Empowerment among Pakistani nursing leaders: A grounded theory approach

Empowerment among Pakistani nursing leaders Nursing is a growing profession worldwide; however, its image still suffers from historical social disapproval, particularly in third-world countries. It has also been observed that nurses working in various capacities suffer from oppression, which not only damages their personality but reduces their performance quality. To overcome this limitation, inculcating empowerment is essential. The increasing complexity of the healthcare system, with the introduction of sophisticated healthcare technology and increased patient acuity levels, has had a significant impact on nursing practice requirements, and this has created heavy demands and expectations from nursing leaders who are already working in a challenging environment. Thus, attaining empowerment is significantly important for nursing leaders. It plays an essential role in helping to lead the followers to bring positive change and influence society as a whole. Although considerable research has been done internationally, less attention has been paid to the empowerment of nursing leaders in Pakistan. It would, thus, be of interest to learn how Pakistani nursing leaders go through the empowerment process. Based on that, a theory will be developed that would enable nursing leaders to come up with a guiding tool that will help nurture current and future nursing leaders. The study\u27s objectives are to discover the key concepts and their relationship with empowerment from the Pakistani nursing leaders’ perspective, identify the empowerment processes, and generate a grounded theory of empowerment. The study utilized the qualitative design using the grounded theory approach. National nursing leaders from the public and private health sectors were selected. Twelve participants (n=12) were interviewed using a structured interview guide. Data analysis was done through constant comparisons of the data and literature reviews. Open coding, axial coding and selective coding were done using the qualitative analysis procedure of grounded theory. Finally, a theoretical model was developed as an outcome of the study. Based on the study findings, conceptual and operational frameworks were proposed. From the conceptual framework, six significant categories highlighted the core category of ‘empowerment’. They were the status of a nurse, the nursing profession, power relationships, leadership and management and value belief systems. The operational framework focused on challenges adopted strategies and outcomes of empowerment. The outcome was the generation of a theoretical model of empowerment, which was described as a process. The core category represents the central theme, and the relationship among all the categories and subcategories has been illustrated through a diagrammatic representation. Recommendations have been given based on the study findings. The significant recommendations are strengthening the nursing education system, providing national and international exposure to nurses, the commencement of master\u27s and PhD programs in nursing at the government and private s levels, including courses like ethics, gender, politics and empowerment in nursing education, especially in the masters’ program, strengthening the nursing regulatory bodies like the Pakistan nursing council (PNC) and the Pakistan nursing federation (PNF) by inducting strong nursing leadership; induction of more male nurses in the profession to have a gender mix in nursing in Pakistan. Empowerment The empowerment process is one of the significant components of enhancing the image of the nursing profession in Pakistan. It can shape the profession constructively and pragmatically. Building the competencies of nurses by providing higher education and an understanding of the political system is crucial to nurse empowerment in the Pakistani context

Are we empowered? A qualitative approach to unfold the experiences of female nurses in Pakistan

The disparity of men and women in certain societies, such as Pakistan, is a growing concern. The disparity, unchanging mind-set, and definitions rooted in traditions do not free individuals from the socially bound gender identities. In such circumstances, educational institutions can become a way of transforming social structures. Considering female nurses in Pakistan as a case study, this paper explores the notion of “empowerment” and the factors responsible for empowerment or disempowerment of female nurses. The study also evaluates the role of a leading nursing institution in Pakistan namely the Aga Khan University- School of Nursing and Midwifery (AKUSONAM) in empowering female nurses. The data is collected through five focus group discussion among forty-five alumni of AKU-SONAM. The findings of the study presents an “inside-out” understanding of the term “empowerment” by female nurses of Pakistan and; enlists the challenges faced by women in Pakistan in becoming and working as nurses. The study also put forward recommendations for nursing professional bodies such as Pakistan Nursing Council and Pakistan Nursing Federation and other nursing institutions in Pakistan. The paper would serve as a guide to enhance further development in nursing and women empowerment

Menstrual hygiene amongst school Girls: Still a messy business

Background: Menstruation has become a taboo topic among adolescent females, affecting their reproductive health, particularly in more traditional South Asian nations such as Pakistan. The study highlights the societal silence surrounds menstruation, which leads to detrimental practices and attitudes among school-age females. The study reveals the sociocultural, psychological, and educational challenges that teenagers encounter. The presence of myths and misconceptions adds to unsanitary habits, which undermine education and reproductive health.Methodology: A descriptive cross-sectional study was conducted in urban Karachi. The participants were 850 unmarried school-going female adolescents aged 13 to 19. The data were collected using a pre-coded questionnaire. SPSS version 10.0 was used for descriptive and inferential analysis. The significance level was set at a p-value of 0.05 for all analyses. Normal distribution was assessed using the Kolmogorov–Smirnov test.Results: The mean age was 15.39 (±3.266) years, with an average of 7.67 (±2.119) years of schooling. Only 59 %( n=501) received Information before menarche, and 94% (n=797) did not own a TV. Good menstrual knowledge was demonstrated by 72.4 %( n=614). Unhealthy practices were prevalent in 49.8 %( n=422) of participants. There was a significant difference in practices based on educational background.Associations were found between prior Information and menstrual knowledge (χ² = 6.058, p = 0.012) but not between school type and TV ownership. Multivariate analysis revealed that prior Information significantly influenced knowledge (OR: 1.481, 95% CI: 1.082-2.027). Meanwhile, schooling positively influenced practices (Adjusted OR: 1.106, 95% CI: 1.036-1.182), while school type exhibited a reverse association (Adjusted OR: 0.636, 95% CI: 0.483-0.836).Conclusion: There exist intricate challenges surrounding menstruation in urban Karachi, reflecting the absence of sex education in Pakistan. This study advocates for comprehensive strategies to enhance reproductive health education and practices among young women. The study advocates for sex education at the secondary level to help empower adolescent girls. The two potential sources that should be targeted are the midwives who have access to the childbearing mother and their families, and other female members in the community, and the schools where females feel comfortable asking questions that help to mitigate local myths. Community midwives can play a significant role in deciphering what knowledge is being communicated to adolescents

Does empowerment matter? Perceptions of nursing leaders in Pakistan through qualitative approach.

