Medicine and Health Sciences Commons^™

Responding To Health Care Complexity: Suggestions For Integrated And Interprofessional Workplace Learning, Pim Kuipers, Carolyn Ehrlich, Sharon Brownie

School of Nursing & Midwifery, East Africa

This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.

Complementary And Alternative Medicine In Oncology Nursing, Salima Somani, Fauziya Ali, Tazeen S. Ali, Nasreen Sulaiman Lalani

School of Nursing & Midwifery

Use of complementary and alternative medicine (CAM) has increased globally, particularly among oncology patients. This study investigated the knowledge, experience and attitudes of oncology nurses towards CAM. A quantitative study was conducted in tertiary care hospitals in Karachi, Pakistan, where 132 oncology nurses were surveyed. The survey revealed that more than 50% of nurses had never heard about many of the CAM therapies used in Pakistan. Approximately 65% of the nurses had knowledge about prayer and less than 30% had experience of CAM education or training. In addition, the majority of nurses had seen patients using CAM and felt that …

Associations Of Controlling Behavior, Physical And Sexual Violence With Health Symptoms, Tazeen S. Ali, Aamir Abbas, Fazal Ather

School of Nursing & Midwifery

Controlling behavior is often manifested as monitoring, coercing or threatening the partner. Globally, it has been experienced by the women (in range of 5.2% to 56.6%) and often results in their physical and mental ill health. To the best of our knowledge there is no published research on controlling behaviors. Therefore, a cross sectional study was conducted to measure the magnitude of the controlling behaviors and its association to some physical stress symptoms of women. The study was conducted in urban settings of Karachi, Pakistan, using simple random sampling technique. The data was collected by trained midwifes from the 759 …

Women’S Perception And Attitude Towards Male Dominancy And Controlling Behaviors, Tazeen S. Ali, Noureen Karamali, Omer Malik

School of Nursing & Midwifery

Introduction/Background: The study was conducted in urban Karachi, Pakistan to investigate women’s perceptions and attitudes towards male dominancy, female autonomy, and controlling behavior of husbands.
Method: This was investigated in a population based study with a cross-sectional design, involving married women aged 25 to 60 years. A Structured questionnaire developed by World Health Organisation (WHO) on violence was used. Community midwives interviewed these married women living in pre-selected low, middle and upper socio-economic areas of urban Karachi, Pakistan.
Findings: This study revealed women’s overall perception regarding male dominancy and controlling behavior and highlighted this attitude, as being …

The Feasibility Of An Internet-Based Intervention For Chinese People With Mental Illness: A Survey Of Willingness And Attitude, Xiu-Y Yao, Zheng Li, David Arthur, Lili Hu, Gen Cheng

School of Nursing & Midwifery

Background: The easy accessibility, increasing usage, and low cost of internet make it a desirable way of providing health information and delivering interventions for health consumers. Studies in other countries have verified and confirmed the effectiveness of internet-based interventions among people with mental health problems. Similar programs have yet to commence in China. Purpose: This study investigated the willingness for, and attitude toward internet-based intervention in Chinese mental health service users and explored the feasibility of such an intervention.
Methods: A cross-sectional survey utilizing a self-developed questionnaire was administered to 186 mental health service users in Beijing, …

A Single Competency-Based Education And Training And Competency-Based Career Framework For The Australian Health Workforce: Discussing The Potential Value Add, Sharon Brownie, Janelle Thomas

School of Nursing & Midwifery, East Africa

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable – in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation …

Post Exposure Prophylaxis Among Ugandan Nurses Accidents Do Happen, J. Mill, Esther Nderitu, S. Richter

School of Nursing & Midwifery, East Africa

Purpose: In 2009 we conducted a study to explore Ugandan nurses’ practice of universal precautions while caring for persons living with HIV. During our interviews about universal precautions, nurses’ also shared their experience with post-exposure prophylaxis (PEP) following needle-stick injuries. We present findings related to nurses’ understanding of PEP and their experience with, and reporting of, needle stick injuries.

Background: Nurses have high rates of exposure to blood-borne pathogens. Although there is minimal risk of the transmission of blood-borne pathogens from health care workers (HCWs) to patients and vice versa, post-exposure prophylaxis, has become routine following the occupational exposure of …

The Impact Of Caring For Children With Mental Retardation On Families As Perceived By Mothers In Karachi, Pakistan., Arusa Lakhani, Irma Gavino, Aisha Yousafzai

School of Nursing & Midwifery

OBJECTIVE:

To assess how families perceive the positive and negative impacts of caring for a child with mental retardation.

METHODS:

The quantitative descriptive study was conducted from January to August 2007 and comprised 54 families attending a private day-care centre for children with special needs in Karachi, Pakistan. The Kansas Inventory of Parental Perceptions was used to assess mothers' perceptions on the impact of caring for a child with mental retardation. Positive contributions, social comparisons with others, understanding of disability and perception of control were assessed. SPSS 16 was used for statistical analysis.

RESULTS:

Mothers reported positive contribution to family …

A Literature Review About Effectiveness Of Massage Therapy For Cancer Pain., Salima Somani, Saima Merchant, Sharifa Bashir Lalani

School of Nursing & Midwifery

This literature review explores the effectiveness of massage therapy to reduce cancer pain. As part of the review, systematic literature search was carried out on various electronic databases and specialised journals. Included are 19 research-based articles and 8 review articles. The review suggests that cancer has become a common health problem in the world and most of the cancer patients are going through intense and unbearable pain. Studies have reported that most of the cancer patients' pain reduced with therapeutic massage. Seventy-three per cent of cancer patients use massage therapy in the USA. Few studies are available in the context …

Advance Directives: A Policy Required In The Asian Countries, Nasreen Panjwani

School of Nursing & Midwifery

Advancements in health care have resulted in elaborate treatments all over the world and contributed to problems at times for the terminally ill who need palliative care. Futile treatments have demonstrated to defuse the symptoms of the disease without curing. In such scenarios physicians only prolong life of patients, keeping them away from dying peacefully and depriving them from quality of life. In this context, families exhaust their financial and material resources for the treatment of their loved ones without any substantial results. Health care systems are passionate about prolonging life and are ignoring the component of caring by disregarding …

Dowry Practices And Their Negative Consequences From A Female Perspective In Karachi, Pakistan —A Qualitative Study, Tazeen Saeed Ali, Gunnhildur Árnadóttir, Asli Kulane

School of Nursing & Midwifery

Aim:

To assess the pattern, demand and opinion of dowry among women in urban Karachi, Pakistan and their perceived negative consequences of dowry. Setting: Pakistan is a low income country, predominantly Muslim, with around 190 million inhabitants. Karachi is the biggest city with roughly 13 million inhabitants.

Method:

Qualitative study, using content analysis of five focus group discussions with women. Results: The theme “Dowry practices and their consequences” emerged, along with five categories and 14 subcategories, describing the “burden of dowry”, “dowry in society”, “dowry problems created by parents-in-law”, “negative consequences of dowry practice” and “good intentions”.

Conclusion:

Problems due …

Validity And Reliability Testing: Urdu Translated Modified Response To Symptoms Questionnaire, Saleema Allana, Tazeen S. Ali, Khurshid Khowaja, Aamir Hameed, Debra Kay Moser

School of Nursing & Midwifery

Objective: To determine validity and reliability of the Urdu translated, modified "Response to symptoms questionnaire" (RSQ) among acute coronary syndrome (ACS) patients in Karachi.
Study Design: A qualitative, tool validation study.
Place and Duration of Study: Two tertiary care hospitals in Karachi, the Aga Khan University Hospital, Karachi and the Karachi Institute of Heart Diseases, from December 2010 to April 2011.
Methodology: After making certain modifications, the original tool in English was translated into Urdu. Next, five cardiology experts evaluated the tool for its content and face validity. Test retest and inter rater reliabilities were computed for the RSQ using …

Compliance To Antipsychotic Medication: A Challenge For Client, Family And Health Care Providers., Ambreen Tharani, Salima Farooq, Faiza Saleem, Anila Naveed

School of Nursing & Midwifery

Compliance with anti-psychotic medications plays a significant role in managing clients with schizophrenia. It not only helps in controlling the symptoms, but also decreases the risk of relapses and ultimately improves quality of life (QoL) for the clients. However, compliance with anti-psychotic medication remains a challenge for the client, family and healthcare providers. Identification of these associated factors is vital to make appropriate plan to enhance medication compliance. In this paper, various factors are highlighted that are associated with medication compliance in clients with schizophrenia.

Experience Of Nurses With Using Ehealth In Gilgit-Baltistan, Pakistan: A Qualitative Study In Primary And Secondary Healthcare, Saleema A. Gulzar, Shariq Khoja, Afroz Sajwani

School of Nursing & Midwifery

Background: To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices.
Methods: All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses' …

Clinical Application Of Nightingale’S Environmental Theory, Shirin Rahim

School of Nursing & Midwifery

Florence Nightingale (1820-1910) the first nursing theorist and the first one to lay the foundation of modern nursing has based her philosophy on spiritualism. Selanders (2010) quotes (Cook, 1913, Vol. 1, p. 15) in saying, that “She records in her diary an interaction with God at age 16 when He “called her to His service” (p.82). Her devotion towards God and her belief of spirituality was the foundation of almost all that Nightingale did as a nurse and for nursing profession. (Allighood and Tommy 2010). Nightingale has taken the same premise for her environmental theory. In this theory Nightingale (1860) …

Intimate Partner Violence And Mental Health Effects: A Population-Based Study Among Married Women In Karachi, Pakistan, Tazeen S. Ali, Ingrid Mogren, Gunilla Krantz

School of Nursing & Midwifery

Background: Intimate partner violence (IPV) is recognized all over the world for its association with mental health problems in women. In Pakistan, such violence occurs commonly, but detailed information on mental health effects is scarce. The purpose of this study is to focused on married couples in urban Karachi to investigate mental health effects associated with physical, sexual and psychological violence perpetrated by husbands towards wives. Disclosure rates and health care-seeking behaviour were also investigated.
Method: This cross-sectional study involved 759 women between the ages of 25 and 60 years, selected using a multi-stage random sampling technique. The women …

Prevalence Of Perceived Heavy Postpartum Hemorrhage And Its Associated Factors Among Married Mothers In Squatter Settlements Of Karachi, Tazeen S. Ali, Fazal Ather

School of Nursing & Midwifery

Objectives; To estimate the prevalence of postpartum hemorrhage (PPH) and identify its associated factors among the married women of 15-49 years, residingin the Karachi, Pakistan. Methodology: This cross-sectional survey was carried out in five squatter settlements of Karachi during 2000-2001. Information was collected regarding age, gravida, education, antenatal, natal and postnatal care, with perceived puerperal morbidities from 525 mothers, who were in their 42nd to 56th post delivery day. Univariate and multivariate analyses were computed using multiple logistic regression method. Results: The estimated prevalence for perceived PPH was 7.24%. Three hundred and ninety six (75.4 %) women received ante-natal …

Prevalence And Factors Associated With Maternal Postpartum Haemorrhage In Khyber Agency, Pakistan, N Gani, Tazeen S. Ali

School of Nursing & Midwifery

Background: Postpartum haemorrhage (PPH) is one of the main causes of maternal mortality globally. The objective of this study was to estimate the prevalence of PPH and identify factors associated with PPH in Khyber Agency, Pakistan.
Methodology: A quantitative, cross-sectional study design was selected to estimate the prevalence and associated factors for PPH among married women aged 15–49 years, residing in the Khyber Agency, FATA, Pakistan. A pre-tested structured questionnaire was adapted with some modifications to interview 1,000 women.
Results: Prevalence of PPH was 21.3% in the study population. Factors associated with PPH were age, number of pregnancies, …

Women's Health: An Achievable Goal For Public Health Nursing In Pakistan, Samina Vertejee, Noureen Nasruddin Karamali

School of Nursing & Midwifery

Monsoons of 2010; left devastated effects in Pakistan; it wiped away thousands of houses and damaged health infrastructure. The national and international communities rescued Internally Displaced People (IDP). Alongside the other health professionals' Public health nurses (PHN) were instrumental in assisting IDPs. This is a case study of a 30 year old postnatal woman; who sustained an injury on her right breast and developed an abscess in IDP camp. The client was assisted by the team of public health nurses by timely referral to undergo incision and drainage for appropriate management. Moreover, post procedure follow-up assisted the woman in wound …

Self-Management Education Interventions For Persons With Schizophrenia: A Meta-Analysis, Haiou Zou, Zheng Li, Marie T Nolan, David Arthur, Hongxing Wang, Lili Hu

School of Nursing & Midwifery

Although self-management education programs for persons with schizophrenia are being developed and advocated, uncertainty about their overall effectiveness remains. The purpose of this meta-analysis was to examine outcomes of self-management education interventions in persons with schizophrenia. Six electronic databases were searched. Manual searches were conducted of the reference lists of the identified studies and major psychiatric journals. Randomized controlled trials of self-management education interventions aimed at reducing relapse and hospital readmissions, as well as improving symptoms, psychosocial functioning, and adherence to medication treatment were identified. Data were extracted and the quality of included studies were rated by two authors independently. …

Media Created Violence: A Social Determinant Of Mental Health., Shamshad Begum, Shaneela Sadruddin Khowaja, Gulnar Ali

School of Nursing & Midwifery

In today's high technological world, scientific discoveries contribute remarkable development to human life, but it could also have an adverse impact on mankind. Among all these advancements, media is one of the inventions which aims at capturing a countless group of viewers and transmit information via various mediums. Media violence is considered one of the hampering determinants which harms an individual psychologically. The primary goal of a health professional is to work for the maintenance of mental health. Therefore, it is imperative to create an understanding about the impact of media violence on mental health, particularly in the Pakistani context. …

Factors Associated With Stress Among Adolescents In The City Of Nawabshah, Pakistan, Yasmin Parpio, Salima Farooq, Saleema A. Gulzar, Ambreen Tharani, Tazeen Saeed Ali, Fawad Javed

School of Nursing & Midwifery

Objective: To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan.
Methods: The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population.
Results: Of the total, 529 (66%) children belonged to …

Women Trafficking: Causes, Concerns, Care!, Shaneela Sadaruddin Khowaja, Ambreen Tharani, Ajmal Agha, Rozina Karmaliani Professor

School of Nursing & Midwifery

Pakistan is both a country of origin and destination as far as women trafficking is concerned. Poverty, gender discrimination, lack of education, and ignorance about legal rights are some of the underlying causes. Available data suggest several areas of concern, like, for instance: direct health effects, maladaptive coping leading to the use of illicit drugs, and inaccessibility to healthcare facilities. Therefore, numerous interventions would be required at three levels: the prevention of trafficking, the protection of victims and the prosecution of the traffickers.

Assessment Of Knowledge, Skill And Attitude Of Oncology Nurses In Chemotherapy Administration In Tertiary Hospital Pakistan., Najma Khan, Khurshid Zulfiqar Ali Khowaja, Tazeen Saeed Ali

School of Nursing & Midwifery

Objective:

To measure the levels of nurse’s knowledge and attitude after the conduct of education session regarding chemotherapy administration and management.

Methodology:

This research study was conducted at two oncology units of tertiary Hospital Rawalpindi. A prepost test intervention study design was used on 35 nurses by using Verity’s tools.

Results:

The mean scores of knowledge were calculated by Cochran’s Q test showed that knowledge scores have significantly increased with ‘educational training’ (p value < 0.001). The difference in the attitude of the nurses was not found to be statistically significant in repeated measure of ANOVA.

Conclusion:

The results show that knowledge is the weakest component and attitude is strongest component of oncology nurses ‘competencies in chemotherapy administration.

Hidden Voices Of Hermaphrodites, Zohra Asif Jetha, Nasreen Sulaiman Lalani, Gulnar Akber Ali

School of Nursing & Midwifery

Gender is a psychological component which is given by the society to a person, while sex is a biological component which is awarded by the God. However, there are certain conditions in which the biological aspects are put to challenge with the social and psychological aspects of gender. Hermaphrodites are a third gender role, who is neither male or female man nor woman but contains the element of both. One may question that if they are neither male nor female then who they are and whether they are equally treated in our society. Looking at the challenges faced by hermaphrodites, …

Community Mental Health Services: A Way Forward To Rehabilitate Chronic Mentally Ill Client., Ambreen Tharani, Salima Farooq, Anila Naveed

School of Nursing & Midwifery

Schizophrenia and other mental illnesses produce devastating effects on a clients' personal and psychosocial wellbeing. Besides the sufferer, it has irrevocable impacts on the lives of their loved ones. With advancement in the treatment modalities, researches have proven that hospital based care and psychotropic drugs are not the sole solution in managing the client symptoms. Deinstitutionalization is the paradigm shift from hospital based to community based care model that allows client/s to spend rest of their lives in the community setting. A well-structured community care based programme that focuses on psychosocial interventions has significant contribution in treatment and rehabilitation of …

Ways Of Teaching: Striving To Enhance Student's Understanding In Classroom Setting, Zohra Asif Jetha, Shaneela Sadruddin Khowaja, Shamshad Begum

School of Nursing & Midwifery

Learning is enhanced when instruction is being designed in-relation to students’ learning styles. Attention to learning styles and learner’s diversity has shown an increase students’ motivation towards learning. Effective teaching is defined as maximizing learner educational achievement, and teacher and student subject contentment. The key attributes of effective teaching are teacher’s preparation; knowledge on the subject; attitude; enthusiasm; and content clarity. Moreover, applying various theories of learning such as behaviorism, cognitivism and humanism are the effective ways to enhance students’ learning journey. Therefore, these effective teaching strategies should be promoted and encouraged in the real world of teaching.

Domestic Violence Against Infertile Women In Karachi, Pakistan, Neelofar Sami, Tazeen S. Ali

School of Nursing & Midwifery

This study investigates the prevalence of physical and psychological violence against infertile women in Karachi, Pakistan. A total of 400 infertile women attending the selected infertility clinics in Karachi, Pakistan were interviewed using the to investigate their experiences of physical and psychological violence. Out of 400 infertile women, 278 (64%) reported to be the victims of violence during the last 12 months before they were interviewed. Nearly one quarter (23.1%) reported facing physical violence. All women reported their husbands and their family members to be the perpetrators. It is concluded that Clinicians should identify the abused women and provide them …

Violence Permeating Daily Life: A Qualitative Study Investigating Perspectives On Violence Among Women In Karachi, Pakistan, Tazeen S. Ali, Gunilla Krantz, Ingrid Mogren

School of Nursing & Midwifery

Background: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life.

Methods: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.

Results: One major theme emerged during the analysis, …

Rapidly Progressive Periodontal Disease Associated With Human Immunodeficiency Virus, Khalid Al Hezaimi, Fawad Javed, Tazeen S. Ali, Mansour Al Askar, Abdulaziz Al Rasheed

School of Nursing & Midwifery

Severe periodontal inflammation with generalized dental plaque accumulation, spontaneous and severe gingival bleeding, fungal infection, and interdental papillae necrosis are presented in a patient infected with human immunodeficiency virus (HIV). Bite-wing radiographs revealed a generalized horizontal alveolar bone loss of 7-8 millimetres in both arches. Erythematous patches were noted on the gingival mucosa in both jaws. DNA testing was performed to indentify the periodontopathogens. The patient had no signs or symptoms of acquired immunodeficiency syndrome. This case-report presents the massive periodontal destruction that occurred in a patient infected with HIV. Therefore, it is highly recommended that patients infected with HIV …