Who made a significant contribution to nursing by authoring Notes on Nursing

Christmal D. Christmals, RN, MSc, PhD,1,2 Janet Gross, RN, DSN,3,4 Lydia Aziato, RN, PhD,5 and Susan J. Armstrong, RN, NE, DCur1

Christmal D. Christmals

1Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa

2Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg South Africa

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Janet Gross

3Morehead State University, KY, USA

4Global Health Services Partnership, US Peace Corps, Liberia

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Lydia Aziato

5Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana

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Susan J. Armstrong

1Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa

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Author information Article notes Copyright and License information Disclaimer

1Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa

2Department of Nursing Education, School of Therapeutic Sciences, University of Witwatersrand, Johannesburg South Africa

3Morehead State University, KY, USA

4Global Health Services Partnership, US Peace Corps, Liberia

5Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Accra, Ghana

Christmal D. Christmals, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, Gauteng 2193, South Africa. Emails: az.ca.stiw.stneduts@801968; moc.oohay@lamtsirhceoj

Received 2018 Jan 17; Revised 2018 Mar 10; Accepted 2018 Apr 7.

Copyright © The Author(s) 2018

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Abstract

Introduction

For nursing practice to be responsive to the needs of patients, it must be driven by contextual research evidence. To guide institutional and national nursing research policy, there is need to determine the quantity and quality of nursing research in Ghana.

Purpose

The purpose of this integrative literature review was to quantify, critically evaluate, and describe nursing research publication in Ghana from January 2007 to December 2016 with regard to the country's research capacity to sustain evidence-based practice.

Results

Sixty (60) out of 749 articles identified from EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar using three keywords (nursing, health, and Ghana) were included. A total of 60,778 human subjects were used in these studies. There were more quantitative (28) studies than qualitative (23) studies. These studies recorded 219 authors from 120 institutions, 55 of which were outside Ghana. Forty-five percent of the articles were published in journals with impact factor. There was a steady increase in publication in Ghana over the decade. A majority of the studies published in education were in curriculum implementation and evaluation.

Conclusions

The increasing number of peer-reviewed nursing research publications in Ghana and the curriculum implementation and evaluation in Ghana signified an increasing capacity of the country to implement and sustain evidence-based practice.

Recommendations

It is recommended that regular research be conducted to evaluate the responsiveness to old and new nursing programs in Ghana.

Keywords: Ghana, nursing research, evidence-based practice, sub-Saharan Africa

Background

Nursing education started in Ghana in 1878 where male orderlies were trained to bathe and feed patients during the British colonial era (Adu-Gyamfi & Brenya, 2016). Nursing developed from the 19th century to the 21stcentury when it became well recognized as a profession in Ghana, providing the highest number of health-care workers than any other category in the country. Despite nurses forming the majority of health-care professionals in Ghana, Bell, Rominski, Bam, Donkor, and Lori (2013) reported a nurse-to-patient ratio of 1:2,024 in some parts of Ghana. This was as a result of the limited opportunity of the nursing education institutions to enroll and train qualified students (Bell et al., 2013).

In Ghana, nurses are given extended roles through task-shifting, especially in rural settings where there are no medical doctors (Gyamfi et al., 2017; Okyere, Mwanri, & Ward, 2017). These nurses are expected to take on extended roles without any form of training or licensure, creating anxiety and the opportunity for adverse effects and medicolegal malpractice (Okyere et al., 2017). Nurses are responsible for a large portion of health-care decision-making in Ghana. If nursing practice is more responsive and efficient, health-care services and indices in Ghana will improve. For nursing practice to be efficient and responsive to the needs of the population of Ghana, it must be contextual research-driven (Agyei, Kofi, Fiankor, & Osman, 2015; Jirojwong & Welch, 2013; Tingen, Burnett, Murchison, & Zhu, 2009). The importance of nursing research in providing quality and cost-effective care to patients as well as professional development cannot be overstated (Agyei et al., 2015; Jirojwong & Welch, 2013; Tingen et al., 2009). Eliminating evidence from practice makes practice outdated and dangerous to patients (Agyei et al., 2015).

Nursing practice, education, and administration in Ghana is based on tradition rather than evidence (Adu-Gyamfi & Brenya, 2016; Baatiema et al., 2017). Culture and socioeconomic status of patients, an insufficient number of health facilities, poor staff development, lack of practice protocols, health professional incompetency, lack of collaboration, and lack of political will were barriers to evidence-based practice in Ghana, as outlined by Baatiema et al. (2017).

Agyei et al. (2015) found that nurses exhibited the readiness to employ evidence in practice but did not have the knowledge and skills to translate research into practice. They recommended that nurses and other medical practitioners should be equipped with the knowledge and skills necessary for evidence-based practice in Ghana. The authors, however, believed that the responsiveness of nursing practice, education, and management was associated with the research output of Ghana. International evidence and policies conflict with the cultural context of Ghana and health-care practice, resulting in nursing practice being based on traditions rather than such evidence and policies (Donkor & Andrews, 2011).

In a sub-Saharan Africa-wide review of clinical nursing education research, Kpodo, Thurling, and Armstrong (2016) discovered that West Africa lagged behind the East and the Southern parts of Africa in clinical nursing research dissemination. In the same study, it was discovered that none of the studies included came from Ghana (Kpodo et al., 2016). The quantity, quality, and level of evidence, type, journals of publication, and focus of nursing research in Ghana, however, were not known.

Purpose

The purpose of this study was to quantify, critically evaluate, and describe nursing research publications in Ghana from January 2007 to December 2016 with regard to the country’s research capacity to sustain evidence-based practice.

Methodology

An integrative literature review framework developed by Whittemore and Knafl (2005) guided the review (Christmal & Gross, 2017). An integrative literature review is important in exploring the length and breadth of studies published in a particular jurisdiction or on a topic of interest. Reviews help in exploring the context and concepts under study. The integrative review methodology was preferred for this study due to its ability to allow for the inclusion of both qualitative and quantitative studies. The framework consisted of five stages, namely, “problem identification, literature search, data evaluation, data analysis, and presentation.” The report was guided by Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) checklist of reviews (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009).

The Search Process

Boolean combination of the keywords—nursing, health, and Ghana—was used to conduct an advanced computerized search in EBSCOhost, ProQuest, PubMed, Science Direct, Scopus, Wiley Online Library, and Google Scholar. The database searches provided 615 titles. An additional 182 titles were identified through a hand search conducted using known authors’ names and the search terms in Google search engine. The studies were loaded onto the Mendeley reference manager, and 48 duplicates were identified and removed, leaving 749 articles.

