Determinants of adherence to ministry of health’s national guidelines on management of severe pre-eclampsia among nurses working at Kenyatta National Hospital, Kenya

Abstract

This study examined the determinants of adherence to national guidelines in the management of severe preeclampsia at Kenyatta National Hospital. A cross-sectional study design was employed, with a total sample of 147 participants selected through systematic random sampling. Key informant interviews were conducted with five nursing officers in charge. Data collection tools included questionnaires for midwives and an interview guide for nursing officers. Quantitative data were analyzed using descriptive statistics such as means, frequencies, and percentages, as well as inferential statistics, including the Chi-square test. Qualitative data underwent thematic analysis and were presented narratively. The findings indicated that socio-demographic factors, particularly age, had a significant association with adherence to the management guidelines. Training, knowledge of guideline use, perceived necessity and ease of use, as well as confidence in applying the guidelines, were also significantly associated with adherence. Institutional factors, including workload and access to guideline copies, demonstrated a significant influence on adherence. However, no significant association was found between adherence and medicine stockouts or equipment availability. The study recommends the implementation of targeted training programs for younger and less experienced nurses, emphasizing the practical application of severe preeclampsia management guidelines, alongside mandatory refresher courses. Regular assessments of nurses’ knowledge on these guidelines should be conducted to provide individualized feedback. Additionally, mentorship programs and peer support groups should be established to facilitate experience sharing and address misconceptions regarding guideline adherence. To address staff shortages, workload redistribution strategies should be explored. Furthermore, a robust system for monitoring and managing medication stocks should be developed to ensure consistent availability of essential drugs, such as magnesium sulfate and antihypertensives.