Reviewers of our journal's manuscripts contribute immensely to the quality and standards of the papers we publish. On behalf of the Editorial Board, we thank all the reviewers who generously contributed their time, expertise, and thoughtful critique to our peer review process when called upon in 2025.
Objectives:To examine the association between physical activity (PA) and knowledge of PA recommendations, sociodemographic, and behavioural characteristics among adults attending the outpatient department of a secondary health facility. Design:Cross-sectional using a multi-stage sampling method. Setting:Outpatient department of a secondary health facility. Participants:Adults aged 18 years and older attending the outpatient department of a secondary health facility. Main outcome Measures:Global Physical Activity Questionnaire (GPAQ). Results:Of 480 participants, the majority were females (57.7%), had a healthy weight (63.3%), were unmarried (44.6%), and had at least one child (58.5%). Less than half of the participants were in the pre-contemplation stage (30.8%), had adequate knowledge of physical activity recommendations (17.1%), and met recommended physical activity levels (46.3%). Females (Odds Ratio (OR) = 0.40, 95% Confidence Interval (CI) = 0.24-0.67, p < 0.001), older adults (OR = 0.23, 95% CI = 0.08-0.64, p = 0.005), people with high sedentary behaviour (OR = 0.47, 95%CI = 0.22-0.95, p = 0.036) and people in the pre-contemplation stage (reference) were less likely to engage in physical activity. Conclusions:Engaging in physical activity is strongly influenced by age, gender, sedentary behaviour, and stages of behaviour change. These determinants should be considered in interventions for promoting physical activity among community-dwelling adults. Funding:None declared.
Gaucher disease is a rare inherited disorder caused by a deficiency of the lysosomal enzyme β-glucocerebrosidase, leading to the accumulation of glucocerebroside within macrophages. This accumulation results in a wide spectrum of clinical manifestations, which may be life-threatening in severe cases. We report the first documented case in Senegal of a patient with Gaucher disease successfully treated with enzyme replacement therapy. The diagnosis was established based on characteristic bone marrow findings showing Gaucher cells, together with markedly reduced β-glucocerebrosidase activity and elevated chitotriosidase levels. The disease was diagnosed at the age of 11 years, and regular intravenous enzyme replacement therapy was initiated. Treatment was well tolerated and resulted in significant clinical improvement and a marked enhancement in the patient's quality of life. However, genetic confirmation by GBA1 mutation analysis could not be performed due to limited access to molecular testing, which represents an important limitation of this report and prevented precise molecular classification of the disease. This case highlights the importance of early diagnosis and timely initiation of enzyme replacement therapy to prevent severe complications in Gaucher disease. Long-term follow-up studies remain necessary to further evaluate the efficacy and safety of enzyme replacement therapy in this setting. Funding:None declared.
Objective:To determine the prevalence and distribution of human coronaviruses among persons presenting with respiratory symptoms during the COVID-19 pandemic in Ghana. Design:A retrospective cross-sectional study. Setting:Outpatients and inpatients with respiratory tract infections during the COVID-19 pandemic in Ghana. Participants:A total of 350 samples were collected from persons presenting with respiratory symptoms between July and December 2021. These samples were previously tested and confirmed negative for both SARS-CoV-2 and influenza viruses. Intervention:None. Main outcome:It was expected that human coronaviruses (HCoVs) 229E, NL63, OC43, and HKU1 would be detected among SARS-CoV-2 and influenza-negative patients presenting with respiratory symptoms. Results:Of the 350 samples analysed, HCoVs were detected in 123 (35%). Among these, 83% (102/123) were from outpatients, with 17% (21/123) from inpatients. The distribution of specific HCoVs was as follows: 22% (78/350) tested positive for NL63, 5% (18/350) for OC43, 4% (14/350) for HKU1, and 4% (13/350) for 229E. The highest detection rate was observed in the 15-24-year age group, accounting for 46% (56/123) of positive cases, followed by the 25-44-year group at 29% (36/123). The lowest detection rate was noted in infants under 1 year old. Additionally, eight cases (2%) showed co-detections of different HCoVs, with NL63 co-infections being the most common. Conclusion:HCoVs 229E, NL63, OC43, and HKU1 were prevalent in our study population. This study underscores the importance of differential diagnoses for respiratory viruses with pandemic potential. Funding:This study was funded by a fellowship from the West African Genetic Medicine Centre (WAGMC/2021/0009).
Objectives:To compare transvaginal sonographic cervical assessment and Bishop Score (BS) in predicting successful induction (vaginal delivery within 24 hours) among low-risk postdate pregnancies (late term and post-term) induced at a tertiary hospital in Ghana. Design:An analytical cross-sectional study conducted between 2022 and 2023. Participants:Women with low-risk post-date pregnancies admitted for induction of labour. Transvaginal sonographic cervical assessment and BS were done for participants before the start of induction. Main outcome measures:The predictive abilities of the transvaginal sonographic cervical length (TVSCL), the BS and the posterior cervical angle (PCA) in predicting vaginal delivery. Results:Of 184 women recruited, 168 were included in the final analysis. The rate of vaginal delivery was 82.1%. Successful induction occurred in 117/168 participants (69.9%) [CI:62.1-76.5]. TVSCL ≤ 2.5cm was comparable in accuracy with BS ≥ 4 in predicting vaginal delivery. For predicting vaginal delivery within 24 hours, the accuracy of the PCA at ≥ 106 was marginally higher than the BS [AUC: 62.3; 61.0], although both were statistically significant. 95% of women preferred transvaginal sonographic assessment. Conclusion:BS and transvaginal sonographic assessment were comparable in predicting delivery when used for pre-induction cervical assessment. Transvaginal sonographic cervical assessment was better tolerated. Funding:None declared.
Objective:To determine the agreement and diagnostic accuracy of retinoscopy, subjective and autorefraction among young adults in a sampled Ghanaian population. Design:A descriptive cross-sectional design. Setting:Optometry Department of Bishop Ackom Memorial Christian Eye Centre, Cape Coast, Ghana. Participants:Refractive error data were obtained from 100 adults aged 18-35 years (200 eyes)using autorefraction, retinoscopy and subjective refraction. Main outcome measures:Spherical equivalent, J0 and J45 values, and sensitivity and specificity for myopia and hyperopia detection. Results:The mean age was 23.38 ± 4.39 years, 61% females. This study used Bland-Altman analysis and intraclass correlation to compare refractive techniques. For spherical equivalents, retinoscopy and subjective refraction yielded high agreement (ICC=0.9), and autorefraction and subjective refraction exhibited significant agreement (ICC=0.8, p < 0.001). Retinoscopy and subjective refraction showed a significant correlation (ICC = 0.81, p < 0.001). Similarly, autorefraction and subjective refraction for J0 correlated (ICC=0.67, p < 0.001), and retinoscopy and subjective refraction showed low agreement on the J45 axis (ICC=0.01, p=0.48). Autorefraction and subjective refraction were weakly but significantly correlated (ICC=0.22, p < 0.001). The specificity and sensitivity of retinoscopy in detecting myopia are similar to those of autorefraction. The accuracy of retinoscopy was greater than that of autorefraction in detecting myopia. However, retinoscopy and autorefraction demonstrated equal accuracy in detecting hyperopia. Conclusion:In young adults, retinoscopy shows strong agreement with subjective refraction, demonstrating its consistency in evaluating spherical equivalents and the J0 axis. Although efficient, autorefraction showed reduced precision and less consistency for J45 axis determination. Funding:None declared.
Objectives:The primary goal of treatment of metastatic breast cancer (MBC) is to improve patients' quality of life (QoL). This study aimed to explore the expectations of patients with metastatic breast cancer receiving systemic therapy. Design:A longitudinal qualitative approach was used in this study. Setting:The study was conducted in the breast clinic and the oncology department of a tertiary facility in Ghana. Participants:Fifty-six (56) women diagnosed with MBC aged between 18 and 75 years participated in the study. Intervention:In-depth interviews were conducted to explore participants' expectations regarding the systemic treatment they received before its initiation and 3 months after its initiation. The data was analysed thematically. Results:At the start of treatment, participants expected to be healed or cured, to avoid death, to experience improvement in their symptoms, and to be able to perform their usual functions/roles. At three months follow-up, 50% of the women had died. Of the 28 who were alive, some had experienced improvement in their symptoms, some had no change, and others had deteriorated. The cost of treatment was a concern. Conclusion:Women with MBC have unfeasible expectations of a cure from the treatment they receive. After starting systemic treatment for their disease, symptoms improved for some participants, while others deteriorated. Mortality among women with MBC is high. Funding:None declared.
Objective:To determine the sociodemographic characteristics, risk factors, treatment outcomes and predictors of death of newly diagnosed patients with venous thromboembolism (VTE). Design:A retrospective study. Settings:University of Ghana Medical Centre (UGMC) Ltd, a 650-bed quaternary hospital located in Accra, Ghana. Participants:One hundred and eighty-six adult patients admitted with a diagnosis of deep vein thrombosis and pulmonary embolism (PE), confirmed by Computed tomography pulmonary angiography (CTPA), from January 2022 to April 2024, were included in this study. All patients with a differential diagnosis of DVT or PE for whom confirmation by Doppler USG and CTPA could not be obtained were excluded. Main outcome measure:Risk factors, treatment outcomes and predictors of death of patients diagnosed with venous thromboembolism. Results:The mean age of study participants was 62.7 years (±15.5), and a slightly higher proportion were female (n=108, 58.1%). The mortality rate was 16.3%. Close to half of the patients (n=88, 47.3%) had a history of immobilisation as the predominant risk factor for VTE. On multivariate analysis, increasing age (OR 1.04, 95% CI 1.00-1.08), increasing urea level (OR 1.12, 95% CI 1.03 - 1.21) and presence of cancer (OR 6.02, 95% CI 0.003) remained significant predictors of mortality. Conclusion:Immobilisation was the main risk factor for VTE in this study. In-hospital mortality was relatively high, with death in 1 in 6 patients diagnosed. Patients with advanced age, high urea and malignancy should be monitored closely and early aggressive treatment instituted to reduce mortality. Funding:None declared.
Ghana's pursuit of a national electronic health record (EHR) system dates back over a decade before the introduction of the Lightwave Health Information Management System (LHIMS). In 2010, the Ministry of Health launched the National e-Health Strategy, which explicitly called for the application of information and communication technologies to improve health-system performance and service efficiency.1 The strategy identified the lack of interoperability, fragmented hospital data silos, and manual patient records as critical barriers. It therefore proposes a national e-health architecture grounded in shared standards and enhanced coordination between public and private providers. It also emphasised that early e-health initiatives were small, uncoordinated pilots and highlighted the need for a unified national platform for patient information.
Objectives:This study assessed the effects of 12-week green tea supplementation on fertility hormones and oxidative stress markers in obese males with varying gonadal statuses. Design:A 12-week interventional study measuring hormonal and oxidative stress changes pre- and post-supplementation. Setting:Conducted in Onitsha, Anambra State, involving community-dwelling obese males categorised by gonadal status. Participants:One hundred obese males (aged 29-50) were categorised into Eugonadism, Compensatory Hypogonadism, and Hypergonadotropic Hypogonadism groups. Normal-weight eugonadic males served as controls. Participants were selected based on BMI and gonadal hormone levels. Interventions:Participants consumed two bags of green tea infused in 150 mL of boiled water daily for 12 weeks. Blood samples were collected at baseline, 1 month, and 2 months. Hormonal levels: luteinising hormone (LH), Follicle Stimulating Hormone (FSH), prolactin, testosterone, and oestradiol were measured using ELISA, while oxidative stress markers: malondialdehyde (MDA), total antioxidant capacity (TAC), and glutathione peroxidase (GPx) were analysed colourimetrically. Main outcome measures:changes in oxidative stress markers and reproductive hormone levels post-supplementation. Results:Obese participants had significantly higher MDA and lower TAC and GPx than controls (p<0.05). Green tea significantly reduced MDA, oestradiol, and prolactin, whereas it increased TAC, GPx, and testosterone (p < 0.05). LH and FSH were normalised in Eugonadic and Compensatory Hypogonadic groups but remained elevated in Hypergonadotropic Hypogonadism. Conclusions:Green tea supplementation reduced oxidative stress and improved hormonal balance in obese males, suggesting its potential for managing obesity-related reproductive dysfunction. Further studies should explore long-term effects. Funding:
Objective:To determine the context-specific perceived facilitators and barriers to routine utilisation of standardised outcome measures (SOMs) by physiotherapists (PTs) in Namibia. Design:Questionnaire-based cross-sectional survey. Setting:Private or public clinics/hospitals in Namibia. Participants:Practising physiotherapists. Main outcome measures:The study evaluated "routine" utilisation of SOMs operationally defined as using SOMs for 70% to 100% of the time in clinical practice. The study also determined the perceived facilitators and barriers to the routine utilisation. Results:Of the 99 respondents, 96 (96.9%) had complete questionnaires. The majority of participants were female (n=64, 66.7%), had a Bachelor's degree (n=86, 89.6%), trained outside Namibia (n=82, 85.4%), and were practising as private practitioners (n=74, 77.1%). About half of the participants (n=47, 49.0%) "routinely" used SOMs, especially impairment-based tools. The most common reasons for SOMs utilisation were tool affordability and availability. However, about a quarter (n=41, 43.6%) were strongly deterred from using SOMs because of the language of construction of the tool, whilst 36.2% (n=34) highlighted that most SOMs had a higher reading proficiency than the patient population. Time-related barriers were also perceived by 34.0% (n=32) of the participants. Conclusions:Routine utilisation of SOMs by PTs is below average in Namibia, primarily due to tool-related factors, such as the language of construction. Funding:None declared.
