• Placing care: the impact of the physical environment on experiences of providing and utilizing palliative care

      Agom, David; Sixsmith, Judith; Ominyi, Jude; Onyeka, Tonia; Agom, Joy C.; University of Bedfordshire; University of Dundee; University of Nigeria; Regent College, London (Lippincott, Williams & Wilkins, 2022-08-05)
      Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts. This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context. Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data. Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff. Hospital design for palliative and end-of-life care in Nigeria is "autoinhibitory" (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria.
    • Psycho-behavioral responses of Nigerian health workers to an initial human-to-human transmission of the coronavirus disease

      Onu, Justus; Onyeka, Tonia; Unaogu, Ngozichukwu Nneka; Mohammed, Alhassan Datti; Okunade, Kehinde; Oriji, Sunday; Agom, David; Edewuba, Dorothy; Alumona, Cajetan Okwudili; Echieh, Chidiebere Peter; et al. (PAGEPress, 2022-05-24)
      Previous pandemics have had significant impact on psychological well-being of front-line health care workers. Issues such as fear of contracting the disease, high workload as a result of high numbers of infected cases, increased job stress and unavailability of personal protective equipment have been implicated in development of psychological distress in this subset of individuals. The aim of the present paper is to describe psychobehavioral responses of health care workers and potential predictors of emotional response at onset of COVID-19 outbreak in Nigeria. Cross-sectional web-based survey and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were administered anonymously to 444 respondents comprising various categories of frontline healthcare workers. Stepwise multiple linear regression was used to determine predictors of anxiety scores. Participants were mostly young adults (mean age 38 years), females (57%), living with a partner (78.2%) and medical doctors (56.8%). Restrictions in clinical activities and use of hand sanitizers were commonest precautionary behaviors. Commonest emotional responses were anger and despair (27.0% and 25.7%), respectively. About 42.8% had clinically significant anxiety symptoms with highest burden among nurses. Perception of likelihood of 2nd wave (p=0.03), self-preparedness (p=0.04), gender (p=0.01) and cadre (p=0.02) were significant predictors of emotional response of anxiety. Study findings highlighted diverse psychological reactions of health care workers with a large proportion screening positive for significant anxiety symptoms. This has implications for planning a comprehensive psychosocial response to COVID-19 pandemic and for future pandemics among frontline health care workers in lowresource settings.