The 749 article titles were scanned for relevance to the study, and 703 studies were irrelevant to the review and were discarded, leaving 46 articles. Two nursing education and researchers in Ghana were contacted to evaluate the list of 46 studies retrieved and provide links to any articles that were not captured by the computerized search. One researcher provided a list of 15 relevant articles, whereas the other provided the names of other prominent authors in Ghana who were then searched in Research Gate and Google Scholar for publications resulting in the retrieval of 23 articles. In all, 84 articles were preliminarily included for critical appraisal.

Inclusion/Exclusion Criteria

Studies were included if they were published between 2007 and 2016, in a peer-reviewed journal, and on nursing in Ghana. The study had to be conducted by at least one nursing author from Ghana, and the setting of the study must have been within Ghana. After the critical appraisal, a total of 60 articles were included in this study (Figure 1) and displayed on the data matrix in Table 1. The excluded studies and the reasons for exclusion were shown in Table 2.

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Figure 1.

Literature search, evaluation, and inclusion process.

PRISMA = Prevention and Recovery Information System for Monitoring and Analysis.

Table 1.

Studies Included.

No.Author(s), YearPurposeMethodology/samplingData collection/analysisNursing specialtyMain findingsJournal/impact factorLevel (L) of evidence, gradeQuantitative studies included1.Abasimi et al. (2015)To examine the source and level of stress among nursing trainees in GhanaCross-sectional survey 273 nursing traineesQuestionnaire Inferential statisticsEducationNew students should be taught skills to adapt to college education. Counseling services should be provided at nursing colleges.International Journal of Psychology and Behavioral SciencesL6, IIIB2.Abuosi and Abor (2015)To assess the impact of social, economic, and demographical variables on intentions of nursing students to emigrate from GhanaCross-sectional descriptive study 747 second- and third-year nursing studentsQuestionnaire Inferential statisticsManagementFinancial and nonfinancial incentives should be made available for nurses. Those practicing in rural areas should have more incentives.Journal of International Migration and IntegrationL6, IIIB3.Acheampong et al. (2016)To determine the cause, types, and the effect of medication errors in an emergency unit in GhanaCross-sectional nonparticipant observation 338 patients; 49 nurses; 1,332 observationsNonparticipant observation Descriptive statisticsEmergency nursingMedication errors are frequent in emergency units but are not very fatal in nature.Journal of Patient Safety 2.446L6, IIIB4.Asamani et al. (2014)To describe nursing documentation in GhanaRetrospective record review 100 patient care records in 2 hospitalsQuestionnaire Descriptive statisticsManagementNursing documentation is poor in Ghana compared with developed countries as 46% care is not documented. Stakeholders should engage multidisciplinary teams to develop documentation guidelines for nurses.British Journal of NursingL6, IIIB5.Asamani et al. (2016)To explore the leadership style of nurse managers and its influence on job turnover among nursesCross-sectional survey 273 nursing staff in 5 hospitalsQuestionnaire Descriptive and regression analysesManagementNurse managers in Ghana use supportive, achievement-oriented, and participative leadership styles. Nurses have moderate-level job satisfaction, and majority intended to leave the workplace.Journal of Health SciencesL6, IIIB6.Asamani et al. (2016)To examine the influence of nurse manager’s leadership style on nurse’s productivityCross-sectional survey 275 nurses and midwivesQuestionnaire Descriptive and inferential statisticsManagementThere is need to introduce performance standards and monitor the productivity of nurses.British Journal of Healthcare ManagementL6, IIIB7.Atinga et al. (2015)To study the factors related to quality care and to suggest options to improve the delivery of health careCross-sectional 379 emergency patientsQuestionnaire Principal component analysis (PCA)ManagementThe study provided important feedbacks to improve health-care delivery.African Journal of Emergency MedicineL6, IIIB8.Bam et al. (2014)To determine stressors in clinical practice and coping mechanism adopted by nursesQuantitative descriptive 89 nursing studentsQuestionnaire Descriptive statistics using SPSSManagementMany students experienced stressors in clinical settings and used relationship-based coping mechanisms to deal with them. It is recommended that the clinical facility and the nursing institutions collaborate to support students in clinical practice.Journal of Science and TechnologyL6, IIIB9.Bell et al. (2013)To describe the strengths, weaknesses, and the status of undergraduate nursing education in GhanaDescriptive and cross-sectional study. 10 undergraduate students, 3 key faculty membersFocus group, key informant interviews, and nonparticipant observations Thematic analysisEducationThere is faculty shortage, poor physical infrastructure compounded by high levels of preventable diseases and injuries. The understanding of needs, opportunities, and state of undergraduate nursing in Ghana can inform the development of strategies to improve undergraduate nursing education in low-resource countries.Nursing & Health Sciences 1.37L6, IIIB10.Boso and Gross (2015)To assess the perception of nursing educators on critical thinkingCross-sectional survey design 106 nurse educatorsQuestionnaire Descriptive and inferential statisticsEducationCurrent nursing education in Ghana does not prepare the nurses to be critical thinkers. Professional development programs in critical thinking should be organized for practicing nurses.Advances in Medical Education and PracticeL6, IIIB11.Brennan et al. (2013)To test the effectiveness of a 1-day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) program in increasing Ghanaian nurses’ knowledgePreexperimental one-group, pretest, posttest design. 40 nurses from a public teaching hospital in GhanaQuestionnaire & Knowledge Emergency Triage and Treatment (ETAT) instrument Descriptive and inferential statisticsEmergency nursingThe program may increase self-efficacy of pediatric resuscitation and knowledge of pediatric resuscitation.International Nursing Review 1.073L3, IIIB12.Dakwah et al. (2011)To examine the effectiveness of context-based learning on undergraduates’ ability to educate patientComparative quasi-experimental study 22 first-year and 36 third-year nursing studentsHealth Promotion Disease Prevention Inventory Inferential statisticsEducationContext-based learning effective in improving students’ self-efficacy in patient education.Journal of Nursing Education 1.060L3, IIIA13.Danso (2014)To study the exclusive breastfeeding practices among working women in a metropolis in GhanaCross-sectional survey 1,000 working womenQuestionnaire Descriptive statisticsMaternal and child healthFull-time work and family issues make it difficult for working mothers to breastfeed their babies exclusively.International Journal of NursingL6, IIIB14.Donkor and Sandall (2007)To investigate the impact of infertility on womenSurvey 615 women receiving infertility