Soins infirmiers en contexte d'épidémie à mortalité rapide : cas de la fièvre hémorragique à virus Lassa au Bénin : un défi professionnel

Authors: Ahossi, Eusebe
Advisor: Dallaire, Clémence
Abstract: Problematic: VHF are characterized as quick lethal fatal diseases because they cause death in 50% to 90% of clinically diagnosed cases (Hewlett & Hewlett, 2005). The Ebola virus struck Africa in 2014, causing more than 28,607 cases and 11,289 deaths. The Lassa virus infects 100,000 to 300,000 people in West Africa every year and kills more than 5,000 one. Between 2014 and 2018, the Republic of Benin experienced four confirmed outbreak cases of Lassa VHF and was recorded on the list of endemic countries to Lassa disease. A total of 43 deaths, including 5 health workers (one doctor and 4 health care providers) out of 93 infected persons were recorded. Each outbreak case triggers a panic attack in the population and among health workers. Purpose: This qualitative study aims to explore nursing practice in the context of the Lassa VHF epidemic in Benin in order to understand more the reasons explaining the high mortality rate among the population and among health workers. Framework: The study framework incorporates three elements: McCormack and McCance's theory of person-centred care (2015), Kitson, Robertson-Malt and Conroy's basic care framework (2013) and World Health Organization's (OMS, 2014b) and Centers for Disease Control and Prevention's guides (CDC, 2014) to VHF prevention and control measures. Method: In this research, a qualitative estimate type of multiple case study is used with an exploratory, descriptive and explanatory approach. Three techniques are used for data collection: interviewing (narrative type), document exploration and observation. A total of five groups of participants were recruited: patient survivors (n=4), caregiver survivors (n=2), nursing and obstetrical care providers (n=6), non-caregiver controls (n=13), trained agents for the prevention and management of VHF cases (n=6) and authorities and partners involved in epidemic management (n=7). Results: The five topics from the reference terms that served as themes for data collection served as the basis for the analysis using Ritchie, Lewis, Nicholls and Ormston's (2013) analysis method. These themes are: prerequisites, care environment, care provision, case satisfaction and measures to prevent and control VHF. The results highlighted the factors that explain the high case-fatality rates during epidemics, the constraints faced by Beninese nurses during the provision of care in the context of a Lassa HSF epidemic and the autonomous role they play in this high-risk care environment. Discussion: This study enabled to explore nursing care in the context of a fatal epidemic and the conditions of practice of nurses in the health facilities studied. The empirical results provided relevant informations that can be used as guideline for the preparation and improvement of nursing management of Lassa VHF cases. To this end, a model of management focused on the Lassa fever patient has been proposed as a working tool for nurses in Benin and Africa.
Document Type: Thèse de doctorat
Issue Date: 2020
Open Access Date: 14 February 2020
Grantor: Université Laval
Collection:Thèses et mémoires

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