Knowledge and experiences of nurses regarding the preparation of adolescents with congenital heart disease for adulthood at Windhoek central hospital, Windhoek, Namibia

Abstract

The purpose of the study was to determine the nurse’s knowledge and explore the experience of nurses regarding the preparation of adolescents with Congenital Heart Disease (CHD) for adulthood. A convergent mixed method design was used. A descriptive design was applied to describe the nurses’ knowledge on preparation of the adolescents with CHD for adulthood according to the following domains: a) prevention of complications, b) physical activities, c) sexuality and heredity, d) contraception and pregnancy planning for the quantitative data. For qualitative data, a phenomenological descriptive approach was followed to explore and describe the experience of the nurses with regards to the educating, and counselling of adolescents with CHD in preparation for adulthood at Windhoek Central Hospital’s In- and Out-patient cardiac departments. Out of 26 nurses who provide care at Windhoek Central Hospital’s cardiac departments, only 17 nurses who met the inclusive criteria were interviewed. Due to the low numbers, all participants were eligible for both methods. The quantitative data was analyzed and synthesized using the Statistical Package of Social Science (SPSS-version 27) software, which is designed for quantitative data analysis. Descriptive factor analyses were produced using statistical methods using SPSS version 27. The qualitative raw data for this study were analysed through Atlas.ti using the coding system, then the most descriptive words were converted into themes. To achieve the aim of the study, two objectives were set: (a) to determine the nurses’ knowledge on preparation of adolescents with congenital heart disease for adulthood with regard to the prevention of complications, physical activities, sexuality and heredity, contraception and pregnancy planning; and (b) to Explore the nurses’ experience with regards to education, counselling, and preparation of adolescents with CHD for adulthood. ii Objective (a): The study comprised mostly of registered nurses (76.5%), with 17.6% enrolled nurses and only 5.9% of nurses are cardiac specialist nurses. The findings revealed that most nurses (52.9%) who provide direct nursing care to the adolescents with congenital heart disease in a transition period qualified for a long time as nurses and they have appropriate experience for preparing the adolescents with CHD for adulthood. The findings from the quantitative data indicated that although nurse demonstrate good knowledge that adolescent with CHD should consult health facilities in case of side effects of medication (94.1%), avoidance of physical demanding occupation (100%) however only 76.5% of nurses agreed that adolescents with CHD in transition should not partake in any competitive sport. While nurses acknowledged that adolescents with CHD may engage in sexual activities that they are capable of performing (70.6%) and that adolescents with CHD are at risk of pregnancy related complications (100%). However, the respondents nevertheless had average knowledge about action adolescents with CHD should take in event of medication side effect (52.9%), poor knowledge about risks incurred by engagement in sexual activities (11.8%), subsequent poor knowledge about risk of hereditary of CHD to the offspring (11.8%) and average knowledge about the choices of contraceptive for adolescents with CHD, most respondents 82.4% correctly recommended the Implanon as the suitable method of contraceptive for adolescents with CHD, however this method of contraceptive is standard for all adolescents with CHD at Windhoek central hospital cardiac department, without considering the specific cardiac lesion, type of cardiac surgical intervention and treatment regimen for an individual adolescent with congenital heart disease, as proposed by Sable et., (2011) and World Health organization (2009). Additionally, the findings indicated that nurses use a holistic approach when preparing the adolescent with CHD for adulthood by focusing on key aspects of preparation such as: iii prevention of complications, physical activities, sexuality, heredity, contraception and pregnancy. Objective (b): Nurses felt that, they encouraged disease acceptance during counselling as this might result in better physical and mental well-being of the adolescents with congenital heart disease. It is worthy to note that most of the participants in the interviews spoke highly on the importance of treatment adherence. Moreover, nurses had the impression that sufficient knowledge is provided to adolescents with adolescents with CHD with regard to International Normalized Ratio training. Although a holistic approach on other matters that affect the adolescents with CHD is used by nurses to ensure a smooth transition, the nurses’ perceive that there is still a need for psychological support to help the adolescents to cope with the disease as CHD requires ongoing medical attention as CHD causes limitations to the patient’s daily activities. Nurses felt that although activities intolerance was mostly discussed with the transitioning adolescents with CHD, nurses’ did not discuss the benefits of exercise. Therefore, adolescents with CHD could risk developing perceived physical activity restrictions. From the qualitative section, the main themes which emerged were Inform patients on the nature of CHD, Extreme physical activities, The future of adolescents living with CHD, Educate on sexual activities, Educate on career choice, Nurses knowledge, Care and empathy psychological support and Policy/guideline. The researcher recommended the implementation of a checklist to guide the nurses in assessing the needs of adolescents with CHD in the transition period as well as in-service training for nurses to initiate an effective and efficient education and counselling to the adolescent with CHD in a transition period.