treatmentInterviews Sequential multiple regression analysisReproductive healthHigh levels of stigma are associated with childlessness. Social status derived from other sources helps women to cope with childlessness stigma.Social Science & Medicine 2.814L6, IIIB15.Donkor (2009)To study the exclusive breastfeeding and weaning practices among women in GhanaDescriptive study 60 breastfeeding mothersQuestionnaire Descriptive statisticsMaternal and child healthAbout two third of mothers do exclusive breastfeeding while about one third adds other foods to breast milk. Health workers must educate breastfeeding and expectant mothers to improve exclusive breastfeeding in Ghana.African Journal of Midwifery and Women’s HealthL6, IIIB16.Donkor and Obed (2012)To investigate how much time women spent at the antenatal clinic, contributing factors, and the level of satisfaction with the antenatal practices in GhanaQuantitative descriptive 316 womenQuestionnaire Descriptive statistics using SPSSMaternal and child healthWomen spent about 7 hours at the clinic especially to see the doctor. The women said their waiting time is too long, and about half of them are dissatisfied with it.African Journal of Midwifery and Women’s HealthL6, IIIB17.Dzomeku et al. (2013)To determine the level of satisfaction of patients admitted to a teaching hospital in GhanaDescriptive cross-sectional survey 100 inpatients selected by convenience samplingQuestionnaire Descriptive statisticsManagementMore males were satisfied with care than females. Patients with a higher level of education were less satisfied. The older the patient, the more satisfied they are with care. Patients expected to be treated with dignity, love, and care.International Journal of Research in Medical and Health Sciences 1.08L6, IIIB18.Hammah and Donkor (2013)To investigate the adherence to active management of labor by midwivesQuantitative descriptive 50 midwives working in the labor wardsAMTSL checklist and questionnaire Descriptive statisticsMaternal and child healthMajority of nurses used active management of the third stage of labor. Barriers to the use of active management of labor include shortage of staff, improper training of staff, and poor storage of oxytocin.African Journal of Midwifery and Women’s HealthL6, IIIB19.Ibrahim et al. (2016)To determine differences in child and maternal mortality under cash-and-carry and the national health insurance systemsCross-sectional study 8,312 birth recordsRecord review Inferential statistics (Fisher’s exact tests)ManagementThere is no significant difference in child mortality among mothers of all categories under both cash-and-carry and national health insurance systems. Maternal mortality was reduced by half under the health insurance system. There are more twin deaths in the cash-and-carry system than in the health insurance system.BMC Pregnancy and Childbirth 2.18L6, IIIB20.Moyer et al. (2016)To describe what midwifery student know about respectful care during laborCross-sectional survey 929 final-year studentsQuestionnaire Descriptive and inferential statisticsEducationThe institutions have created an environment that promotes psychosocial care for mothers in labor and make nurses accountable for care given to mothers in labor.Midwifery 1.861L6, IIIB21.Naab et al. (2014)To describe the beliefs of women in Ghana regarding infertility and how it correlated to the sociodemographic statisticsDescriptive cross-sectional survey 203womenQuestionnaire Descriptive statistics (SPSS 18.0)Reproductive healthMajority of the women believed infertility is an acute disorder and they could personally or medically control it. There is the need to explore beliefs of women about infertility that may affect their health behavior.Journal of Infertility and Reproductive BiologyL6, IIIB22.Nakua et al. (2015To assess the burden of musculoskeletal disorder and risk factors with regard to age and gender among elderly GhanaianSurvey 34,124 (aged 50+) and 8,340 (aged 18–49)Questionnaire Descriptive and inferential statisticsGeriatricsWomen suffer from chronic back pain than men in Ghana.BMC Musculoskeletal Disorders 1.684L6, IIIB23.Nakua et al. (2015)To evaluate an intervention to promote skilled obstetric care and related factors involved in the use of unskilled birth attendants during delivery in GhanaCross-sectional survey 50 communities and 400 women for data collectionQuestionnaire Inferential statisticsManagementThere is the need for the skilled obstetricians to be culturally sensitive and demonstrate a good relationship with their clients to promote skilled obstetric care uptake among rural women in Ghana.BMC Pregnancy and Childbirth 2.18L6, IIIB24.Nakua et al. (2015)To study the prevalence of refractive error in high school students in a town in GhanaSurvey 504 children aged 12–17Interview and eye screening test Descriptive and inferential statisticsChild healthChildren in urban areas are at higher risk compared with their rural counterparts. We suggest that an efficient preschool vision examination must be made part of the admission policy of all schools in Ghana.Journal of Science and Technology (Ghana)L6, IIIB25.Owiredu et al. (2008)To examine the relationship between indices of diabetes, cardiovascular risk factors, and morbidity conditions among Pentecostal and charismatic church members in GhanaQuantitative descriptive study 383 church membersPhysical assessment and blood assay Descriptive and inferential statisticsChronic diseasesThere is an increasing association between indices of obesity, the severity of cardiovascular diseases, and comorbidities among the church member in Kumasi.Journal of Medical SciencesL6, IIIB26.Rominski et al. (2016)To find out the factors that are connected with the willingness of midwifery student to provide abortion careSurvey 853 nursing studentsQuestionnaire Multivariate regression analysisReproductive healthStudents are willing to provide abortion care postregistration. It is very important to make sure the midwifery students are well trained to provide abortion services to increase safe abortion care providers in the country.Contraception 2.788L6, IIIB27.Rominski et al. (2011)To explain the functional nursing status and the motivation for further education among emergency nurses in a teaching hospital in GhanaSurvey 77 accident and emergency nursesMCQs, questionnaire open-ended questions, and focus groups Thematic analysisManagementThe nurses are interested in learning to acquire new knowledge, skills, attitudes, and use of modern technology to improve their functions.African Journal of Emergency MedicineL6, IIIB28.Sossah and Asiedu (2015)To investigate stress and stress management among nursing studentsDescriptive cross-sectional study 240 studentsQuestionnaire Descriptive statisticsEducationClinical settings are the highest source of stress for the students. Students use physical activity, emotional, and spiritual support to handle stress.European Journal of Research and Reflection in Educational SciencesL6, IIIBQualitative studies included1.Adipa et al. (2015)To understand nurses’ viewpoints on oxygen administration in emergency unit in GhanaQualitative descriptive 12 nurses purposive sampledInterviews Thematic analysisEmergency nursingNurses need more training on oxygen administration, whereas there is the need to develop protocols on oxygen therapy for nurses in emergency units in Ghana.International Journal of Africa Nursing SciencesL6, Q12.Aziato and Adejumo (2014)Explored the psychosocial factors influencing family caregivers during the care of patients who had undergone surgery and were in painQualitative exploratory 12 family caregivers and 1 key informantInterview Content analysis using NVivo softwareSurgical nursingHealth workers should reinforce postoperative pain management for clients and caregivers. Caregivers should be recognized and included in the care of their clients. Health facilities should recognize observance faith practices for surgical patients in Ghana.Africa Journal of Nursing and MidwiferyL6, Q13.Aziato and Clegg-Lamptey (2014)To study the reactions of women with breast cancer and what influences their care decisionsExploratory descriptive study 12 women with cancerFace-to-face interviews Thematic analysisOncologyOther people, alternative treatment, religion and support, knowledge, and effects on intimacy influence their treatment decisions. Health professionals should find effective ways of counseling and communicate with breast cancer patients.Health Care Women International 0.950L6, Q14.Aziato and Adejumo (2013)To determine why nurses have inadequate knowledge in managing postoperative pain in GhanaEthnographic design 12 nursesInterviews Content analysisSurgical nursingNursing curricula in Ghana should inculcate credit-bearing pain management courses. There should be pain management in-service training programs in place for nurses. There must be regular evaluation of in-service pain management training programs.Nurse Education in Practice 0.964L6,Q15.Aziato and Adejumo (2014)To explore the experiences of preoperative patients in Ghana to improve preoperative careEthnographic design 13 surgical patientsInterviews Content analysisSurgical nursingThere is the need for public and patient education on surgery and its effects on the patient to reduce the negative public perceptions about the surgical procedures.Clinical Nursing Research 1.359L6, Q16.Aziato et al. (2016)To understand pain and aches in older GhanaiansExploratory descriptive phenomenological design 12 participantsInterviews Content analysisGeriatricsCarers for the elderly should learn the age-related changes that contribute to pain. Pain management in the elderly needs an improvement.International Journal of Caring SciencesL6, Q17.Aziato et al. (2014)To understand dysmenorrhea and its effect on high school girlsDescriptive phenomenology 16 high school girlsInterview Thematic content analysisReproductive healthSevere dysmenorrhea has negative effects on high school girls and is misconceived by them. Education of high school girls on dysmenorrhea and effective management processes should be put in place.Reproductive Health 2.035L6, Q18.Aziato and Antwi (2016)To find out what facilitates or inhibits the use of herbal medicine among adults in GhanaInductive exploratory qualitative approach 16 participantsInterview Content analysisHerbal medicineThe deception from the manufacturers and marketers of herbal medicine results in a negative perception about herbal medicine. There is the need to educate the public and ensure that the appropriate herbal medicine products are being patronized.BMC Complementary and Alternative Medicine 1.987L6, Q19.Aziato et al. (2014)To understand coping strategies among adolescent students with dysmenorrheaDescriptive phenomenology 16 high school and university studentsInterview Content analysisReproductive healthSchool clinic and hospitals were attended by students with dysmenorrhea. Health workers have seen negative attitudes toward dysmenorrhea management. Developing the mental ability to manage dysmenorrhea, planning before onset, and spiritual and social support helped students cope with dysmenorrhea.Journal of Pediatric and Adolescent Gynecology 1.605L6, Q110.Aziato et al. (2016)To explore the perceptions and experiences of adolescents who underwent abortionA vignette-based focus group approach 92 adolescent girl aged 10–19 yearsFocus group Participatory approachReproductive healthUnwanted pregnancies in adolescents generate varying reactions from family, friends, and the community. Those reactions determine the whether the pregnancy will be kept or aborted.Journal of Pediatric and Adolescent Gynecology 1.605L6, Q111.Aziato and Odai (2016)To describe the use of herbal medicine in health-care facilities in GhanaDescriptive qualitative design 13 key informantsInterview Content analysisHerbal medicineIt is difficult to get material for the manufacture of herbal medicines. There was an introduction of herbal medicine institutions and regulatory boards to check the quality of the products. Herbal medicine is administered as an adjuvant treatment.Journal of Herbal Medicine 1.200L6, Q112.Aziato et al. (2016)To understand religious beliefs of postpartum women in GhanaDescriptive phenomenological 13 womenInterview Content analysisCultural issues/competenceReligiosity should be taught in nursing schools. Women should be supported to exhibit their religious faith with respect to childbirth.BMC Pregnancy and Childbirth 2.18L6, Q113.Aziato et al. (2016)To gain deeper understanding of midwives perception of pain and their religious believes that influences caring for women in labor painsInterpretive phenomenology 27 Ghanaian female midwivesInterview Colaizzi’s qualitative analysisCultural issues/competenceMidwives should provide the environment for expectant mothers to practice their religious practices regarding labor pains and should take those religious practices into account is caring for these women in labor.Reproductive Health 2.035L6, Q114.Aziato et al. (2016)To explore how nurses feel, cope, and manage painQualitative interpretive design 17 nursesInterview Content analysisManagementNurses believe pain is not pleasant. Being conscious of personal pain experience will make nurses take care of patients in pain effectively.Southern African Journal of Social Work and Social DevelopmentL6, Q115.Bam and Bell (2015)To describe the outcomes of a 5-year implementation of an emergency nursing program in a city in GhanaQualitative descriptive 13 (program graduates, doctors, and facility administrators)Interview Thematic analysisEducationThe program graduate 36 nurses and 26 currently enrolled. The graduates of this program are leading emergency care in Africa.Annals of Global Health 1.417L6, Q116.Bonsu et al. (2014)To study the emotional and psychosocial experiences of women leaving with advanced breast cancer in a city in GhanaQualitative exploratory descriptive design 10 women living with breast cancerInterview Content analysisOncologyBreast cancer-associated pain leads to suicidal ideations. The women received support from friends, family and spiritual leaders and believe God will help them to live well. A multidisciplinary team should be instituted to manage patients with advanced disease. Pain management education is to be given to such women.International Journal of Palliative CareL6, QII17.Donkor and Sandall (2009)To study the coping strategies of women seeking treatment for infertility in GhanaExploratory study 615 women seeking infertility treatmentInterview Descriptive statistics and thematic analysisReproductive healthWomen coped through the support of their