Critical Illness and Rurality: Interfacility Transfers to Urban Centres and the Impact on Rural Families

A relative’s critical illness is an intensely stressful time for family members. In the past, it was generally assumed that family members were relatively unaffected by a relative’s admission to an intensive care unit. However, there has been increasing understanding and concern in the healthcare community that family members experience negative, long-term psychological, emotional, physical and financial consequences from this experience. In addition to these noted negative consequences, it has been suggested that the unique context of rural family members of critically ill patients may result in additional burdens. In rural areas, a critically ill patient’s healthcare needs at times exceed the service capacity of the local hospital, thereby necessitating an interfacility transfer of the patient to a distant urban centre for advanced critical care services. To date, the rural family member’s experience of this phenomenon is poorly understood, specifically within the context of North America. The purpose of this study was to gain an increased understanding of the meaning of the lived experiences for rural family members whose relative undergoes an interfacility transfer to an urban tertiary centre for advanced critical care services. Munhall’s method of interpretive phenomenology was used to guide this study. Purposive sampling strategies resulted in the recruitment of 11 participants who experienced this phenomenon. Data analysis revealed the common themes of a longing for home, a sacrifice of self, and a persistent need to be close to the critically ill patient. Unique, context-specific meanings were also revealed by analyzing data through the lenses of the four life-worlds: corporeality, relationality, spatiality, and temporality. These meanings included a sense of vulnerability in the urban centre, a reluctance to communicate with urban healthcare providers, a loss of connection to both the critically ill relative and other family members, and a need to maintain responsibilities at home while in the urban centre. Through this study, nurses may better understand the multiple possible, context-specific meanings of this experience for rural family members thereby enhancing the individualized nursing care of these family members. Specifically, rural nurses may advocate for family members to be provided telephone contact details of the transport team or be permitted to accompany their relative during transfer to maintain a sense of closeness during transport. Urban nurses may appreciate the uniqueness of both rurality as culture and the loss of supports experienced by family members during this event and, thus, offer additional supports to rural family members. This improved understanding is specifically important for urban and rural critical care nurses who are in a key position to implement interventions to mitigate additive burdens experienced by rural family members

Armed violence and poverty in Southern Somalia: a case study for the Armed Violence and Poverty Initiative

YesThis report on Southern Sudan is one of 13 case studies (all of which can be found at www.bradford.ac.uk/cics). This research draws upon secondary data sources, including existing research studies, reports and evaluations commissioned by operational agencies, and early warning and survey data where this has been available. These secondary sources have been complemented by interviews with government officers, aid policymakers and practitioners, researchers and members of the local population. The analysis and opinions expressed in this report are those of the authors and do not necessarily represent the views or policy of DFID or the UK government

Contradictions and conflict: A meta-ethnographic study of migrant women’s experiences of breastfeeding in a new country

Abstract Background Studies report mixed findings about rates of both exclusive and partial breastfeeding amongst women who are migrants or refugees in high income countries. It is important to understand the beliefs and experiences that impact on migrant and refugee women’s infant feeding decisions in order to appropriately support women to breastfeed in a new country. The aim of this paper is to report the findings of a meta-ethnographic study that explored migrant and refugee women’s experiences and practices related to breastfeeding in a new country. Methods CINAHL, MEDLINE, PubMed, SCOPUS and the Cochrane Library with Full Text databases were searched for the period January 2000 to May 2012. Out of 2355 papers retrieved 11 met the inclusion criteria. A meta-ethnographic synthesis was undertaken using the analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool. Results Eight qualitative studies and three studies reporting both qualitative and quantitative data were included and one overarching theme emerged: ‘Breastfeeding in a new country: facing contradictions and conflict’. This theme comprised four sub-themes ‘Mother’s milk is best’; ‘Contradictions and conflict in breastfeeding practices’; ‘Producing breast milk requires energy and good health’; and ‘The dominant role of female relatives’. Migrant women who valued, but did not have access to, traditional postpartum practices, were more likely to cease breastfeeding. Women reported a clash between their individual beliefs and practices and the dominant practices in the new country, and also a tension with family members either in the country of origin or in the new country. Conclusion Migrant women experience tensions in their breastfeeding experience and require support from professionals who can sensitively address their individual needs. Strategies to engage grandmothers in educational opportunities may offer a novel approach to breastfeeding support.</p

Contradictions and conflict: A meta-ethnographic study of migrant women’s experiences of breastfeeding in a new country

Abstract Background Studies report mixed findings about rates of both exclusive and partial breastfeeding amongst women who are migrants or refugees in high income countries. It is important to understand the beliefs and experiences that impact on migrant and refugee women’s infant feeding decisions in order to appropriately support women to breastfeed in a new country. The aim of this paper is to report the findings of a meta-ethnographic study that explored migrant and refugee women’s experiences and practices related to breastfeeding in a new country. Methods CINAHL, MEDLINE, PubMed, SCOPUS and the Cochrane Library with Full Text databases were searched for the period January 2000 to May 2012. Out of 2355 papers retrieved 11 met the inclusion criteria. A meta-ethnographic synthesis was undertaken using the analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool. Results Eight qualitative studies and three studies reporting both qualitative and quantitative data were included and one overarching theme emerged: ‘Breastfeeding in a new country: facing contradictions and conflict’. This theme comprised four sub-themes ‘Mother’s milk is best’; ‘Contradictions and conflict in breastfeeding practices’; ‘Producing breast milk requires energy and good health’; and ‘The dominant role of female relatives’. Migrant women who valued, but did not have access to, traditional postpartum practices, were more likely to cease breastfeeding. Women reported a clash between their individual beliefs and practices and the dominant practices in the new country, and also a tension with family members either in the country of origin or in the new country. Conclusion Migrant women experience tensions in their breastfeeding experience and require support from professionals who can sensitively address their individual needs. Strategies to engage grandmothers in educational opportunities may offer a novel approach to breastfeeding support

Characteristics of immunisation support programmes in Canada: a scoping review and environmental scan

Objective To identify, characterise and map the existing knowledge about programmes that provide immunisation support to Canadians and barriers and facilitators to their delivery.Design Scoping review and environmental scan.Introduction Vaccine hesitancy may be associated with unmet support needs of individuals. Immunisation support programmes that provide multicomponent approaches can improve vaccine confidence and equitable access.Inclusion criteria Canadian programmes that focus on providing information about immunisation for the general public, but excluding articles targeting health professionals. The primary concept involves mapping the characteristics of programmes and our secondary concept examines barriers and facilitators to programme delivery.Methods The Joanna Briggs Institute (JBI) methodology guided this review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and translated for six databases in November 2021 (updated October 2022). Unpublished literature was identified through the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and other relevant sources. Stakeholders (n=124) from Canadian regional health authorities were also contacted by email for publicly accessible information. Two independent raters screened and extracted data from identified material. Results are presented in tabular form.Results The search strategy and environmental scan resulted in 15 287 sources. A total of 161 full-text sources were reviewed after applying eligibility criteria, resulting in 50 articles. Programmes were delivered in multiple Canadian provinces, focusing on various vaccine types. All programmes aimed to increase vaccine uptake and were mostly provided in person. Multidisciplinary delivery teams based on collaborations among multiple entities were credited as a facilitator to programme delivery across settings. Limitations on programme resources, attitudes of programme staff and participants, and systems organisation were identified as barriers to delivery.Conclusions This review highlighted characteristics of immunisation support programmes across various settings and described multiple facilitators and barriers. These findings can inform future interventions that aim to support Canadians in making decisions about immunisation