Background. NCDs are the greatest global contributors to morbidity and mortality and are a major health challenge in the 21st century. The global burden of NCDs remains unacceptably high. Access to care remains a challenge for the majority of persons living with NCDs in sub-Saharan Africa. In Uganda, 55% of refugee households, including those with chronic illnesses, lack access to health services. Of these, 56% are in the West-Nile region where the Bidibidi settlement is located, with 61% of its refugee households in need of health services especially for NCDs (UNHCR, 2019). Data on NCDs in Bidibidi are scarce. Unpublished health facilities’ (HFs) data indicate that cardiovascular diseases (CVDs) (54.3%) and metabolic disorders (20.6%) were the leading causes of consultation for major NCDs (IRC, 2019). No readiness assessment has ever been conducted to inform strategies for the efficient management of NCDs to avert more morbidity, mortality, and the economic burden associated with NCD management or complications among refugees. This study sought to determine the readiness of HFs in managing hypertension (HTN) and diabetes cases at primary health facilities in the Bidibidi refugee settlement, Yumbe district, Uganda. Methods. The study used facility-based, cross-sectional design and quantitative approach to assess readiness for the management of HTN and diabetes. All the 16 HFs at the Health Centre III (HCIII) level in Bidibidi were studied, and a sample size of 148 healthcare workers (HCWs) was determined using Yamane’s formula (1967). Proportionate sample sizes were determined at each HF and the simple random sampling technique was used. HF data were collected using the Service Availability and Readiness Assessment (SARA) checklist and a structured questionnaire used among HCWs. Data were analyzed using SPSS version 20. Univariate analysis involved descriptive statistics; bivariate analysis used chi-square, Fisher’s exact test, and multivariable regression analysis for readiness of HCWs. Results. 16 HCIIIs were studied in five zones and involved 148 HCWs with a mean age of 28 (std ±4) years. The majority 71.6% (106) were aged 20–29 years, 52.7% were females, and 37.8% (56/148) were nurses. Among the 16 HFs, readiness average score was 71.7%. The highest readiness score was 89.5% while the lowest was 52.6%. The 16 HFs had 100% diagnostic equipment, 96% had diagnostics, and 58.8% had essential drugs (low for nifedipine, 37.5%, and metformin, 31.2%). Availability of guidelines for the management of HTN and diabetes was 94%, but only low scores were observed for job aid (12.5%), trained staff (50%), and supervision visits (19%). Only 6.25% of the HFs had all the clinical readiness parameters. On the other hand, only 24% (36) of the HCWs were found to be ready to manage HTN and diabetes cases. Chi-square tests on sex ( p < 0.001 ), education level ( p = 0.002 ), and Fisher’s tests on profession ( p < 0.001 ) established that HCWs with bachelor’s degree (AOR = 3.15, 95% CI: 0.569–17.480) and diploma (AOR = 2.93, 95% CI: 1.22–7.032) were more likely to be ready compared to the reference group (certificate holders). Medical officers (AOR = 4.85, 95% CI: 0.108–217.142) and clinical officers (AOR = 3.79, 95 CI: 0.673–21.336) were more likely to be ready compared to the reference group, and midwives (AOR = 0.12, 95% CI: 0.013–1.097) were less likely to be ready compared to the reference group. In addition, female HCWs were significantly less likely to be ready compared to male HCWs (AOR = 0.19, 95% CI: 0.073–474). Conclusion. HFs readiness was high, but readiness among HCWs was low. HFs had high scores in equipment, diagnostics, and guidelines, but essential drugs, trained staff, and supervision visits as well HCWs had low scores in trainings and supervisions received. Being male, bachelor’s degree holders, diploma holders, medical officers, and clinical officers increased the readiness of the HCWs.

Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers' approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings -despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers' approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study's findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as key challenges to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.

Background The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients. Objective To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings. Design A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Data sources The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020. Methods Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools. Findings A total of 15 studies – two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies ( n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes. Conclusion The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings

Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of ‘followers’ (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 ‘followers’ (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison’s Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P &lt; 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P &lt; 0.0001). Organizational culture (OC) was associated (P &lt; 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting.