Experiences of adopting blended pedagogies in health assessment course in post RN baccalaureate program of nursing in Karachi, Pakistan

Purpose: There is little known about whether faculty and students in a resource constricted context experience a change in learning due to the adoption of blended learning (BL) pedagogies in a lab based course. The study aimed to understand the experiences of faculty and students’ related to the adoption of BL pedagogies in health assessment course.Design: An action research design was used in this study to integrate planning, action and research in the setting where the change is required. The study sample consisted of year 1 Post RN BScN students enrolled at the Aga Khan University School of Nursing and Midwifery, and the faculty assigned to teach in Health Assessment course. Of the 83 Post RN BScN students and the 6 nursing faculty invited, 53 students and 6 teachers (n= 59) consented to participate in the study. Data was collected using focus group discussions.Results: Findings revealed five major categories; Students’ readiness, motivation and self- directedness; Teacher competence, commitment, and comfort; Use of blended strategies; Resources; and Contextual factors & challenges.Conclusion: This study was the first of its kind in Pakistan. The findings of the study indicate towards the ways that can improve the use of BL in a resource constrained context

Content validity of a tool measuring medication errors.

The objective of this study was to determine content and face validity of a tool measuring medication errors among nursing students in baccalaureate nursing education. Data was collected from the Aga Khan University School of Nursing and Midwifery (AKUSoNaM), Karachi, from March to August 2014. The tool was developed utilizing literature and the expertise of the team members, expert in different areas. The developed tool was then sent to five experts from all over Karachi for ensuring the content validity of the tool, which was measured on relevance and clarity of the questions. The Scale Content Validity Index (S-CVI) for clarity and relevance of the questions was found to be 0.94 and 0.98, respectively. The tool measuring medication errors has an excellent content validity. This tool should be used for future studies on medication errors, with different study populations such as medical students, doctors, and nurses

Association of awareness about hepatitis C infection with patterns of health seeking behavior among hepatitis C patients in Karachi, Pakistan

Background: Hepatitis C infection is one of the significant causes of morbidity and mortality throughout the world. In Pakistan, hepatitis C infection rate is 4.8%, which is the second highest prevalence rate among all developing countries. This study aimed to identify the association between awareness about hepatitis C infection and pattern of health seeking behavior among patients living with hepatitis C in Karachi, Pakistan. Methods: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan between March and May 2013. Data were collected through a modified questionnaire on ‘awareness about hepatitis C and patterns of health seeking behavior among hepatitis C patients’. Results: We did not find any association between participants’ awareness of hepatitis C infection and their primary contact with a health care provider. However, this study found that only half of the study participants (52%) had correct knowledge of hepatitisC. The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=368), followed by spiritual healers (n=206), and a few participants approached traditional healers (n=39) and homeopaths (n=11). Conclusions: The study did not find any association between the patients’ level of awareness about hepatitis C infection and their primary contact with health careproviders. However, it has been found that patterns of health seeking behavior are strongly related to the patients’ cultural practices and beliefs, which affect their choiceof health care providers. This study has provided a basis for planning interventional studies aimed at improving patients’ level of awareness about hepatitis C and their health seeking behavior

The patterns of health seeking behavior among patients with hepatitis C in Karachi, Pakistan

Background: The study aimed to assess the patterns of health seeking behavior and the level satisfaction with the health care providers among hepatitis C patients in Karachi, Pakistan. Methodology: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients, who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan, between March and May 2013. Results: The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=359), followed by spiritual healers (n=103), and a few participants approached traditional healers (n=38) and homeopaths (n=11). The pattern of health seeking behavior also revealed that the participants were taking treatment from more than one health care provider at the same time. Participants who visited doctors had effective treatment outcomes and they were satisfied with their doctors. However, those participants who visited homeopaths, traditional healers and spiritual healers had ineffective treatment outcomes and they were not satisfied with these health care providers. Conclusion: The patterns of health seeking behavior are strongly related to the patients\u27 cultural practices and beliefs, which affect their choice of health care providers. This study has provided a basis for planning interventional studies aimed at improving patients\u27 health seeking behaviors

Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach.

Abstract Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women\u27s Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition

Factors associated with prehospital delay in acute coronary syndrome, among men and women in Karachi, Pakistan

Prehospital delay in Acute Coronary Syndrome (ACS) is the time from the onset of ACS symptoms till the patient\u27s arrival at the hospital\u27s Emergency Department (ED). Despite the known significance of prehospital delay time (PDT) in determining clinical outcomes in ACS, quite prolonged delay times have been reported among ACS patients, globally\u27 Gender differences in PDT and its associated factors have been explored internationally; however, this phenomenon has not been studied before in Pakistan. Objective: The current study aimed to identify gender differences in the PDT, its components, and in the factors of delay among ACS patients. The study also aimed to explore the independent correlates of the PDT, among men and women with ACS. Methodology: This analytical, comparative, cross-sectional study was conducted on249 ACS patients at the Aga Khan University Hospital and at the Karachi Institute of Heart Diseases, between February and April, 201 1. Data was collected through the modified \u27Response to Symptoms Questionnaire\u27, and it was analyzed using comparative and regression analyses. Results: The median PDT of women was found to be 7 hours, as opposed to 3.5 hours among men (P-Value: 0.001). Women had a median \u27decision delay\u27 of 3 hours, versus 1.5 hours among men (P-Value: \u3c0.001). The median \u27physician-to-hospital delay\u27 was 4.5 hours among women\u27 versus 2 hours among men (P-Value: 0.008). Significantly prolonged delay times were observed when patients consulted general physicians (GPs). Moreover, \u27vi most women delayed due to social factors, like \u27responses of attendants to the patients\u27 symptoms\u27 (P-Value: 0.002), \u27delayed because was worried about expenses required for the treatment\u27(P-Value: 0.002), and \u27not wanting to trouble others\u27 (P-Value: 0.1); whereas, most men delayed due to individual related factors, like \u27waiting for symptoms to subside\u27(P-Value: \u3c0.001), \u27not recognizing the symptoms as cardiac\u27 (P-Value: \u3c0,001), and \u27behavioral response to the symptoms\u27(P-Value: 0.08). \u27Having anxiety\u27 and \u27lack of knowledge about symptoms\u27 were associated with extended PDT among both genders. Conclusion: This study concludes that women delayed more than men in reaching the hospital, and both the genders had different factors of delay. The findings of the current study may be of value for other international studies on the subject. With respect to Pakistan, this possibly seminal baseline study may provide important insights for designing empirical and interventional studies, in the future

Applying Meta-Theory to Qualitative and Mixed-Methods Research

Meta-theory refers to broad perspectives, which make claims regarding the nature of reality. Meta-theories philosophically underpin research and practice. Despite this centrality of meta-theory to research and practice, research studies seldom have a strong articulated philosophical basis. There are persuasive philosophical arguments for invoking meta-theory in qualitative and mixed-methods research. We argue that selecting and applying a particular meta-theory is a matter of personal expression and historicity. In this article, we describe the meta-theory of critical realism (CR), which underpins our research around complex heart failure disease management interventions. CR posits that reality is mind independent and views this reality via a stratified ontology. Its explanatory focus, generative logic, multifactorial and open systems approach, and its openness to a variety of methods make it a viable meta-theory for research in a variety of disciplines, utilizing qualitative, quantitative, and mixed methods. CR hermeneutics, ethnographies, grounded theories, mixed-methods studies, and critical realist reviews follow the meta-theoretical assumptions of CR; these are extremely useful in exploring complex interventions holistically, including their components, contexts, and mechanisms

Students’ cognitive engagement in Care of Elderly Course using Blended Learning Methodologies

AKUSONAM has been a trendsetter for nursing education in Pakistan; including the offering of Care of Elderly course to 37 undergraduate nursing students in 2013. It was offered in blended learning format, along with hands on exposure in a variety of geriatric care settings. This study was conducted for course enrollees. Methodology Through the retrospective descriptive study design, student\u27s Cognitive Engagement (CE) in Online Discussion Forums (ODF) was assessed. Researcher designed demographic tool was used to collect demographic data; while Zhu (2006) framework was used to assess CE. Discourse analysis of three ODFs was done for participants who consented to participate. Each group was assigned letter A, B or C for anonymity purpose. Findings The data revealed wide-ranging CE using the Zhu framework. Majority of the participants in all three groups have used statement type I and II, whereas the higher level of CE was least observed amongst the participants. In group (A) statements type I and II were used by 49.99% of participants; only 20.83% participants demonstrated the use of scaffolding. In group (C) 59.25% of participants used statements type I II, and scaffolding. Group (B) used statement type I significantly (25%). Conclusion The discourse analysis revealed that CE varied among the three groups. Moreover, higher level of CE such as questioning, mentoring and reflections were the least used in ODFs. This determines the future need to focus on ensuring higher levels of CE amongst course participants

Reported Medication errors committed by undergraduate (Four Year BScN) students at AKU-SoNaM, Karachi, Pakistan

Medication administration is an important part of the baccalaureate nursing curriculums. Medication errors by undergraduate nursing students have been frequently reported at faculty meetings at the study setting. As per researchers’ knowledge, no study has been conducted in the local context so as to identify the medication errors committed by nursing students. A retrospective study was done to identify the reported medication errors, their types and associated factors, through a document review, for the enrolled four year BScN students at Aga Khan University School of Nursing and Midwifery (AKU-SoNaM) for 2010 to 2013. This study was the first of its kind, which explored medication errors among nursing students in South Asia. The findings will be of importance for nursing students, educators and service providers

Awareness about hepatitis C among patients suffering from hepatitis C in Karachi, Pakistan

Objectives: To assess the level of awareness about hepatitis C among patients suffering from hepatitis C in Karachi,Pakistan. Study design settings and duration: A descriptive, cross sectional study, conducted among hepatitis C patients recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, between March and May 2013. Patients and Methods A sample size of 247 was calculated using the Open Epi software. Data were collected using a questionnaire and all eligible patients were briefed about the study purpose, risks, benefits, and their rights as participants. All patients who agreed to participate gave written informed consent. The completed questionnaire took a maximum of 25 30 minutes. For the data analysis, frequencies and percentages were computed to find out the estimated proportions of different variables. Results: A total of 250 HCV patients participated in the study. Most of the patients had incorrect knowledge about transmission of disease where 76.8% said that it is transmitted through sharing of towel/clothes, coughing (75.2%) or eating in same utensils (53.6%). Tattooing (66.4%), kissing (66%), sexual intercourse (54.4%), ear and nose piercing (53.6%) were also identified as transmission sources. Almost 91% patients had misconceptions that preventive vaccine for hepatitis C infection is available. Almost 61% patients thought that exposure to needles/syringeswas the cause of their hepatitis C while 22% said it was medical instruments. Food and water as the cause of their hepatitis was reported by 19.1%. Conclusion: Patients suffering from hepatitis C have misconceptions about disease transmission, its risk f actors, and the availability of preventive vaccine for hepatitis C. There is a dire need to improve public awareness about common diseases and their preventio