Objective:To determine the seroprevalence and risk factors associated with hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV) infection in rural haemodialysis patients at the Franceville haemodialysis centre in Gabon. Design:Retrospective, descriptive and analytical study using exhaustive sampling. Setting:Study conducted in a rural setting at the Franceville haemodialysis centre. Participants:One hundred nineteen records of haemodialysis patients in whom HBV, HCV and HIV serologies were performed. Four incomplete files were excluded. Main Outcome Measures:Viral infection, frequency of socioclinical characteristics, and univariate analysis. Results:One hundred and fifteen haemodialysis patients were included, 70 men and 45 women. The mean age was 46.64±18.74 years. The seroprevalence of infection was 1.74%, 4.35% and 12.17% for HBV, HCV and HIV, respectively. HBV infection was associated with previous dialysis (p=0.000; OR: 36.667; 95% CI [1.825-736.304]), duration of dialysis (p=0.019; OR: 0.055; 95% CI [0.003-11.324]), elevated transaminases (p=0.000; OR:112; 95% CI [3.738-3355.535]), and initial nephropathy (p=0.0157; OR:15.149; 95% CI [0.853-268.535]). HCV infection was associated with elevated transaminases (p=0.001; OR: 27.25; 95% CI [1.432-518.553]) and incident kidney disease (p=0.039; OR: 8.916; 95% CI [0.751-105.791]). HIV infection was associated with incident kidney disease (p=0.000; OR:6.852; 95% CI [1.982-23.689]). Conclusion:A low seroprevalence of HBV, HCV and a moderate seroprevalence of HIV infection has been reported in haemodialysis patients. Certain factors are associated with these infections. Systematic vaccination against HBV, responsible sexual behaviour and current and future strict hygiene measures will help to reduce viral infections in dialysis. Funding:None declared.
Objectives:To describe the epidemiology of paediatric ocular trauma (POT) presenting at a tertiary health institution in Ghana and factors influencing visual outcome. Design:Prospective study. Setting:Korle-Bu Teaching Hospital, Accra, Ghana. Participants:Children aged 0-15 years presenting with trauma involving the globe and/or adnexa from January 2022 to February 2023. Interventions:Clinical management of ocular trauma. Main outcome measures:best-corrected visual acuity at 6 weeks, and factors influencing visual outcome. Results:A significant proportion of children (59.2%) presenting with trauma were between ages 6-10 years (mean age 7.2±3.3 years), with the majority being male (70%). There was no caregiver at the time of injury in most cases (76%). Globe injuries were predominant (78.6%), and most (56.3%) were open globe injuries (OGIs). OGIs and organic objects as causes of injury were associated with unfavourable visual outcomes (p < 0.05). Early presentation, an inorganic object as the cause of injury, a favourable presenting visual acuity, a closed-globe injury, and a higher Paediatric Ocular Trauma Score (POTS) were associated with a favourable visual outcome. A third of children were blind (best-corrected visual acuity < 3/60) in the affected eye at follow-up. Conclusion:Open globe injuries were the most common type of injury and often resulted in poor visual outcomes. Better public awareness, caregiver education, and adult supervision can help prevent these injuries. Funding:None declared.