husband, their faith in Christianity, their economic achievements, and avoiding situations that reminded them of childlessness.African Journal of Reproductive HealthL6, Q118.Donkor and Andrews (2011)To describe how ethical issues are dealt with in GhanaQualitative descriptive 200 participant nursesQuestionnaire Descriptive statisticsEthicsEthical practice in Ghana does not completely follow the ICN code of ethics; it is influenced by local institutional and cultural practices. Cultural practices augment International Council of Nurses (ICN) code of ethics, whereas some other cultural practices conflict the code.International Nursing Review 1.073L6, Q119.Dzomeku (2011)To determine the level of satisfaction with care of women in labor in GhanaQualitative descriptive/exploratory 12 expectant mothersInterview and focus group discussion Content analysisMaternal and child healthThe rules and regulations guiding practice should be strictly enforced. Midwives need to know the expectations of expectant mothers so they could work to meet them.International Journal of Nursing and MidwiferyL6, Q120.Korsah (2011)To describe facilitating and obstructive factors to therapeutic nurse–patient communicationQualitative descriptive/exploratory 12 nursesInterview Thematic content analysisManagementUse of role-playing in teaching students patient communications facilitates the therapeutic relationship. Nurses must be held accountable for abuse of patients and relatives. Nurses must use reflective practice to evaluate their relationship with patients.Open Journal of NursingL6, Q121.Opare et al. (2016)To explore the needs and the difficulties of community mental health nursesExploratory descriptive qualitative design 13 community psychiatric nursesInterview Thematic analysisMental health nursingPsychiatric nurses had various challenges including logistics, stigmatization, and assault from patients in the community.Pyrex Journal of Nursing and MidwiferyL6, Q122.Rominski et al. (2016)To evaluate the poor treatment of women in labor from midwifery students point of viewQualitative descriptive/exploratory 83 studentsFocus group discussions Thematic analysisMaternal and child healthThe student reported various disrespectful behaviors toward expectant mothers but believe there is the need for the women in labor at the orthodox health-care setting to be treated with respect so as to increase skilled birth attendant rate in Ghana.Health Policy and Planning 2.513L6,Q123.Stevens et al. (2014)To explore the effect and the sustainability of the first pediatric nursing program established in GhanaQualitative descriptive 44 stakeholdersFocus groups and individual interviews Thematic analysisEducationThe program is well aligned with the system-based paradigm of health professional education. It is expected that the system-based approach will be maintained for future designs and recommendations so as to make the program an international example of a human resource for health planning and education.Journal of Nursing Education and PracticeL6, Q1Other studies included1.Aziato and Adejumo (2015)To develop clinical guidelines for postoperative pain management for GhanaMultimethod study 27 experts and stakeholders and 29 member expert consensus forumA systematic review, expert participatory approachesSurgical nursingThe guideline developed with four foci: the relationship between patient and family teaching, teamwork, monitoring and hospital leadership inputs, and application of best practices in postoperative pain management.International Journal of Africa Nursing SciencesL52.Aziato et al. (2015)To develop and validate a postoperative pain assessment toolMixed methods design Qualitative (17 patients and 25 nurses) Quantitative (150 postoperative patients).Qualitative: interviews and focus groups Quantitative: application of three pain scales (0–10 Numeric Rating Scale (NRS); Wong-Baker FACES [FPS] scales; and (Colour-Circle Pain Scale [CCPS]) Content analysis, descriptive statistics, and inferential statisticsSurgical nursingA validated tool for assessing pain in children makes it objective, but pain scales must be developed to take sociocultural factors for the particular context into account.BMC NursingL63.Bell et al. (2014)To develop an emergency nursing program for GhanaMultimethod study Expert groupCurriculum developmentEducationThe 12-month diploma in emergency nursing have been developed with the expected outcomes: “an innovative, interdisciplinary, team-based clinical training model, a unique and low-resource emergency nursing curriculum and a comprehensive and sustainable training program to increase in-country retention of nurses.”International Emergency Nursing 0.974L64.Bell et al. (2014)To develop and validate an assessment tool for trauma care nurses in AfricaMultimethod study Expert groupDelphi technique and pilot testing of instrumentTrauma nursingAn instrument was developed to assess trauma care nurses’ knowledge, attitudes, and skills among emergency nurses in Africa.Lancet Global Health 14.722L65.Aziato (2016)To determine factors influencing female education in GhanaLiterature reviewA focused integrated review approach Content analysisCommunity healthFactors that promote female education should be implemented to encourage females to go to school. The families and the community should take interest in promoting female education.Southern African Journal of Social Work and Social DevelopmentL66.Donkor and Andrews (2011)To discuss the challenges and the opportunities in the current day nursing in GhanaLiterature review Government reports and policy documents on nursing were sourced from official websites and reviewed.Literature search Thematic content analysisManagementThere is the inadequate capacity of nursing institutions to train quality nurses. There is shortage of nurses within hospitals and low morale of nursing faculty. The increased home-based training, international partnership, and human resource development programs are opportunities available to deal with the challenges.International Nursing Review 1.073L67.Appiah (2014)To describe how Ghanaian nurses working in Seventh-Day Adventist hospitals can be more missionary in their practicePosition paperPersonal opinionCultural issues/competenceEvangelism should be included in the nursing training curriculum. Workshops on evangelism should be organized by the hospitals and departments of nursing.Journal of AIIAS Africa Theological AssociationL78.Aziato (2015)To discuss how a failed attempt lead to an outstanding success in a further attempt of PhD in NursingReflexive ethnographicPersonal experienceEducationNurses must take up the challenge to enroll in PhD programs, but adequate support should be made available to them on an individual basis.International Journal of Higher EducationL79.Oware-Gyekye (2015)To expose areas where nursing and midwifery could project their imagePosition paperPersonal opinionManagementNursing in Ghana has a bad image, and nurses have to work to improve it. Professional bodies must get involved in building a good image for nursing. Nurses must get political knowledge and be active in politics of the country; nurses must encourage continuing education and specialization, use the social media to the nurses’ advantage, and organize continuing education programs.West African Journal of NursingL7

