Qualitative research in an international research program : maintaining momentum while building capacity in nurses

The article describes capacity building components that underpin the participatory action research (PAR) process for this international program. Although nurses are well positioned to lead positive change and advance health, barriers such as the dearth of nurse researchers with doctoral-level training prevent them from effectively responding to rapidly changing health care settings. This research program aimed to improve nursing practice in HIV care. The involvement of decision-makers was strategic, towards influencing policy, and changing nursing practice. The research program was developed with full participation of investigators who represented all participating countries: Canada, Barbados, Jamaica, Uganda, Kenya, and South Africa

The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa

Sherpa Romeo green journal. Open access article. Creative Commons Attribution 4.0 international License (CC BY 4.0) appliesBackground: The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low-and-middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care. Methods: A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test. Results: Response rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self—pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73–0.82), p = 0.002; workplace policies—pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance—pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising—pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002—and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation—pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). Multivariate results for Kenya and Jamaica were non-significant. Twelve hubs were established; 11 were active at follow-up. Hub members (n = 34) reported significant improvements in their capacity to address care gaps. Conclusions: Leadership hubs, comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy. Overall, hubs did not provide the necessary force to improve the uptake of evidence-informed HIV care in their districts. If hubs are to succeed, they must be integrated within district health authorities and become part of formal, legal organisations that can regularise and sustain them.Ye

The Jamaica asthma and allergies national prevalence survey: rationale and methods

<p>Abstract</p> <p>Background</p> <p>Asthma is a significant public health problem in the Caribbean. Prevalence surveys using standardized measures of asthma provide valid prevalence estimates to facilitate regional and international comparisons and monitoring of trends. This paper describes methods used in the Jamaica Asthma and Allergies National Prevalence Survey, challenges associated with this survey and strategies used to overcome these challenges.</p> <p>Methods/Design</p> <p>An island wide, cross-sectional, community-based survey of asthma, asthma symptoms and allergies was done among adults and children using the European Community Respiratory Health Survey Questionnaire for adults and the International Study of Asthma and Allergies in Children. Stratified multi-stage cluster sampling was used to select 2, 163 adults aged 18 years and older and 2, 017 children aged 2-17 years for the survey. The Kish selection table was used to select one adult and one child per household. Data analysis accounted for sampling design and prevalence estimates were weighted to produce national estimates.</p> <p>Discussion</p> <p>The Jamaica Asthma and Allergies National Prevalence Survey is the first population- based survey in the Caribbean to determine the prevalence of asthma and allergies both in adults and children using standardized methods. With response rates exceeding 80% in both groups, this approach facilitated cost-effective gathering of high quality asthma prevalence data that will facilitate international and regional comparison and monitoring of asthma prevalence trends. Another unique feature of this study was the partnership with the Ministry of Health in Jamaica, which ensured the collection of data relevant for decision-making to facilitate the uptake of research evidence. The findings of this study will provide important data on the burden of asthma and allergies in Jamaica and contribute to evidence-informed planning of comprehensive asthma management and education programs.</p

A review of equity issues in quantitative studies on health inequalities: the case of asthma in adults

<p>Abstract</p> <p>Background</p> <p>The term 'inequities' refers to avoidable differences rooted in injustice. This review examined whether or not, and how, quantitative studies identifying inequalities in risk factors and health service utilization for asthma explicitly addressed underlying inequities. Asthma was chosen because recent decades have seen strong increases in asthma prevalence in many international settings, and inequalities in risk factors and related outcomes.</p> <p>Methods</p> <p>A review was conducted of studies that identified social inequalities in asthma-related outcomes or health service use in adult populations. Data were extracted on use of equity terms (objective evidence), and discussion of equity issues without using the exact terms (subjective evidence).</p> <p>Results</p> <p>Of the 219 unique articles retrieved, 21 were eligible for inclusion. None used the terms equity/inequity. While all but one article traced at least partial pathways to inequity, only 52% proposed any intervention and 55% of these interventions focused exclusively on the more proximal, clinical level.</p> <p>Conclusions</p> <p>Without more in-depth and systematic examination of inequities underlying asthma prevalence, quantitative studies may fail to provide the evidence required to inform equity-oriented interventions to address underlying circumstances restricting opportunities for health.</p

Nutrition in critical illness: Critical care nurses’ knowledge and skills in the nutritional management of adults requiring intensive care – A review of the literature

Background: Critical illness is physiologically debilitating and is affected by the nutritional status of patients. There is a strong relationship between adequate nutritional status and recovery from critical illness. The health care team, nurses in particular, play a major role in the management and maintenance of an optimal nutritional status in patients who are critically ill. Aims of the review: 1) To examine current evidence regarding the relationship between nutrition and critical illness 2) to examine the relationship between nutritional intake and clinical outcomes of critically ill patients; 3) To determine the role of critical care nurses and the health care team in meeting the nutritional needs of critically ill patients. Methods: A Computerized search of Google Scholar, CINAHL, ProQuest, Medline, and HINARI was done using key terms. The search was delimited to peer reviewed, full text descriptive and intervention research articles with abstracts, which were reviewed. Results: Current evidence suggests that there is a strong positive relationship between nutritional status and critical illness. Improved nutritional status is associated with positive clinical outcomes. However, the evidence is inconsistent in supporting this relationship. The healthcare team particularly nurses’ play a major role in the nutritional status of critically ill patients. Conclusion: Maintaining optimal nutritional status is key to improving clinical outcomes of critically ill patients. Knowledge and skills of the healthcare team in nutritional management and the availability of management protocols are important in maintaining optimal nutrition of critically ill patients