Objective:To explore the caregiving burden of caregivers of children with Sickle Cell Disease (SCD) to provide a foundation for policy interventions. Design:A qualitative study based on convenience sampling. Setting:The Sickle Cell Clinic of the Paediatric Department of a secondary health facility. Participants:Primary caregivers of children with SCD who had been attending the clinic for at least one year were included. Caregivers whose children had another chronic illness were excluded to avoid confounding. Eleven care-givers participated in the study. Interventions:No intervention. Main outcome measures:Caregiving burden among participants caring for children with Sickle Cell Disease (SCD). Results:The four main themes that emerged from the study were the financial, psychological, social, and physical burdens of caregiving. The financial and psychological burdens were noted to have the most substantial impact on their quality of life. Conclusion:Addressing the needs of caregivers of children with SCD goes beyond financial support. Providing psychological interventions is crucial to alleviating the emotional burden of the disease on caregivers. The study revealed the multifaceted challenges faced by caregivers; hence, the need for a holistic approach to support families affected by SCD in Ghana. Funding:None declared.
Objective:To determine mental health literacy levels and their predictors among primary health care workers across Nigeria's five geopolitical zones, and to identify common patient presentations and rates of suspected psychological illness. Design:A cross-sectional, mixed-methods study using a census method. Setting:The National Refresher Course Centre of the National Association of Community Health Practitioners of Nigeria, held at Wesley University, Ondo State. Participants:66 members of the National Association of Community Health Practitioners of Nigeria. Interventions:A semi-structured questionnaire to collect socio-demographic data and Focus Group Discussions were also conducted among Community Health Practitioners in each zone. Main outcome measures:Mental health literacy and the predictors. Results:Mental health literacy among primary health care workers was low, with only 12.1% demonstrating above-average knowledge, mainly associated with longer work experience and a family history of mental illness. Patients commonly presented with physical complaints and symptoms such as fever, headache, insomnia, weight loss, and weakness, while underlying mental health conditions like anxiety, depression, and substance use disorders were often unrecognised. Routine mental health assessment was rare, and referrals to psychiatric services were infrequent, with most workers reporting only two to three referrals in the past year. Conclusion:The mental health literacy of primary health care workers in Nigeria is critically low, highlighting an urgent need for extensive capacity building to improve the detection of psychological illness for comprehensive healthcare delivery. Funding:None declared.
Objective:The purpose of this study was to assess health staff's knowledge and facility compliance with the World Health Organisation (WHO) treatment guidelines for Severe Acute Malnutrition (SAM) in selected hospitals in the Volta Region of Ghana. Design:This study employed a cross-sectional design. Setting:Three hospitals in the Volta Region of Ghana: Ho Municipal Hospital, Ho Teaching Hospital and Adidome Government Hospital. Participants:All health staff, including doctors, dietitians, nurses, and health assistants/health aides, involved in the treatment of SAM in the pediatric wards of the selected hospitals (70 in all). Main outcome measure:Health staff's training and knowledge of the WHO protocol for management of SAM, as well as their facility's compliance with the feeding aspect of the WHO protocol. Results:Majority of respondents (84%) had adequate knowledge of the WHO protocol, whilst only 37.1% graded their facilities as compliant with the feeding aspect of the WHO protocol. Less than half (41.4%) of participants received training on the WHO protocol for SAM management. There were significant associations between the training of participants on the WHO protocol and their knowledge of the WHO treatment guidelines, as well as the facility's compliance with the feeding aspect of the guidelines. Conclusion:Despite adequate knowledge of the WHO SAM protocol among health professionals, the majority graded their facilities as non-compliant, highlighting the need for targeted training and institutional support to improve adherence and enhance SAM treatment outcomes in Ghana. Funding:None declared.
Objective:To assess the sexual functioning of Nigerians with T2DM in comparison to healthy controls. Design:Comparative descriptive cross-sectional survey. Setting:Olabisi Onabanjo University Teaching Hospital. Participants:A Consecutive sample of 210 adult Nigerians with T2DM and 121 without diabetes. Main outcome measures:Sexual functioning was assessed with the Changes in Sexual Functioning Questionnaire. Results:Participants with diabetes had a higher prevalence of SD than those without diabetes (76.2% vs 34.7%). This remained unchanged when stratified by gender and sexual response cycles. Increasing age and female gender were significantly associated with SD among participants with diabetes. A one-year increase in age has 1.09 odds of increased SD among participants with diabetes (OR = 1.09, CI = 1.05 - 1.13), while the female participants demonstrated higher SD when compared with males, irrespective of diabetes status, [with diabetes (80.7% vs 65%) and without diabetes (60% vs 20.6%)]. They were also three times as likely to have SD as their male counterparts (OR = 3.39, CI = 1.59-7.24, p = 0.002). Conclusion:People with diabetes reported lower sexual functioning compared with those without diabetes, with a more than double the prevalence. Females had a higher prevalence of SD than males, irrespective of diabetes status, associated with age among participants with diabetes. Funding:None declared.
Objectives:To demonstrate the relationship between adiponectin and insulin resistance among adolescents and young adults. Design:A cross-sectional descriptive study. Setting:This study was conducted within a tertiary institution and the medical outpatient department (MOPD) of its adjourning tertiary health-care institution. Participants:The study was conducted among students of a tertiary institution and patients attending the ABUAD Multi-system Hospital, aged 16-24 years. Main outcome measure:The mean levels of serum adiponectin in obese adolescents and young adults and its relationship with clinical correlates of insulin resistance. Results:Mean serum adiponectin level was 6.8 µg/ml, which is comparable to what has been obtained in other studies. Statistically non-significant negative correlations were noted between serum adiponectin and the homeostasis model assessment of insulin resistance (HOMA-IR), as well as with the clinical correlates of insulin resistance such as Body Mass Index and diastolic blood pressure. Conclusion:This study demonstrated no significant correlation between serum adiponectin and markers of insulin resistance among these participants and may not be a useful marker of insulin resistance among this group of individuals; hence, its routine measurement may not be appropriate. A follow-up study involving more obese subjects may, however, be more revealing. Funding:None declared.
Objective:The interchangeability of Goldmann Applanation Tonometry (GAT) with or without fluorescein requires clarification among African populations. The present study aimed to determine the agreement between IOP measurement using GAT with and without fluorescein in consecutive patients in Ghana. Design:A prospective cross-sectional clinic-based study design. Setting:The study was conducted at the Ophthalmology and Optometry units of the UCC Eye Clinic, Cape Coast, Ghana. Participants:A convenient sample of 104 consecutive patients who visited the clinic. The participants were randomised into two groups, where those in the first had their IOPs first measured without fluorescein and later with fluorescein on GAT; participants in the second group had their IOPs first measured with fluorescein and later without fluorescein after a 10-minute washout period. The central corneal thickness was measured using the Anterior Segment model of Zeiss Cirrus HD-OCT. Results:There was no agreement between the unadjusted IOP measures with and without fluorescein with GAT using the Bland Altman analysis (p < 0.0001, Lower limit: -0.9433, Upper limit: 6.8914; 95% CI = -1.6097 to -.02769). There were no statistically significant differences in gender between unadjusted IOP measurements with (Mann Whitney U test, p = 0.110) and without (Mann-Whitney U test, p = 0.083) fluorescein. Conclusion:Unadjusted IOP measurement without fluorescein was approximately 3 mmHg significantly lower than with fluorescein. We recommend practitioners maintain the gold standard GAT with fluorescein to guide accurate glaucoma diagnosis and management decision-making. Funding:Self-funded.
Objectives:To explore patient rights outcomes in nurse-patient clinical interactions in the Yendi Hospital and promote patients' rights in Ghana using a proposed Caring Space Model. Design:An ethnographic research design was implemented, and purposive sampling was used to recruit participants. Data were gathered across nine inpatient units through in-depth individual interviews (n = 39), ethnographic participant observations (over 400 hours), and a focus group discussion from December 2021 to April 2022. A reflexive thematic analysis was conducted to explore participants' knowledge, experiences, and barriers to upholding patient rights in clinical interactions. Setting:The study was conducted in the Yendi Municipal Hospital. Participants:Included Nurses (n=11), patients (n=21), and caregivers (n=11) who were 18 years of age or older and provided voluntary consent. Additionally, nurses must have at least three years of experience in a hospital setting. Results:The study found that most patients and caregivers are unaware of the Ghanaian Patients' Charter. Nurses who were familiar with the Charter failed to educate patients and caregivers because they feared that doing so would cause undue stress. Poor patient rights outcomes were rooted in human and material resource constraints, affecting nurse-patient and nurse-nurse manager relationships. Patient rights education, transformative nursing leadership practices, and effective communication during clinical interactions can enhance patient rights and safety. Conclusion:To promote patient-centred care, a model of the Caring Space has been developed to advance ethical nursing and caring practices that elevate patient rights in patient-provider clinical interactions. Funding:No funding.
