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Article History

Received: 19 March 2021

Accepted: 18 May 2022

First Online: 6 June 2022

Declarations

:

: This study was approved by the Malawi National Health Science Research and Ethics Committee (Protocol 18/01/1972). This was done to fulfil the Council for International Organisation of Medical Sciences (CIOMS) guidelines when carrying out research on human beings. The CIOMS guidelines emphasise on the application of the Declaration of Helsinki in developing countries. The guidelines take the position that research involving human subjects must not violate any universally applicable ethical standards, but acknowledge that, in superficial aspects, the application of the ethical principles, e.g., in relation to individual autonomy and informed consent, needs to take account of cultural values, while respecting absolutely the ethical standards. The guidelines state that any research carried out on human beings should be approved by the ethics research committee to make sure that it meets all the ethical issues to protect the population [CitationRef removed]. Before the National Health Science Research and Ethics Committee approval, all central hospitals’ research committees where data was collected accepted the study and wrote letters in support of the study as an ethics clearance requirement. Upon approval, a letter of introduction was submitted to authorities of the central hospitals. The Deputy Hospital Director (Nursing) or Chief Nursing Officer (Administration) was requested to provide the names of all RNMs practising at the facility on permanent basis. The names were randomly selected. The research assistants together with the RNM manager in the particular department or unit verified that each of the selected RNM in the department or unit was a permanent member of staff. The research assistant then met the respondents and issued an information letter outlining the purpose of the study, the rights of the RNM to decide whether to participate and the anonymity of the responses. Participants were informed that they could withdraw from participating in the study at any point before data analysis without fear of any penalty. A consent form was issued for the respondents to sign expressing their willingness to participate in the study. Only those participants that signed the consent form were provided with the questionnaire. The questionnaires were put in envelopes and handed out to the respondents. Consenting participants then completed the questionnaires and research assistants collected all questionnaires once completed.

: Not applicable.

: The authors declare that they have no competing interest.