Creating enabling environment for student engagement: Faculty practices of critical thinking

Critical thinking (CT) is considered an important attribute in practice disciplines and faculty members in nursing, medicine, and education are expected to facilitate the development of CT in their graduates so that these individuals can be critical, reflective, competent, and caring professionals and service providers (Distler, 2007; Shiau & Chen, 2008; Worell & Profetto-McGrath, 2007). When students are actively engaged in their learning, and classrooms have an enabling environment, critical thinking is promoted. Teachers must reflect upon their teaching pedagogy when students do not participate in stimulating discussions, or asks questions in class. Research suggests that lack of understanding of CT affects teachers’ CT practices in the classroom. Literature supports that teaching learning activities and opportunities that emphasize encouragement of students’ participation in classroom fosters communication, student engagement, creativity, self – directedness and critical thinking (Choy & Cheah, 2009). Thus it is vital to explore what CT practices can be performed by educators to influence students’ CT. The present study aimed to identify perceptions and practices of CT among educators from the disciplines of nursing, medicine, and education in higher education in Karachi, Pakistan. A descriptive exploratory design was used where 12 multidisciplinary educators participated in semi structured interviews and allowed classroom observations. Four major themes were identified, but this paper will explore multidisciplinary educators’ practices of CT in a classroom setting. The faculty needs to be aware of how their practices of critical thinking can create an enabling learning environment, and what factors in its physical, psychological and intellectual environment can affect critical thinking in students

Prospects for the sustainability of delivering the basic package of Health Services in Afghanistan: a stakeholder analysis

This study explored the readiness of stakeholders in Afghanistan for sustaining delivery of the Basic Package of Health Services (BPHS) without external technical and financial assistance. A stakeholder analysis was applied using qualitative methods. Fifteen stakeholders were purposively drawn from the Afghanistan ministries of public health and finance, political representatives, development partners, nonprofit organizations and public health experts. Data were collected through in-depth interviews with the stakeholders and desk review of pertinent documents. We found that sustainability of the BPHS in Afghanistan is questionable as stakeholders are sub optimally organized to come up with effective alternatives. Uneven ownership and divisive positioning are bottlenecks to the evolution of a realistic continuation plan. Those with the most significant influence are lukewarm, while those who are most supportive have the least influence. Sustainability needs to be tackled at the start in designing the BPHS rather than in the wake of eventual donor withdrawal

Can rote learners be transformed into critical thinkers through a concept – mapping intervention?

Critical thinking is an important outcome of higher education in any discipline. International literature reveals that teaching strategies—such as reflections, self-directed learning, questioning, and concept mapping—which ask for active engagement of students in their learning, foster critical thinking. Social context of the learning environment, and the instructor’s competence and approach to teaching also influence students’ critical thinking abilities. Contrary to the required teaching practices, didactic teaching and rote learning are still prevalent in most teaching institutions and disciplines in Pakistan. The focus of this paper is to report on the process and findings of a quasi-experimental study in which students at Aga Khan University School of nursing were taught and encouraged to use concept mapping as a way for knowledge acquisition. A total of 97 nursing students in their first year of the programme were enrolled in the study. In the pre-intervention phase all students were assessed for their level of self-directed learning and ways of knowing, using two instruments, named- SDLRS (Self Directed Learning Readiness Scale) and WOKAT (Ways of Knowing Assessment Tool). The students were allocated to experimental and controlled groups based on their score on WOKAT. Those in the experimental group were taught to develop concept-maps. In the post-intervention phase, all students were reassessed on SDLRD, WOKAT, and GPA and their scores were compared between the groups. Findings of the study showed significant difference between the controlled and experimental groups in terms of students GPA but no substantial change was noted in their scores on SDLRS and WOKAT

A step by step methodological approach to appraise the quality of written feedback using comment analysis

Several studies have been conducted to analyze the quality of written feedback given by teachers on students’ written assignments. However, it has been observed that there is no clear existing method or tool to facilitate the analysis of teachers’ written feedback. This paper aims to document a step by step methodological approach to analyze teachers’ comments and appraise the quality of feedback on students’ written assignments. A self-initiated tool was developed from the comment analysis process which revealed the use of various formats and modes employed to provide written feedback to the students. In addition, this tool helped to determine the focus and tone of the feedback. Using a step by step approach, the tool also helped to identify clarity in the given feedback. This paper is an addition to the existing literature in the qualitative research method for in-depth analysis of teachers’ comments. This effort will not only appraise the quality of given feedback but also help in further development of a comprehensive qualitative tool to assess its quality

Experience of caregivers with the survivors of Hepatitis C

Objectives: To assess and describe the experiences of those caring for hepatitis C patients in Karachi, Pakistan. Methods: Using a qualitative approach, the study adopted a descriptive exploratory design for which 8 caregirers were selected through snowball sampling technique from different parts of Karachi. Data was collected between May and July 2010 through semi-structured interviews from the caregivers. The interviews were recorded on tape and were transcribed verbatim. The data was manually analysed for extracting themes and categories. Results: The analyses of data led to one theme - \\u27deadly, dangerous, and devastating. Two associated categories could also be noted: \\u27perceptions and misperceptions of the caregivers about hepatitis C\\u27 and \\u27challenges and adversities of the disease.\\u27 Conclusion: The diagnosis of hepatitis C had a profound impact on patients\\u27 and the caregivers\\u27 wellbeing. Although to some extent, caregivers were found to have fulfilled their role, but it was evident that better disease knowledge, funds and social support could have further helped them to address issues related to the disease

Women experiences of using external breast prosthesis after mastectomy.

Objective: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. Methods: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. Results: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. Conclusions: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women\u27s physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers\u27 support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints

Quality of life and its determinants in adult cancer patients undergoing chemotherapy treatment in Pakistan.

Objective: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals\u27 well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients\u27 survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. Methods: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (\u3e19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. Results: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (\u3e1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. Conclusions: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients

Levels and predictors of self-care among patients with hypertension in Pakistan

Background: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol.Results: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population.Conclusion: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications

Physicians’ and nurses’ perspectives on the importance of advance directives in tertiary care hospitals

Objective: This study aimed to explore and identify the nurses’ and physicians’ views about Advance Directives and identified their perspectives on its importance, in the context of Pakistan.Methodology: Using a purposive sample, six physicians and seven nurses from two tertiary care hospitals in Karachi participated in the study. Data was collected using semi structured interviews that were transcribed verbatim. The interviews were coded and categorized manually. Analysis of the data drew four categories: roles of physicians and nurses in the End of life care, challenges they faced while taking end of life care decisions; their perspectives about Advance Directives, and the scope of acceptability of Advance Directives in the context of a Pakistani society.Results: This study revealed that patients’ families and physicians usually take decisions for patients’ End of Life care. Although majority of participants acknowledged the usefulness of Advance Directives, they explicated several issues that may be encountered in implementing it. The issues included non-disclosure of diagnosis to the patient in Pakistani culture, the tedious legalization process involved, and the potential problem of forged documents.Conclusion: Participants recommended establishment of Palliative Care services before execution of Advance Directives. This study indicated viability of Advance Directives; however, a wider exploration would be required in terms of study population. Reforms to support this concept would be required in systems, structure, legal policy, and training of Health care professionals. Besides these transformations, promotion of public education about the advantages of Advance Directives could enhance their acceptability among the general population