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Note. AMTSL = active management of the third stage of labor; MCQs = multiple choice questions; ICN = International Council of Nurses.

Table 2.

Excluded Articles and Reasons for Exclusion.

No.Author(s), YearPurposeMethodology/samplingData collection/analysisNursing specialtyMain findingsJournal/impact factorReasons for exclusion1.Koduah et al. (2016)To explain how national agenda influence health policy development in lower middle-income countriesPosition paperPersonal opinionManagementNational-level decision-makers use their legal framework, financial, and structural authority to influence health sector policy in Ghana.Social Science & Medicine 2.184No nurse author from Ghana2.Nalle and Lasater (2010)Exclude—not research3.Ware Winters-Moorhead (2009)To discuss how study abroad imparts nursing students experiential learningJournal of National Black Nurses AssociationNo nurse author from Ghana4.Tabi et al. (2010)To study how women in polygamous marriages in Ghana cope with issues related to such marriagesQualitative exploratory study 15 married womenInterview Thematic analysisCommunity health/maternal healthInability to conceive for a husband is the major reason women allow husbands to marry other wives to protect their marriage from divorce. Women in polygamous marriages feel lonely, unhappy, compete with other wives for children and intimacy and feel jealous of other wives. Polygamy, however, reduces women’s domestic chores. They cope with befriending cowives and drawing on their religious faith.International Nursing Review 1.073No nurse author from Ghana5.Wikinson and Callister (2010)To explore the perception of Ghanaian women about childbearingFocused ethnography 24 mothers receiving care at the selected clinicInterviews Thematic analysisMaternal healthWomen view childbirth as a dangerous passage, feared witchcraft in delivery.Health Care Women InternationalNo nurse author from Ghana6.Boafo et al. (2015)To record workplace violence and its effect on Ghanaian nursesCross-sectional study 592 professional nursesQuestionnaire Descriptive and inferential statistics using SPSS 20ManagementThe majority of perpetrators of sexual harassment were medical doctors (50%). The majority of perpetrators of sexual harassment were medical doctors (50%). Medical doctors were responsible for 50% of sexual harassment problems. There must be educational programs to inform health-care professional on the effects of sexual harassment. Institutions should have explicit policies in place to deal with sexual harassment.Nursing OpenNo nurse author from Ghana7.Canavan et al. (2016)To estimate the association between prescription practices and medication available for the two most common mental health diagnosis in GhanaRecord review Patient records 7,296: schizophrenia 1,807: epilepsyPatient record review Descriptive and inferential statistics using SAS software, version 9.2 (SASPractice (mental health)Many patients are giving medications corresponding to their diagnosis, but the use of different classes of psychiatric medications and lack of medications in the psychiatric hospitals poses major challenges. There is the need for projects to be instituted to monitor accurate data gathering on mental health practices in Ghana.International Journal of Mental HealthNo nurse author8.Clark et al. (2010)To describe the determinants of the provision of postabortion care among physician and midwives in GhanaSecondary data analysis 1,448 health service providers selected from each of the 428 health facilitiesSurvey data Descriptive and inferential statisticsPractice (reproductive health)Midwives give an efficient cost-effective postabortion care (PAC) to females to reduce maternal mortality, but this produces yields less than that of physicians as a result of some barriers to the provision of PAC by midwives in public hospitals. Physicians restrict nurses from doing uterine evacuation so as to receive the financial gains of it. Private-sector midwives do better in PAC than public-sector midwives.Journal of Midwifery and Women’s Health 1.432No nurse author9.Ibrahim et al. (2015)To determine the differences in low birth weight children under cash-and-carry and national health insurance system in northern GhanaRetrospective static group comparison design 1,433 infant delivery recordsDocument analysis Inferential statisticsManagement Practice (maternal and child health)The rate of low birth weight babies born in the cash-and-carry system dropped by a significant margin (927%) under the health insurance system.Maternal and Child Health Journal 1.917No nurse author10.Lori et al. (2015)To examine how often sharp injuries happen and how nursing staff know and do when exposed to sharp injuries in an emergency department of a hospital in GhanaMixed method descriptive study 45 nursing staff 3 nursing administrators Hospital policy/proceduresInterviews, survey, and document review Descriptive statisticsManagement Practice (safety)More than one quarter of nurses were exposed to sharp injuries. Nursing staff was educated on the risk of sharps injuries and the protocol to follow when exposed. Only a small number of nurses could state the processes to follow when exposed.International Emergency Nursing 0.974No nurse author11.Martel et al. (2014)To describe the status of postgraduate emergency health professional education in Ghana and the opportunity to establish a licensing authority for emergency physiciansQualitative descriptive Postgraduate emergency education programs in GhanaProgram evaluationEducationThere has been a great achievement in the development of emergency care professional training in Ghana, leading to the accreditation of emergency nursing training program and extension of emergency medical care to all 10 regions of Ghana.Journal of Emergency Medicine 1.238No nurse author from Ghana12.Mill and Ogilvie (2003)To discuss the methodological decision leading to rigor in qualitative research through literature review and discuss criteria used in determining rigor in qualitative researchA participatory action research design was used. 17 Ghanaian women were used in the study.Interview and focus group discussions Thematic analysisParticipatory action research provided a flexible, socially and culturally adaptable framework to guide this international research project.Journal of Advanced Nursing 1.917No nurse author from Ghana13.Raingruber et al. (2010)To explore Ghanaian sex workers’ knowledge on HIV/AIDS and challenges related to sex work.Qualitative descriptivePractice (community health)The sex workers think sex work is hard, but God will protect their health. They believe stigma is a real thing, but sex work gives them autonomy.Issues in Mental Health Nursing 0.990No nurse author from Ghana14.Adeyinka et al. (2008)To examine how nursing mothers breastfeed in two West African countriesDescriptive survey 300 nursing mothers attending antenatal clinic were randomly selectedQuestionnaire Inferential statisticsMaternal and child healthLatest information on breastfeeding practices should be provided to the nursing mothers. Peer support should be provided to the breastfeeding mothers. Mobile technology and the media should be innovatively used in educating the nursing mothers. Documents should be translated into local languages for the mothers.Pakistan Journal of NutritionNo nurse author from Ghana15.Amoakoh-Coleman et al. (2016)To discuss resourcing of public health centers and center compliance to antenatal principlesCross-sectional analysis 946 pregnant womenRecord review and facility audit Inferential statisticsManagementHealth-care providers should seek to understand the barriers to their adherence to guidelines at the public health centers.BMC Health Services Research 1.606No nurse author from Ghana16.Appiah and Chigozie (2014)To investigate the perceptions and challenges of exclusive breastfeeding on nursing mothersCross-sectional descriptive study 80 nursing mothers in a city in GhanaQuestionnaire Descriptive statistics using SPSSMaternal and child healthEducation on exclusive breastfeeding must be expanded to cover nursing mothers who have limited ability or cannot read or write.International Journal of Agriculture and Rural DevelopmentNo nurse author from Ghana17.Quartey and Kwakye (2009)To determine why nurses emigrate and the overall benefit of travelingSurvey 200 Ghanaian trained nurse (100 from Ghana, 100 from the UK)Questionnaire Descriptive statistics and cost-benefit analysisManagementTraveling of nurses to practice outside Ghana brings positive financial impact on Ghana but produces negative social impact such as increased mortality due to the nursing shortage.Ghana Social Science JournalNo nurse author from Ghana18.Keelson and Donkor (2014)To study how locum nursing could reduce nursing workload and improve health-care deliverySurvey approach 250 locum nursesQuestionnaire Descriptive statisticsManagementLocum nurses are not enough in Ghana, whereas the limited numbers contribute to reducing nursing shortage and improving health-care delivery in Ghana.Australian Journal of Business and Management ResearchNo nurse author from Ghana19.Yakong et al. (2010)The aim of this part of the study was to describe rural women’s perspectives on their experiences in seeking reproductive care from professional nursesQualitative descriptive 27 Ghanaian womenInterview, focus groups, and participant observation Thematic analysesMaternal healthNursing education in Ghana must place emphasis on basic relational practices. Structural changes to health clinics and routine nursing practices are necessary to create conditions for privacy to address women’s health concerns. Women’s perspectives must be considered for service improvement. Further research is needed to examine nurses’ perspectives on relational care.Journal of Advanced Nursing 1.917No nurse author from Ghana20.Amu and Nyarko (2016)To assess how prepared health workers are in preventing maternal mortality in GhanaQualitative descriptive 12 health workersInterview Thematic analysisMaternal healthGhana health service should provide more human and material resources for effective service delivery.BMC Health Services Research 1.606No nurse author from Ghana21.Ackatia-Armah et al. (2016)To explain how mothers develop reflective trust in community health workersEthnography 39 nursing mothers, 10 health workersObservations interviews and focus group discussions Thematic analysisCommunity healthHealth-care practice and training should be done in a way to earn the trust of the community served. Community health training should be context specific to gaining trust from nursing mothers.Social Science & Medicine 2.814No nurse author from Ghana22.Pomevor and Adomah-Afari (2016)To examine the quality of human resource available for neonatal care and the perception of health workers on quality neonatal care in GhanaQualitative descriptive Midwives and hospital documentsInterview, observation, and documentary review Thematic analysisManagementHealth-care providers were worried about the shortage of staff, staff competence, the limited and poor state of instruments, and personal protective equipment available for use. The health-care stakeholders must redirect their attention to issues relating to quality neonatal care in Ghana and other countries of similar concerns.International Journal of Health Care Quality AssuranceNo nurse author from Ghana23.Osafo et al. (2012)To understand how health professionals behave toward suicidal patients and how they prevent suicides in GhanaQualitative descriptive 17 informants (9 clinical psychologists and 8 emergency ward nurses)Semistructured interviews Thematic analysisMental health nursingThe behavior of health workers toward suicide is based on two main concepts: morality and mental health. The psychologists believe suicide is mental illness, whereas nurses believe it is a crime. Nurses believe talking to suicidal patients, making legal laws against committing suicide, and use of religious coercion are ways in preventing suicide.International Journal of Nursing Studies 3.561No nurse author from Ghana24.Adu-Gyamfi and Brenya (2016)To review the literature on Florence Nightingale and nature of nursing from the Colonial period and examine the activities and interactions of nurses with patients in a city in GhanaLiterature reviewLiterature search Thematic content analysisManagementChallenges faced by nursing in Ghana today do not differ from those faced by Nightingales and therefore the need for Ghanaian nurses to emulate Nightingale.International Scholarly Research NoticesNo nurse author from Ghana

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Critical Appraisal

The 84 studies were extracted onto the data matrix as shown in Tables 1 and ​and2.2. The content of the matrix was evaluated by three reviewers, one serving as the adjudicator on the studies when the other two reviewers disagreed on including a study. The three reviewers had extensive experience in integrative and scoping literature review. Two of the reviewers had published a peer-reviewed study on integrative literature review methodology.

Evidence level and quality of studies

As applied by Kpodo et al. (2016), a combination of evidence level described by Ackley, Ladwig, Swan, and Tucker (2008) and the quality grading system applied by Maree and Schmollgruber (2014) were used to describe the quality of studies included in the review. For example, a cross-sectional survey conducted by Boso and Gross (2015) was graded as Level VI (L6), Grade IIIB as it is a descriptive study (Ackley et al., 2008) and included a well-calculated sample size and standard definition of outcome variables (Maree & Schmollgruber, 2014). The details of the grading system are presented in Table 3.

Table 3.

Evidence Level and Quality Rating Scales.

Evidence level (Ackley et al., 2008)Level IStudies are systematic reviews of randomized controlled trialsLevel IIStudies are from a well-designed single randomized control trialsLevel IIIStudies from well-designed control trial in which there was no randomization of the subject and quasi-experimental studiesLevel IVEvidence from well-designed case-control trialsLevel VEvidence from a systematic review of descriptive and qualitative studies is assignedLevel VIDescriptive and qualitative studies are assignedLevel VIIStudies from expert opinion and authorities in any field of study are assignedQuantitative study grading system developed by Mann (Molassiotis et al., 2006).Grade IARandomized controlled trial where the sample size has been calculated and an accurate, standard definition of outcome variables is providedGrade IBRandomized controlled trial providing only the standard definition of outcome variablesGrade ICRandomized controlled trial that does not include the previously mentioned criteriaGrade IIAProspective studies with a comparison group or retrospective studies with controls clarifying confounding variables where the sample size has been calculated and an accurate standard definition of outcome variables and adjustment for the effects of important variables are includedGrade IIBStudies having at least one of the criteria for a Grade IIA studyGrade IIIAAll other studies containing a comparison group, calculated sample size, and accurate standard definition of outcome variablesGrade IIIBAll other studies including at least one of the criteria of Grade IIIAGrade IIICAll other studies that do not include any of the previously mentioned criteriaQualitative study rating scales (Cesario, Morin, and Santa-Donato, 1996) Studies are graded with a 10-item scale: 0 (no evidence), 1 (poor evidence), 2 (fair evidence) and 3 (good evidence).QIGood quality: scores between 22.5 and 30QIIFair quality: scores of 15 to 22.4QIIIPoor quality: scores less than 15

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Source: Kpodo et al. (2016); Maree and Schmollgruber (2014).

