, good interpersonal relationships among staff, and effective management and leadership. Barriers included, self-perceived knowledge and skills insufficiencies, moral distress, logistical concerns, and poor working conditions.
Conclusion
The findings revealed specific facilitating factors and barriers to nurses’ work performance. Nurses at these study sites, in conjunction with faculty in the Master’s Nephrology Track at the University of Rwanda, could become change agents and begin to increase facilitating factors and decrease barriers. Continual improvement in facilitating factors is needed to keep nurses performing well.

Abstract
Background
Diabetes mellitus type 2 (T2DM) is the most prevalent form of diabetes that has continued to increase worldwide over the past decades. The cornerstone of T2DM management is education on self-management. Evidence shows that nurses have insufficient knowledge of the content of T2DM patient education.
Objective
To assess nurses’ knowledge of health education content for T2DM patients, and to establish the relationship between their education and knowledge level of T2DM health education.
Methods
A descriptive cross-sectional design and total population sampling strategy were used to recruit nursing staff at a medical/surgical unit. Fifty-one nurses at the referral hospital of Rwanda completed the self-administered questionnaire. Descriptive statistics were used for data analysis.
Results
Nurses exhibited poor knowledge of diabetes health education. There was no significant relationship between the nurses’ level of education and diabetes health education knowledge (p=0.102).
Conclusion
Nurses had good general knowledge of diabetes, though a low level of knowledge of diabetes health education in this low-resource setting. Hospitals equipped with a T2DM protocol and appropriate staff training would likely improve the nurses’ knowledge and patient care outcomes.

Abstract
Background
About 1.4 million people worldwide are affected by hand hygiene-associated infections from healthcare providers, and altered perceptions might be the contributory factor.
Objective
To assess nurses’ perceptions and adherence to the “five moments of hand hygiene” in selected units at a University Teaching Hospital in Rwanda.
Methods
A descriptive cross-sectional design was used. A sample size of 84 nurses was selected using convenience sampling. The perceptions survey questionnaire and the observation checklist was used to collect data. Descriptive and inferential statistics were used to analyse the data.
Results
Sixty-nine (82.1%) had a positive perception of susceptibility and severity, and 75 (89.2%) had a positive perception of the benefits of hand hygiene. All 84 (100%) and 67 (79.8%) had a negative perception of perceived barriers and action (cues) to hand hygiene ; respectively. Highest adherence rate (82.1%) was after body fluid exposure risk, lowest before touching a patient (27.4%), with an average adherence rate of 53.6% to the “five moments.” Qualification was associated with nurses’ perceptions (p =.002) and department of work with adherence to hand hygiene (p =.001).
Conclusion
The overall perceptions of nurses were negative with inadequate adherence to hand hygiene practices. Therefore, this necessitates new strategies and reinforcement of hand hygiene among the nurses.