Role of Maseno University school of Medicine and Nursing students in patient care outside a health care facility

JAMII POA INITIATIVE
SURVEY ON THE ROLE PLAYED BY MASENO UNIVERSITY MEDICAL
AND NURSING STUDENTS IN PROVIDING ASSISTANCE IN MANAGING
OF SYMPTOMS AND DISEASES OUTSIDE HEALTH CARE FACILITIES
CONDUCTED FROM 20TH
JULY 2017 TO 21ST
JULY 2017

PROPERTY OF JAMII POA INITIATIVE
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DECLARATION
I, Kevin Tony Okoth, declare that this research is original, having been conducted by the Jamii
Poa Initiative program that I run. This research is of its own kind, and the first one to be conducted
among Maseno University medical and nursing students and will therefore benefit the facility in
picture.
ACKNOWLEDGEMENT
I wish to acknowledge all students of Maseno University School of Medicine and Nursing for
participating in the study despite their tight schedule. I also wish to give special thanks to their
class representatives for helping pass the information about the survey and forwarding the survey
form via their social media platforms. Indeed this is a step towards developing the research attitude
among students at the undergraduate level. Thank you and God bless you.
Special dedication to my late dad, Timothy Okoth for raising me up to the standards of the son he
wanted, and to fulfil his wish of me being a doctor. May your soul rest in Eternal Peace.
Author:
Kevin Tony Okoth
MbchB
Maseno University, School of Medicine
Date________________ Signature____________________________

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DECLARATION........................................................................................................................... 1
ACKNOWLEDGEMENT............................................................................................................ 1
ABBREVIATIONS....................................................................................................................... 4
ABSTRACT................................................................................................................................... 5
1 INTRODUCTION ................................................................................................................. 6
1.1 BACKGROUND INFORMATION .............................................................................................6
1.2 RATIONALE................................................................................................................................7
1.3 OBJECTIVES...............................................................................................................................7
1.4 HYPOTHESIS ..............................................................................................................................7
1.5 RESEARCH QUESTION.............................................................................................................7
2 LITERATURE REVIEW..................................................................................................... 8
3 METHODOLOGY.............................................................................................................. 10
3.1 STUDY AREA, STUDY DESIGN, STUDY SAMPLE ............................................................10
3.2 SAMPLING TECHNIQUE ........................................................................................................10
3.3 SAMPLE SIZE ...........................................................................................................................10
3.4 DATA COLLECTION & ANALYSIS.......................................................................................10
3.5 INCLUSION AND EXCLUSION CRITERIA ..........................................................................10
3.6 STUDY LIMITATIONS.............................................................................................................10
4 RESULTS............................................................................................................................. 11
4.1 SPECIALTY OF STUDY...........................................................................................................11
Figure 4.1: Specialty of study .............................................................................................................11
4.2 YEAR OF STUDY .....................................................................................................................11
Figure 4.2: Year of study ....................................................................................................................12
4.3 CONTACTED TO HELP MANAGE SYMPTOMS OR DISEASE..........................................12
Figure 4.3: Number of respondents contacted to help manage symptoms or disease.........................13
4.4 NEED FOR ASSISTANCE BEFORE HELPING CLIENT ......................................................13
Figure 4.4: Need for assistance...........................................................................................................14
4.5 TYPE OF ASSISTANCE OFFERED.........................................................................................14
Figure 4.5 (A): Type of assistance offered..........................................................................................15
Figure 4.5 B: types of hands-on assistance.........................................................................................16
4.6 PEOPLE ASSISTED IN LAST 2 MONTHS .............................................................................16
Figure 4.6: People assisted in last 2 months .......................................................................................16

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4.7 PROBLEMS “CLIENTS” COMPLAINED OF .........................................................................17
Figure 4.7: Problems “clients” complained of....................................................................................17
4.8 FOLLOW UP AFTER ASSISTANCE.......................................................................................18
Figure 4.8: Follow up after assistance ................................................................................................18
4.9 “CLIENTS” GOT WELL AFTER ASSISTANCE.....................................................................19
Figure 4.9: Condition of “client” after assistance ...............................................................................19
5 DISCUSSION....................................................................................................................... 20
6 CONCLUSION AND RECCOMENDATIONS ............................................................... 22
7 REFERENCES .................................................................................................................... 23
8 APPENDIX........................................................................................................................... 24

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ABBREVIATIONS
CNS Central Nervous System
GIT Gastro-Intestinal Tract
RT Respiratory Tract
GUT Genito-Urinary Tract

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ABSTRACT
Medical and Nursing students play a big role in the society, not only being depended on by their
community as their next hero but also in providing useful decisions on how to help managing their
disease signs and symptoms. For this reason, it is important to assess their roles in decision making
on the same.
This cross sectional survey was conducted between 20th
July 2017 and 21st
July 2017, with a
sample size of 27 students. Purposive sampling was the preferred sampling method. Data
collection was done through an online survey questionnaire made by Google form and sent via
WhatsApp groups of medical and nursing students in Maseno University, providing a one day
timeline for filling in the questionnaire. The study group was Maseno University School of
medicine and nursing students. Data was analyzed via Microsoft Excel and data presented in table
and chart form.
Majority of the respondents were medical students (81.3%) and in their fourth year (48.1%). All
the respondents reported to have been consulted for help before and 74.1% (n=200) had to seek
for assistance before rolling out their advice. 70.4% of the respondents offered an advice and
29.6% both advice and hands on assistance. In the last two months, 85.2% of the respondents
reported to have been asked for assistance and advice, and the most common problems tackled
were on respiratory tract symptoms (65.1%). 85.2% of the respondents did a follow-up on their
clients, and 61.5% of the clients reported back to have felt well after getting assistance.

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1 INTRODUCTION
1.1 BACKGROUND INFORMATION
The study of medicine and nursing, and generally other health related courses require a stress free
environment for the learners to gain content. Although this is hard to achieve, students doing
medicine and nursing have since evolved to cope up with the harsh reality of their ever studying
environment. The seven years of studying for a medical student, (six years for class and ward work
and the seventh for their internship) and the five year curriculum for a degree nursing student (Four
years of class and ward work and the fifth for internship) gradually equips them with clinical skills.
For instance at Maseno University school of medicine, skill gaining starts early enough.
Communication skills is taught in the first year of both medicine and nursing classes. This is in a
bid to help the students communicate appropriately with their patients in future. In the third
semester of the first year, medical students are exposed to nursing care skills where they are taught
the basics of taking and interpreting vital signs, giving injections, first aid skills and other relevant
skills related to nursing care. In the second year of study for both medical and nursing students at
Maseno University, the students go for their community health 1 attachment at various health
centers. At this stage, the students put into use the little they have learnt and merge their nursing
and communication skills in patient care. The second year is also an exposure point for the nursing
students to go to the clinical area, the Jaramogi Oginga Odinga Teaching and Referral Hospital
(JOOTRH) where again they get exposed and nature their skills and knowledge more. In the third
year of studying medicine, the students are again exposed to the clinical area at JOOTRH for their
clinical techniques in preparation for their fourth, fifth and sixth years which are purely clinical.
There is also a lot of “corridor” knowledge gained at the clinical areas. It’s also important to note
that pharmacology is taught at second, third and fourth years of both medicine and nursing courses.
So how does this narrative of how the curriculum is in line with this discussion? The community
surrounding any student doing any health related course, especially those taking their Bachelor’s
degree in medicine and nursing usually view them as ‘‘doctors” who can help them whenever they
feel unwell. Without considering the level of study these students are in, the community, including

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friends often have a big expectation from them. This include giving them an idea on what their
illnesses may be, an advice on what step to take, expecting drug prescription and even hands-on
intervention from them. This is accentuated by the poverty most people are in today in the third
world countries. The inability to access modern care. Some also feel that their illnesses are not
serious to warrant a visit to a real doctor.
1.2 RATIONALE
This study sets to find out the role played by medical & nursing students in providing assistance
in managing of symptoms and diseases outside health care facilities, and how the results can be
used to draw meaningful conclusions and recommendations on improving existing longitudinal
patient care.
1.3 OBJECTIVES
Broad objective
To find out the role played by medical & nursing students in providing assistance in managing of
symptoms and diseases outside health care facilities
Specific Objectives
 To find out the specific roles played by medical and nursing students in disease and
symptom management outside health care facilities
 To investigate the common health problems the students handle
 To know the client follow up by the students
1.4 HYPOTHESIS
Medical and nursing students play a pivotal role in disease and symptom management outside
health care facilities.
1.5 RESEARCH QUESTION
Do medical and nursing students have a role in helping manage disease and symptoms outside a
health care facility?

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2 LITERATURE REVIEW
The study of medicine and nursing, and generally other health related courses requires a stress free
environment for the learners to gain content. Although this is hard to achieve, students doing
medicine and nursing have since evolved to cope up with the harsh reality of their ever studying
environment. The seven years of studying for a medical student, (six years for class and ward work
and the seventh for their internship) and the five year curriculum for a degree nursing student (Four
years of class and ward work and the fifth for internship) gradually equips them with clinical skills.
For instance at Maseno University school of medicine, skill gaining starts early enough.
Communication skills is taught in the first year of both medicine and nursing classes. This is in a
bid to help the students communicate appropriately with their patients in future. In the third
semester of the first year, medical students are exposed to nursing care skills where they are taught
the basics of taking and interpreting vital signs, giving injections, first aid skills and other relevant
skills related to nursing care. In the second year of study for both medical and nursing students at
Maseno University, the students go for their community health 1 attachment at various health
centers. At this stage, the students put into use the little they have learnt and merge their nursing
and communication skills in patient care. The second year is also an exposure point for the nursing
students to go to the clinical area, the Jaramogi Oginga Odinga Teaching and Referral Hospital
(JOOTRH) where again they get exposed and nature their skills and knowledge more. In the third
year of studying medicine, the students are again exposed to the clinical area at JOOTRH for their
clinical techniques in preparation for their fourth, fifth and sixth years which are purely clinical.
There is also a lot of “corridor” knowledge gained at the clinical areas. It’s also important to note
that pharmacology is taught at second, third and fourth years of both medicine and nursing courses.
So how does this narrative of how the curriculum is in line with this discussion? The community
surrounding any student doing any health related course, especially those taking their Bachelor’s
degree in medicine and nursing usually view them as ‘‘doctors” who can help them whenever they
feel unwell. Without considering the level of study these students are in, the community, including
friends often have a big expectation from them. This include giving them an idea on what their
illnesses may be, an advice on what step to take, expecting drug prescription and even hands-on
intervention from them. This is accentuated by the poverty most people are in today in the third

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world countries. The inability to access modern care. Some also feel that their illnesses are not
serious to warrant a visit to a real doctor.
The role of medical and nursing students to provide care for these people can’t be underestimated
as this is usually a test of their knowledge and skills. These skills are gradually gained as one
climbs up the ladder of learning, therefore a finalist’s ability to holistically take care of a patient
cannot be the same as that of a freshman. It’s with this kind of exposure that the students will have
an insight of longitudinal patient care as they progress. This has been demonstrated in Sudan where
students were trained, educated on diabetes mellitus and their interventions evaluated. As a matter
of fact, communication skills is important in health care. It enhances a strong positive relationship
between health care provider team (in this case the students) and the patients to follow through
recommended medication and self-management.
The need to seek for assistance before offering any medical advice or hands on care is based on
the Hippocratic Oath (not to be ashamed to say “I don’t know” and invite a colleague with skills).
Most of the students prefer the internet as the fastest way for help, apart from the notes. Seeking
for help further cements the “Do no harm” part of the Hippocratic Oath.
Care for a sick person does not end when you give medication, but at that moment when your
patient reports that they feel well. This is only achievable through follow up. Patient follow up
help expose the liability when a patient does not comply with the plan of care, prompting for the
best mitigation strategy of the same. How can one achieve this? The simplest way for a student is
by constant communication with the patient. A health care provider will feel satisfied if only their
patients’ condition gets better. You only know whether they feel better or not through follow up.

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3 METHODOLOGY
3.1 STUDY AREA, STUDY DESIGN, STUDY SAMPLE
The study area was at Maseno University, School of Medicine and Nursing, with the medical and
nursing students as the study sample. The study design was cross-sectional survey
3.2 SAMPLING TECHNIQUE
Purposive sampling. The sample of interest was medical and nursing students.
3.3 SAMPLE SIZE
The sample size could not be predetermined given that it would rely on the people willing to fill
the online questionnaire form.
3.4 DATA COLLECTION & ANALYSIS
Data collection was done through an online survey questionnaire made by Google form and sent
via WhatsApp groups of medical and nursing students in Maseno University, providing a one day
timeline for filling in the questionnaire. Data was automatically analyzed by the Google form in-
built excel software.
3.5 INCLUSION AND EXCLUSION CRITERIA
Inclusion criteria was medical and nursing students from Maseno University. Exclusion criteria
was anyone not taking a medical or nursing course, and any medical or nursing student not from
Maseno University.
3.6 STUDY LIMITATIONS
An online survey is a study of its own kind, coming with its own type of challenges. Some of them
are low response rate due to factors like lack of bundles or internet, ignorance by participants, busy
schedule of participants, and the holiday mood that makes people keep off any academic stuff.

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4 RESULTS
4.1 SPECIALTY OF STUDY
Figure 4.1 shows the responses for the specialty of study. Medical students represented 81.5 %
(n=22) of the respondents and 18.5% (n=5) were nursing students.
Figure 4.1: Specialty of study
4.2 YEAR OF STUDY
Figure 4.2 shows the years of study of the respondents. Majority of them 48.1% (n=13) were in
their fourth year. A smaller proportion, each representing 3.7% (n=1) were in year 1 and year 6.
Year 2 represented 14.8% (n=4), year 3 represented 11.1% (n=3) and year 5 represented 18.5%
(n=5). Out of the 22 medical students who participated in the study, n=1 was in year 2, n=2 in year
3, n=13 in year 4, n=5 in year 5 and n=1 in year 6. The nursing students’ representation was as
follows: n=1 in year 1, n=3 in year 2 and n=1 in year 3.

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Figure 4.2: Year of study
4.3 CONTACTED TO HELP MANAGE SYMPTOMS OR DISEASE
Figure 4.3 displays the number of respondents who have ever been contacted to help manage
symptoms or disease. All the respondents, 100% (n=27) reported to have been contacted. NB: one
year 5 medical student checked both boxes for a Yes and No response hence the 3.7% (n=1) No
response below.

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Figure 4.3: Number of respondents contacted to help manage symptoms or disease
4.4 NEED FOR ASSISTANCE BEFORE HELPING CLIENT
Figure 4.4 shows those who sought for assistance before helping their “clients”. 74.1% (n=20) of
them reported to have sought for assistance and 29.6 % (n=8) did not seek for assistance.
A further breakdown to medical students respondents show that the following had to seek for
assistance before helping the “client”: n=2 in year 3, n=9 in year 4, n=1 in year 5 and n=1 in year
6. Medical students who needed no assistance prior are: n=3 in year 4 and n=3 in year 5. The
nursing students who sought assistance were: n= 1 in year 1, n=2 in year 2 and n=1 in year 3. One
year 2 nursing student n=1 did not need assistance.
NB: one year 5 medical student checked both boxes for a Yes and No response hence the additional
1 extra subject in the results below.

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Figure 4.4: Need for assistance
4.5 TYPE OF ASSISTANCE OFFERED
Figure 4.5 A shows the types of assistance offered by the respondents to their “clients”. Most of
them, 70.4% (n=19) offered an advice and hands on assistance provided by 29.6% (n=8) of the
respondents. They types of hands on assistance offered are shown by Figure 4.5 B. They include
administering injections, placing Intravenous lines, wound dressing, doing a physical examination,
draining abscesses and providing first aid procedures like stopping a nose bleed.
Medical students who offered both advice and hands on assistance are as follows: n=1 in year 3,
n=4 in year 4 and n=1 in year 5. Nursing students who did the same are: n=1 in year 1 and n=1 in
year 2.

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A
Figure 4.5 (A): Type of assistance offered

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B
Figure 4.5 B: types of hands-on assistance
4.6 PEOPLE ASSISTED IN LAST 2 MONTHS
Figure 4.6 shows the number of people the respondents have assisted in the last 2 months. This
was in a group bracket of 1-10, 10-20 and above 20. In the last 2 months, 7.4% (n=2) of the
respondents have not assisted anyone. However, majority of them have assisted 1-10 “clients”
representing 85.2% (n=23). 3.7% (n=1) each have assisted 10-20 and above 20 “clients”.
Figure 4.6: People assisted in last 2 months

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4.7 PROBLEMS “CLIENTS” COMPLAINED OF
Figure 4.7 displays the problems the “clients” reported to the respondents. They were grouped into
signs and symptoms of the Central Nervous System (CNS) 19.2% (n=5), Respiratory Tract (RT)
65.4% (n=17), Gastrointestinal System (GIT) 53.8% (n=14), Genitourinary (GUT) 46.2% (n=12)
and reproductive system 38.5% (n=10).
Figure 4.7: Problems “clients” complained of

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4.8 FOLLOW UP AFTER ASSISTANCE
Figure 4.8 shows the number of respondents who did a follow up 85.2% (n=23) and those who did
not do a follow up 18.5% (n=5) after providing assistance to their “clients”. The number of medical
students who did a follow up include: n=2 in year 3, n=10 in year 4, n=4 in year 5 and n=1 in year
6. Nursing students who followed up include: n=1 in year 1 and n=2 in year 2. Medical students
who did not do a follow up are as follows: n=3 in year 4 and n=1 in year 5.
NB: one year 2 nursing student checked both boxes for a Yes and No response hence the additional
1 extra subject in the results below.
Figure 4.8: Follow up after assistance

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4.9 “CLIENTS” GOT WELL AFTER ASSISTANCE
Figure 4.9 shows that 61.5% (n=16) of the respondents had their ‘clients” reporting to have gotten
well after their assistance and 38.5% (n=100 of the respondents were not sure about the condition
of their “clients” after assistance.
Figure 4.9: Condition of “client” after assistance

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5 DISCUSSION
Most of the participants in this survey were medical students, 81.5% (n=22). Only a small number
of nursing students, 18.5 %( n=5) managed to participate. This is a replica of the larger number of
medical students as compared to the nursing class at Maseno University. Majority of the
respondents, 48.1% (n=13) were in their fourth year of medical class. This shows their willingness
to participate as they took the study as their own. Jamii Poa Initiative is run by a fourth year medical
student, who was a motivation to the class. Only one first year and one sixth year managed to
participate. Freshmen at medical school still lack insight on what a scientific study is, and its
significance. However, this would be a stepping stone for them to venture into the field as they
continue learning. Most of the finalists believe that all they have left is graduating and thus
participating in school based research would not be of significance to them.
Generally, there was a low participant turnout due to numerous factors. The study was conducted
at a time when all the students were on a holiday so it was difficult reaching them to explain to
them why it was being conducted. An online needs convenience in terms of time, ability to log in
into the survey questionnaire that bundles up credit for internet accessibility, good network
coverage, need of a smart phone and ability to follow instructions. Some people might not have
been in a position to have one or all of these thus limiting the number of participants. The study
timeline was also for a day and it’s possible that any person who had wished to participate and had
all the necessary factors in check to do so might have missed the chance by the virtue of being
offline.
All participants have been contacted to help manage symptoms or a disease. This is in line with
the trust the community including friends and family have in medical and nursing students when
it comes to managing their illnesses. In as much as the world out there sees them as young
clinicians, it is important to respect the rule of “do no harm”. That’s why 74.1% of the respondents
had to refer to a college, or any written document before proceeding to help their ‘clients”. One of
the Hippocratic oaths suggest that one should seek assistance if not able to handle a situation on
their own. This may be true if one is presented a new case, or that which they are not well aligned
to. While 70.4% of the respondents advised their “clients”, 29.6%provided hands on assistance in

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addition to an advice. Hands on assistance provided ranged from giving medication, conducting
first aid procedures, physical examination and wound dressing to draining abscesses and caring
for trauma patients. These skills are gradually acquired as one advances learning. Also note that
not all “clients” needed hands on attention by the students.
Clustering of problems that “clients ‘complained of might have been a problem to the junior
students, but as the results show, majority had RT infection symptoms and signs. This was
followed by GIT, GUT, reproductive tract and CNS signs and symptoms. This is of significance
for instance when suggesting medication to take. For instance antibiotics in every RT signs and
symptoms bearing in mind that the etiology can be fungal or viral. This may contribute to antibiotic
resistance.
Giving medical care does not end at the point when one gives medication. A close follow up on
the patient is important and this can be easily achieved through to-come-back appointments and
constant communication between the health care provider and the patient. In this survey, only 85.2
% of the respondents did a follow up. They were able to track the condition of their “clients” and
11 of them reported that their “clients” felt well afterwards. N=6 were not sure. Those who did not
do a follow up reported that they were not sure of how their “clients” fared on after offering
assistance to them. All clinicians should adopt a follow up plan as part of their routine.

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6 CONCLUSION AND RECCOMENDATIONS
The survey was a success, albeit low number of respondents because of factors highlighted in the
discussion section. Maseno university medical and nursing students play a pivotal role in
community care by offering advices and hands on assistance based on skills and knowledge they
acquire. With the need to refer when they know not, it’s evident they they wish to preserve the
lives of those they assist. Although not all of them do a follow up on their “clients”, it’s important
to acknowledge those who do so and encourage those who fail to do so.
The following are the recommendations:
1. Need for a large number of students to embrace research and turn out in large numbers to
participate.
2. Need to embrace the study of medicine and nursing more and employ the skills and
knowledge gained to holistically care for people.
3. Maseno University to consider setting up guidelines for longitudinal patient care.

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7 REFERENCES
1. Curry RH. Meaningful Roles for Medical Students in the Provision of Longitudinal Patient Care,
Department of Medicine, Northwestern University Feinberg School of Medicine,Chicago, Illinois.
2. Ahmed ME, Abdelrhan SH. The role of medical students in patient education to promote home
management of diabetes mellitus in wad Medani town, Sudan 2003. J Fam Community Med [serial
online] 2006 [cited 2017 Aug 17];13:41-6. Available
from: http://www.jfcmonline.com/text.asp?2006/13/1/41/97573
3. Asnani MR. (2009). Patient-physician communication. WestIndian Med J, 58(4):357-
61. pubmed
4. Clark, P. A. (2003). Medical practices’ sensitivity to patients’ needs: Opportunities and
practices for improvement. Journal of Ambulatory Care Management, 26(2), 110-
123. pubmed
5. Wanzer, M. B., Booth-Butterfield, M. & Gruber, K. (2004). Perceptions of health care
providers’ communication: Relationships between patient-centered communication and
satisfaction. Health Care Communication, 16(3), 363-384. pubmed
6. Duffy, F. D., Gordon, G. H., Whelan, G., Cole-Kelly, K., & Frankel, R. (2004). Assessing
competence in communication and interpersonal skills: The Kalamazoo II report.
Academic Medicine, 79, 495-507. pubmed
7. Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A. (2002). The
relative importance of physician communication, participatory decision-making, and
patient understanding in diabetes self-management. Journal of General Internal Medicine,
17, 243-252. pubmed

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8 APPENDIX
QUESTIONNAIRE USED TO CONDUCT SURVEY
Survey on the role played by medical & nursing students in providing assistance in managing
of symptoms and diseases outside health care facilities
This is a survey by Jamii Poa Initiative, conducted on medical and nursing students. Please provide
correct and unbiased responses. The results will be shared and presented after analysis. SUBMIT
ONLY ONCE FOR ACCURACY.
Jamii Poa Initiative
1. What is your specialty of study?
Check all that apply.
 Medicine
 Nursing
2. What is your year of study?
 Year 1
 Year 2
 Year 3

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 Year 4
 Year 5
 Year 6
3. Have you ever been contacted by anyone to help them manage their symptoms or
disease?
 Yes
 No
4. If Yes in the question above, did you seek for assistance before proceeding to help?
 Yes
 No
5. Which type of assistance did you offer ?
 An advice
 A hands on assistance
 Both advice and hands on assistance
6. What hands on assistance have you provided?
7. In the last 2 months , how many people have you offered assistance?
 None

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 1-10
 10-20
 Above 20
8. What are some of the problems your "clients" complained of? (Check all the
appropriate fields)
 Central nervous system problems
 Respiratory tract problems
 Gastri intestinal tract (GIT) problems
 Genitourinary tract problems
 Reproductive system problems
9. Did you do a follow up on the people you assisted?
 Yes
 No
10. Did your "clients" get well after your assistance?
 Yes
 No
 Not sure
LINK TO QUESTIONNAIRE AND RESPONSES https://goo.gl/forms/P7llgiUaNpWodVwj1

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