Results

Quality of Studies Included

The majority (92.86%) of the quantitative studies included in this study were Evidence Level VI and Quality Level IIB. Two (7.14%) of the studies were at Level III (one with Quality Grade IIIA and the other IIIB). Thus, the highest level of evidence included in this study was at Level III and Quality Grade IIIA. All the 23 qualitative studies included in this study were of Evidence Level VI (Table 3). Twenty-two (95.65%) of them were of good quality (QI) whereas one was of fair quality (QII; Kpodo et al., 2016; Maree & Schmollgruber, 2014; Molassiotis et al., 2006). The evidence level of the other studies included ranged from Level V to Level VII. Their quality had not been evaluated, but the researchers reached consensus on their importance for inclusion in this study.

Yearly Trend in Publication

In 2007 and 2008, only one article each year was published. There was no study included for the year 2010. Publication increased in 2011 and sharply dropped in 2012 in which only one study was recorded. From 2012 to 2016, there was an encouraging increase in nursing research publication with 2016 recording the highest (16) out of the 60 articles included in this study (Figure 2).

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Figure 2.

Yearly trend in publications over the decade (2007–2016).

Studies Included

Out of the 60 studies included in this review, 28 were quantitative studies, 23 qualitative, 3 were multimethod studies, 1 was a mixed method study, 2 were literature reviews, and 3 were expert opinion and experiences.

Quantitative studies

The quantitative studies included were mostly (85.71%) cross-sectional surveys and quantitative descriptive studies. Two (7.14%) were retrospective record reviews, whereas one (3.57%) each were pretest–posttest and comparative quasi-experimental studies.

A total of 59,246 subjects were used in this study out of which 55,174 were patients, 3,199 were nursing students, 764 were nurses and midwives, and 109 nurse educators.

The majority (10) of the studies were in the area of nursing management and administration, 6 in nursing education, 5 in maternal and child health, 3 on female reproductive health, 2 on emergency nursing, and 1 each in the areas of chronic diseases and geriatrics.

Qualitative studies

Out of the 23 qualitative studies, 5 were descriptive, 6 exploratory descriptive, 4 exploratory, 2 ethnographic, 2 descriptive phenomenological, 1 interpretive phenomenological, 1 interpretive, 1 explanatory descriptive ethnography, and 1 vignette-based focus group approach. There were 1,284 subjects recorded in the qualitative studies, 96 of whom were students and 293 nurses and midwives.

Other studies

Other studies included were three multimethod studies, one mixed method study, two literature reviews, and three expert opinions. These studies recorded 248 subjects. Two studies were published on surgical nursing, two in education, two in management, one in trauma nursing, one in community health, and one in cultural issues.

Authorship and Collaborations

Figures 3, ​,4,4, and ​and55 show the distribution of the 219 authors and 120 institutions who published the 60 articles included in this study. There were more Ghanaian nursing researchers from institutions located in Ghana authoring the studies than authors from institutions outside Ghana. The location in Ghana was important for evaluation of the contextual relevance of the studies.

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Figure 3.

Distribution of authors.

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Figure 4.

Distribution of institutional affiliation of authors.

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Figure 5.

Distribution of principal (first) authorship of studies included.

Impact Factor of Journals Published

Out of the 60 articles included in this study, 27 (45%) were published in journals listed on 2016 Thomson Reuters journal citation report with impact factor (Thomson Reuters, 2016). The impact factor of the journals published ranged from 14.722 (The Lancet Global Health) to 0.950 (Health Care for Women International). Assuming nursing research in Ghana was cited according to the Thomson Reuters impact factor calculations, the probability of nursing research from Ghana being cited was 0.97, that is the sum of impact factors of journals published (58.228) divided by the total number of articles included in this study (60).

Discussion

Nursing research publication is increasing in Ghana just as that of sub-Saharan Africa (Adejumo & Lekalakala-Mokgele, 2009; Kpodo et al., 2016). Even though there is a steady increase in publication of studies in the country, there is more room for improvement in research output. Limited opportunities for postgraduate nursing education and the nonexistence of doctoral nursing program in Ghana at the time of submission of this article are contributory factors to the low research output in Ghana. Contrary to the findings of Sun and Larson (2015) and in concordance with findings from Maree and Schmollgruber (2014), the majority of nursing publications in Ghana were quantitative. The majority of the nursing research in Ghana, however, was exploratory and descriptive, indicating that nursing research was at the developing stage in Ghana (Sun & Larson, 2015).

The highest level of evidence included in this study was Level III (quasi-experimental studies), whereas the majority were of Level VI (descriptive and qualitative studies). Similar levels of evidence were evident in sub-Saharan Africa-wide review conducted by Kpodo et al. (2016). This may be due to the seemingly high use of Heideggerian interpretive research paradigm in nursing (Weaver & Olson, 2006).

Major research areas in nursing in Ghana were education and administration, which was incongruous to the research priority areas recommended by Tlou (1998). Nursing is a practice-based profession; therefore, much focus needs to be placed on clinical research in the country to influence the promotion of evidence-based practice (Sun & Larson, 2015). With the majority of the subjects for the studies included being patients, it was very important for the studies to be directed toward influencing clinical practice to improve the health and well-being of the patients.

Even though the number of peer-reviewed nursing research publications was increasing in Ghana, the majority of the studies were published in journals without impact factor and journals not rated by the Thomson Reuters journal citation result. This was a result of the unavailability of nursing policy or strategy on research dissemination by the Ministry of Education of Ghana (Center for Innovation in Research and Teaching, 2017; World Health Organization, 2014; Yale Center for Clinical Investigation. (2011). Strategies for disseminating research findings. Retrieved from https://depts.washington.edu/ccph/pdf_files/CARE_Dissemination_Strategies_FINAL_eversion.pdf.

Who made a significant contribution to nursing by authorizing notes on nursing?

Which early nursing leader made significant contributions?

Who contributed to the development of nursing?

Who were the important contributors to the nursing profession?