Perspectives of Jamaican nurses and decision makers on the impact of the HIV/AIDS epidemic on the nursing workforce

Objective: To explore how the HIV and AIDS epidemic has affected the nursing workforce and the provision of HIV/AIDS nursing services in Jamaica. Methods: A purposive sample of 20 frontline nurses, nurse managers and 9 decision makers was drawn from participating health institutions. Qualitative semi-structured interviews were audio taped and transcribed verbatim. A coding framework was developed which guided both descriptive and conceptual analysis. Results: The majority of respondents reported that the HIV/AIDS epidemic created increased challenges to the provision of quality nursing care due to higher patient/nurse ratios, increased workload, emotional and physical burnout, greater risk of occupational injury and HIV infection. All respondents revealed that strict implementation of universal precautions was constrained by inadequate supplies of protective gears and equipment. Most of the respondents described stigma perpetrated by nurses towards individuals living with the disease. Conversely, some respondents reported a reduction in bias towards patients living with HIV/AIDS. Institutional responses to the epidemic included increased training in HIV/AIDS care and more rigorous application of standards and procedures for infection control; created new opportunities for nurse leadership in implementing programs and new job opportunities for nurses in Non Governmental Organizations involved in HIV and AIDS care. Conclusion: Findings of this study suggest largely negative effects of the HIV/AIDS epidemic on the nursing workforce as well as indirect positive outcomes. The negative impact on quality of care exists both on individual and institutional levels. Policies and organizational supports are required to reduce the impact of the HIV/AIDS epidemic on the nursing workforce. Key Words: HIV, AIDS, Nursing Workforce, Decision Makers, Jamaic

Nurses’ experiences of stigma in HIV and AIDS care in Jamaica

Objective: To explore how multilayered dimensions of stigma influence nurses provision of nursing care to patients and families living with HIV/AIDS. Methods: A cross-sectional survey was done among 201 frontline nurses, midwives and nurse managers working in the public health care system in Westmoreland, St. James, Trelawny, Kingston & St. Andrew, St. Catherine and St. Thomas. Stigma was measured using the validated HIV/AIDS Stigma Instrument for Nurses. Qualitative data were collected in a purposive sample of 20 nurses and midwives using a semi structured interview guide. Interviews were audio taped and transcribed verbatim coded and thematically analyzed. Results: Quantitative data revealed low levels of stigma against patients with HIV/AIDS. Nurses frequently reported occurrences of subtle stigmatization of patients such as making patients with HIV last to be cared for 48 (23.9%), shouting at or scolding patients with HIV/AIDS 46 (22.4%) and generally giving poor quality care 42 (22.8%). A small proportion, 20 (9.7%) of respondents also reported that nurses who care for patients with HIV/AIDS were stigmatized, particularly nurses who work in hospitals rather than health centres Qualitative interviews with nurses and midwives revealed that stigma and discrimination was a major factor that influenced nurses’ ability to provide care for patients living with HIV. Fear of stigma and discrimination also influenced patients’ decision to disclose their HIV status, which in turn influenced nurses’ ability to provide care. Conclusion: Stigma associated with HIV/AIDS hinders nurses from providing the best possible nursing care to patients and demonstrates a need for continuing education. Key Words: Stigma, Nurses; Nursing Care, HIV/AIDS

Asthma and Allergies in Jamaican Children age 2-17 years: A cross-sectional prevalence survey

Objective: To determine the prevalence and severity of asthma and allergies as well as risk factors for asthma among Jamaican children aged 2-17years. Design: A cross-sectional community-based prevalence survey using the International Study of Asthma and Allergies (ISAAC) questionnaire. The authors selected a representative sample of 2, 017 children using stratified multi-stage, cluster sampling design using enumeration districts as primary sampling units. Setting: Jamaica, a Caribbean island with a total population of approximately 2.6 million geographically divided into 14 parishes. Participants: Children aged 2-17 years, who were resident in private households. Institutionalised children such as those in boarding schools and hospitals were excluded from the survey. Primary and secondary outcomes measures: The prevalence and severity of asthma and allergy symptoms, doctor diagnosed asthma and risk factors for asthma. Results: Almost a fifth (19.6%) of Jamaican children aged 2-17years had current wheeze while 16.7% had self reported doctor-diagnosed asthma. Both were more common among males than females. The prevalence of rhinitis, hay fever and eczema among children was 24.5%, 25% and 17.3%, respectively. Current wheeze was more common among children with rhinitis in the last 12 months (44.3% versus 12.6%, p&lt;0.001), hay fever (36.8% versus 13.8%, p&lt;0.001) and eczema (34.1% versus 16.4%, p&lt;0.001). Independent risk factors for current wheeze, odds ratios (OR), 95 % confidence intervals(CI) were: chest infections in the first year of life 4.83 (3.00-7.77), parental asthma 4.19 (2.8 -6.08), rhinitis in the last twelve months 6.92 (5.16-9.29), hay fever 4.82(3.62-6.41), molds in the home 2.25 (1.16-4.45), cat in the home 2.44 (1.66-3.58) and dog in the home 1.81(1.18-2.78). Conclusions: The prevalence of asthma and allergies in Jamaican children is high. Significant risk factors for asthma include: chest infections in the first year of life, a history of asthma in the family, allergies, molds and pets in the home

Qualitative Research in an International Research Program: Maintaining Momentum while Building Capacity in Nurses

Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decision-makers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses' Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses' involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach