Dr. Wagoro facilitating development of delivery during a bench marking visit
Name: Dr. Miriam Carole Atieno Wagoro
Nursing education:PhD (Mental Health Nursing), MScN (mental health and Psychiatric Nursing, BScN, Dip. Advanced Nursing, KRN, KRPN, KRM, KRCHN
Number of years in the nursing field: Over 30 years in Nursing
Current title: Senior Lecturer and Director School of Nursing Sciences,University of Nairobi
Country of Origin: Kenya
1) Why did you decide to become a nurse and what inspired you to specialize in mental health and psychiatric nursing?
My decision to become nurse was influenced by a staff nurse when I was a young child in lower primary school. I had a younger sister who had a chronic condition. She would be admitted to our regional referral hospital from time to time. My mother used to go with me to the hospital each time she took my sister. At the ward where my sister would be admitted, there used to be a nurse (Whom I later learnt during my nurse studentship was a staff nurse). She was very smart in white uniform and a cap with a big blue band across it. She used to be very kind to us and caring to my sister. As a kid, I thought I needed to be very smart in the uniform and be kind to people when I grow up just as this nurse did. That is how I made a decision to be a nurse. To date my mother who is now in her 80s reminds me if I take care of my patients the way I had said I would when I was a kid.
I was motivated to specialize in mental health and psychiatric nursing during lectures and clinical placement in the mental health units as a basic student. I loved psychology and mental health lectures because they explained “The why of the behaviour” I found the subjects interesting and I thought I needed to understand why people behaved in certain ways. In addition to learning about behaviours, I felt pity on the patients with mental disorders during my clinical experience. They complained of how they were stigmatized and mistreated by their communities. I thought I would make a difference in their life. I therefore applied for the post basic Diploma in Psychiatric nursing (which was, the only available specialization) immediately I completed my basic Registered Nurse Diploma course. When the BScN program was introduced in our Universities, I joined and completed the program after which I was able to join the post graduate MScN (mental health & psychiatric nursing) and became one of the first two graduates of the program.
2) What motivated you to get your PhD?
I wanted to get to the highest level of nursing education in mental health nursing.
3) How long have you been in academia?
I have been in academia for over fifteen years.
4) Can you summarize your recent project on the psychological adversities that patients with ESKD face?
The Project “Psychosocial Experiences of Patients with End Stage Kidney Disease on Replacement Therapy at a National Referral Hospital in Kenya: A Descriptive Phenomelogical Study” was undertaken as one way of finding out the many psychosocial issues that clients experience as health workers concentrate on the physical problems that are given priority. The Psychological problems though not usually paid attention to, influence compliance with physical treatments and negatively influence client’s health outcomes.
Author contribution:
Jane Jackeline W.Mureithi -Conceptualized the study and its design, collected, analysed, interpreted data, wrote report and proof read the manuscript for approval
Miriam Carole Atieno Wagoro – Guided and supervised conceptualization of the study topic and design. Supervised data collection, transcription, analysis, interpretation and report; wrote draft manuscript and critically revise it.
Background: Kenya Renal Association observes that over 10,000 Kenyans are diagnosed with End Stage Kidney Disease (ESKD) annually ( Opiyo, Nyasulu, Olenja,et al ,2019).Of this population, over 10% undergo some form of renal replacement therapy (RRT) to sustain life. However, RRT often leads to some changes and adjustments in one’s life style that the patient may consider psychologically and socially unpleasant or restrictive experiences. Consequently, over 50% of patients on RRT do not comply with therapy. Understanding patient’s experiences is the first step towards improving compliance thereby improving health outcomes for patients. Objective: The researchers set out to explore psychosocial experiences of patients with ESKD. Methodology: A cross sectional qualitative study using descriptive phenomenological approach was conducted at National Referral and Teaching Hospital. Data were collected for 12 weeks from 14 patients selected purposely, using the principle of data saturation. Indepth interviews lasting 35-45 minutes were conducted, audio-taped and complimented with field notes. Inclusion criteria to the study included having a confirmed medical diagnosis of End stage Kidney disease and undergoing RRT. Ethical considerations: principals of Autonomy, Non-maleficence, Beneficence and Justice were observed. Explication of the data: Data from interviews and field notes were transcribed, units of meanings were delineated and clustered to form themes. Identified themes and patterns were categorized and psychosocial experiences of the patients were constructed. Psychological Experiences were identified as anger and fear as exemplified in the extracts below:
Anger- Anger directed at family members who were blamed for abandoning the individual
P2 “My wife has become very negligent she no longer listens to me, she does not spend time with me, she is just annoying”
Fear – Of being alone, probably due to perceived impending death
P10 “When am alone I feel so afraid, I wish my people would stay by my side always, but I know it is impossible”
Social experiences included Neglect and Isolation as exemplified in the extracts below:
Lack of concern –the patients experienced neglect by the people around them
P4 “people just pity us but they don’t care; if they did, they would come to our Harambees”
P13 “everyone is just busy with their own lives; nobody can give us priority in a queue”
Isolation: By the friends for various reasons
P1 “Since I left work, my friends no longer visit; I don’t know if they think I shall beg from them”
Discussion: Although similar categories of psychosocial experiences have been reported by various researchers including Gerogianni.(2016)-Social isolation;Griva (2018)-Anxiety and depression; Shahgholian, and Yousefi, (2018)-Psychosocial experiences; The actual nature and meaning as well as patients’ reaction of the experience differ from patient to patient.
Conclusion: Psychological and social experiences of clients undergoing renal replacement therapy are real and left unattended, may act as barriers to therapy compliance
Implications for nurses: Nurses as clinical practitioners need not only concentrate on the physiological aspects of care, but psychosocial aspects as well.Further,the qualified nurses in the clinical area and academia need to emphasize the importance of biopsychosocial-spiritual holistic evaluation. Nurses can then identify all challenges and design psychological and social interventions to mitigate negative experiences, facilitate coping and enable patients comply with treatment for better health outcomes.
Key words: Psychosocial experiences, End stage kidney disease, descriptive phenomenological study
5) What do you hope will be done with the findings?
In addition to implications for nurses above, it is important for, nurse practitioners in academia and clinical areas to work collaboratively to come up with a specific training package on how to manage the psychosocial issues that patients go through. The cooperation should see improved liaison mental health nursing within the fields of renal care.
6) Do you have any other projects you are currently working on or issues that you are passionate about?
Yes am currently working on “dignity in mental health care”. The project protocol is already approved by the IRB. We are in the process of looking for resources to collect data and subsequently analyze and prepare report
7) As the dean of School of Nursing at the University of Nairobi in Kenya, how do you work with colleagues to motivate students to engage in research and become global nurse leaders?
We recognize the need for mentorship and professionalization of students as part of the succession plan. The following are some of the strategies we use:
- We teach our students research methods, and allocate them supervisors who work with them through proposal writing, data collection and analysis as well as report writing and manuscript preparation.
- We encourage our students to present their work in local and international conferences.
- We encourage our students to register with the professional associations in the student chapter and participate in leadership meetings.
- We have mentored an undergraduate student to the position of regional leadership in Nursing Now campaign and Kenya novice and student nurses’ chapter.
- We link students to Global leaders for mentorship when an opportunity arises.
8) What is the most rewarding part of your work?
The most rewarding part of my work is when I get feedback that through my mentorship, I have empowered a nurse to provide quality care and firmly defend patient’s rights.