AIM: The purpose of the study was to explore the reasons that influence Rwandan nurses to change employment status. METHODOLOGY: The study used quantitative, exploratory, and descriptive design. A convenient sample size of eighty-eight (88) nurses, purposively selected using snowballing method, participated in the study from CAMERWA and RAMA organizations. Data was collected by use of a self -administered questionnaire, which had closed and open ended questions. Data were analyzed by SPSS 13.0 for Windows. FINDINGS: Low salary payments (53.8%),lack of policies and procedures( 42.5%), poor staffing in health care facilities (54.8%)and some respondents said they never choose to be nurses (31 %), and therefore they did not want to remain in nursing(23 .9%.) Reasons included lack of autonomy (65.9%), lack of promotion criteria (52.3%) Lack of career advancement and training were among the major reasons for change of employment status. Nurses however recommended that if the salary is increased, and opportunities for training and further education are improved then retention can be improved, CONCLUSION: Intrinsic and extrinsic factors were both identified as factors that influenced the nurses to change employment status, it is the government and the relevant healthcare facilities to pay attention to what motivates nurses, since they are the major role players in the health sector. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2006.

It has been reported for over the last decade that the quality of nursing care provided towards patients has decreased tremendously. The literature shows the impact of poor quality nursing to patients and assumes the influence of nurses’ perceptions of quality nursing care on its delivery. However, studies about such perceptions are still few in Rwanda. Aim: The purpose of this study was to explore the perceptions of quality nursing care among nurses working in two district hospitals in Rwanda. Methodology: A non-experimental exploratory descriptive design which was quantitative in nature was used. A self-report questionnaire comprised items related to socio-demographic characteristics of participants, perceptions of quality nursing care, nurses’ role in continuous quality improvement and factors affecting the delivery of quality nursing care. The sample was obtained through a purposive non-probability sampling of the nurses (n=150) who were available during data collection from 16 to 28 October 2011, with a return rate of 110 (73%) of completed questionnaires. Results: The findings from demographic data indicated that many of nurses were young, with 48.2% falling into the 20 to 30 year old bracket and the majority of the participants (83.3%) were enrolled nurses. Many of the participants were new to the nursing profession, with 47.2% falling into the 6 months-5 years working experience bracket. This study suggests that nurses had an appropriate perception of quality nursing care, as evidenced by the mean score of 4.183 (SD: .5741), related to nurses’ understanding of quality nursing care with mean score of 4.137 (SD: .5763) for the perceptions of the delivery of quality nursing care. The role played by nurses in continuous quality improvement was evident, but it was constrained by the factors related their nursing practice environment, including: shortage of nurses, lack of time, heavier workloads, and few opportunities for advancement. Conclusion: In summary, this study provided insights into nurses’ perceptions of quality nursing care, and their current ongoing endeavours to provide quality improvement in spite of challenges in their workforce environment. This study has described the challenges which interfere with the delivery of quality nursing care that need to be addressed so that patients may benefit from evidence-based care. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Introduction Patient safety IS fundamental to quality health and nursmg care and the ongomg improvement of patient safety is one of the most urgent issues facing health care today. Quality health and nursing care is a process which can be monitored, but which requires ongoing evaluation and change. The poor quality of patient care is a major problem of many hospitals in Rwanda and the University Central Hospital of Kigali, (CHUK), is no exception, especially in the Intensive Care Unit, (ICU). (Rwanda Ministry of Health Report, 2005). Pmpose of study The purpose of this study was to describe and explore the structure and processes of quality patient care at CHUK Intensive Care Unit, using the JFICM minimum standards, in order to improve the current quality of patient care and to further highlight gaps that might exist in this care for further research. Methodology The research was conducted in the Intensive Care Unit at CHUK. A checklist and self-reporting questionnaires, which were developed by the researcher, guided by the Joint Faculty ofIntensive Care Medicine (2003), constituted the instrument for this study. The sample consisted of 41 participants who were health care workers in the ICU and 20 of the patient's files. These files were used for researcher's observations during the period of data collection being 20thJune to 20th July 2008. A descriptive quantitative design was used. Results Design: While the ICU was in a self contained area with easy access to other departments the actual work environment did not comply with the recommendations of the JFICM (2003) minimum standards ofICU. ICU staffing: The staff consisted of only 1 medical doctor consultant and three specialist anesthetists. There were 11 Registered nurses (RNs) and 16 Enrolled nurses (ENs). A physiotherapist and dietician were available, but there was no biomedical engineer. The quantity of equipment was not adequate for the workload in the unit. There were no guidelines or protocols for nursing care and the unit had neither in-service training programmes nor research programmes available to the medical and nursing staff. While vital signs, ECG and oxygen were well monitored by using the nursing file (Appendix 10), the monitoring of patients was done without any guidelines or written procedures. The nursing reports, also, did not follow any guideline or procedure. Communications were generally poor because of the lack of equipment. The phone was not working for most of the time and there was no biotechnical engineer available to monitor the material and equipment. Conclusion According to the analysis of the structure and process standard based on JFICM (2003), the minimum standard of quality of ICU patient care at CHUK needs to be improved because the unit does not comply with an appropriate design, fulfil the staffing and operational requirements, or have the necessary equipment. Due to the shortage of qualified staff, plus the unavailability of protocols or guidelines, the processes of quality patient care were inadequate and need to be improved. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2009.

This study was conducted to determine the level of knowledge and perceptions of Type Two Diabetes Mellitus (T2DM) among people in Rwamagana District. A quantitative descriptive design and a cluster multistage sampling technique were used in this study. Out of a sample of 355 people, 301 voluntary participated in the study and completed the anonymous questionnaires. The response rate was 85%. The questions in the questionnaire were designed to collect socio-demographic information of the participants, their knowledge of diabetes and their perceptions of diabetes. Analysis of findings revealed that the level of knowledge of diabetes was inadequate and low among participants. Very few participants were able to answer properly the questions aimed to explore their knowledge of the meaning, signs/symptoms, causes, risk factors, management and prevention of diabetes. In addition many participants answered that they had no knowledge about any of the aspects of diabetes explored in our questionnaire. The perceptions were also poor and inadequate, especially perceptions of diabetes management at the community level and of diabetes prevention. The perceived risk of developing diabetes was low and many participants felt that behaviour change was of no importance in the prevention of diabetes, since the majority reported that they were not planning any behaviour change in the future. The findings suggest that there is a need for education campaigns in Rwamagana district to raise public knowledge about all aspects of diabetes. There is a need also to train the community health workers of this district to enable them to offer proper advice at the community level about diabetes prevention and management. The findings from this study could be used to assist in the planning of diabetes prevention and management programs in Rwamagana district. / Thesis (M.N.)-University of KwaZulu-Natal, Howard College, 2010.

Emergency department overcrowding is a growing problem worldwide including Rwanda. Literature shows that this problem has an impact on the functioning of the health care system and the quality of care provided. Research Methodology. This study aimed at exploring the phenomenon of overcrowding in ED/CHUK. Fifty one self-administered questionnaires were distributed to 40 ED nurses; these comprised three questions related to demographic data and 48 questions related to overcrowding. Correlation between overcrowding and causes and overcrowding with outcomes was explored and the pearson's test demonstrated that there is no linear correlation between these variables. Results. Findings from the demographic data demonstrated that the majority (92%) of ED nurse's were young (aged between 20 to 35 years). The majority (74%) of ED nurses had less than one to three years of experience in ED. With regard to overcrowding characteristics; nurses reported that the patient's waiting time for a physician varied between less than 30 min to more than 180 min; ED beds occupancy varied between 1 hour to more than 24 hours; patients were placed in the ED hallways for 1 hour to more than 24 hours; waiting room occupancy varied between less than 1 hour to more than 24 hours. Nurses attributed overcrowding to a variety of causes, including; a lack of inpatients beds (95%), large volume of trauma patients (87%), patients with no urgent condition (66), inappropriate referral of chronic cases (61 %), space limitation in emergency department (76%) and insufficient acuity ED beds (74%). Perceived outcomes (impact) were also multiples including, boarding patient in ED (92%), increased stress among nurses (79%), stress among physicians (60%), and risk of poor outcomes (60%), staff dissatisfaction (58%), violence between health care providers and patients (60%) and increased patient waiting time (58%). Regarding the undertaken interventions to reduce ED overcrowding, 100% of respondent asserted that there was some sporadic interventions, but not consistent. Recommendations: Like in other countries ED/CHUK overcrowding is a complex problem that needs to be addressed by all stakeholders: CHUK managers, hospital staff, ED staff, Rwandan district hospitals and Ministry of health. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

In the 1994 Rwandan genocide, rape was widely used as a strategic weapon against Tutsi women. This study explored the long term psychological effects of rape experienced by these women in order to develop a middle range theory to guide the management of the lasting psychological effects of rape in the context of genocide. A Grounded Theory approach using Strauss and Corbin’s paradigm (Strauss and Corbin, 1990) was used. Data collection entailed in-depth interviews of twenty nine participants, twelve of whom were rape survivors, ten were women who had not been raped, and seven were men from their community. Open coding, axial coding and selective coding were used to analyse the data. The results have shown that women were negatively affected, physically, psychologically and socially, by the rape. Genocide Rape Trauma emerged as a concept that defines these outcomes. It includes unbearable memories, overwhelming feelings, sense of helplessness, somatic distress, negative self-image, altered intimate relationships and social isolation. The extreme brutality, the humiliation that accompanied the experience of rape and multiple losses were reported as risk factors for the lasting psychological effects of rape. These negative outcomes were maintained by poverty, poor physical health, the burden of raising the children born of rape, hostility and stigma from their community, and lack of appropriate support and effective health care services. Facilitating the management of Genocide Rape Trauma emerged as the core category of the middle range developed theory. Recovery from Genocide Rape Trauma required formal and informal support, including psychological and medical care, sensitivity in dealing with genocide rape survivors, and advocacy. Economic empowerment was a key element, while educating the community contributed to the social integration of rape survivors and their children born of rape into their community. Women had developed coping mechanisms of their own to attain psychological relief, and had organized themselves into support groups. This study contributed to clinical practice by providing a holistic approach to taking care of rape survivors. The inclusion of such theory in the curriculum of health care professionals should contribute to the understanding of the lasting impact of rape and how to handle it in an efficient manner. Key words: Rwanda, Genocide, women survivors, Genocide Rape Trauma, Management of the long term psychological effects of rape and Grounded theory. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2013.

No abstract available. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.