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect. Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment. Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management. Conclusions: Nurses’ empowerment is essential for enhancing the image and status of nursing profession in Pakistan. The study identified various personal and professional factors affecting nurses’ empowerment in the country and suggests various strategies, such as access to higher nursing education, development of enhanced nursing leadership competencies and understanding of power and politics of the organization, through which nurses can achieve empowerment

Validity and reliability testing: Urdu translated modified Response to Symptoms Questionnaire.

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 5% of the total sample size of the parent study. RESULTS: Sufficient conceptual and semantic equivalence was found between the Urdu and English versions of the modified RSQ. Content validity index was calculated to be 1 for both relevance and linguistic clarity. Test retest and inter rater reliabilities were calculated to be 95.9% and K = 0.97, respectively. CONCLUSION: The Urdu translated modified RSQ has sufficiently acceptable content validity, test retest and inter rater reliability; hence, it should be used by the researchers for the evaluation of factors associated with pre-hospital delay among Urdu speaking ACS patient populations

Sexual abuse: An ethical dilemma of autonomy vs. beneficence and the role of healthcare providers in a community setting

By virtue of their professions, health workers who deal directly with human lives (such as doctors and nurses) are prone to questioning their decisions and practices, especially from an ethical standpoint. To practise competently, one needs to be equipped with knowledge pertaining to the discipline of bioethics. To elucidate this point, this article will examine a child sexual abuse (CSA) case from a bioethical lens and analyse it through the MORAL ethical decision-making model of Patricia Chricham. While working as a Student Counsellor and practising nurse at a low-income, co-education higher secondary school in Karachi, I encountered a situation which compelled me to reflect on the appropriateness of the decision/action that was taken at that time. A Year-I student, aged 16 and from a Sindhi* family, was referred to me by her teacher for not performing well academically. She reported problems such as headache, insomnia and occasionally nightmares, resulting in frequent absenteeism. Eventually, in private sessions with her, I found that a year ago she has been sexually abused by one of her family friends in his thirties. Her whole body was trembling, and her tearful red eyes were conveying the severity of mental trauma she was experiencing. She had not shared this incident with anyone before me. She was offered to have a meeting with her parents in my presence as counsellor so that she could share that incident with them in a supportive and safe environment. She refused this suggestion, believing that her parents would never understand her and would instead blame her for the incident. Her sister was a medical doctor and ideally could have been a trustworthy and appropriate confidante, but the victim did not give permission to approach her sister either. This anxiety had put her in great agony. With the girl’s consent and without disclosing her identity, I explained the situation to the school principal in order to take his viewpoint of the problem. The principal’s involvement helped in reaching the decision to respect the girl’s wish of not disclosing the incident to her family. Finally, I referred her for further medical consultancy. However, since I was professionally obliged to share all my cases with my Department Head, I took the girl’s consent to discuss this issue without revealing her identity. I documented this case in a separate file that was kept in a locked drawer. This scenario is emblematic of a real ethical dilemma, i.e., whether or not to disclose information about this incident to the girl’s parents. If the girl’s autonomy was respected, then she might be exposed to further abuse as she would not get sufficient support, guidance and protection from her family; whereas if the incident was disclosed to her parents, then her autonomy, which is her fundamental right, would be violated. In the view of some experts, the principles of autonomy and beneficence can conflict with each other (Gladys 1992). Some suggest that despite the beneficent role of an intervention, doing so may still be wrong because it violates the patient’s autonomy (Fry and Veatch 1987). In light of the incident narrated above, the aim of this article is to examine concepts of autonomy versus beneficence. Literature shows that the incidence of CSA may never be known precisely. However, global estimates of CSA using meta-analysis reveal figures ranging from 7.9% of men and 19.7% of women suffering some form of sexual abuse prior to the age of 18 (Pereda et al. 2009). Another meta-analytic study reports an overall global estimate of 12.7% (Stoltenborgh 2011). Globally, 44% of sexual abuse occurs between the ages of 13 and 16 and 68% of these teenagers were abused by close friends or relatives (Medical Study News 2004). In Pakistan, a total of 2,595 cases of CSA were reported in 2010, i.e., approximately seven children are sexually abused every day. This number may be higher given that countless incidences of CSA go unreported (Anwar 2010). Additionally, Ellsberg (2005) found that Latin American, Asian and African women and girls are most likely to be abused by someone known to them, often a family member

Under the veil of silence: Violence against women

Violence can be defined as a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner. Violence against women takes many forms, including domestic Violence, sexual abuse, human trafficking and traditional practices like dowry-related violence and honour killings. Literature revealed that a total of 8,539 cases of violence against women were reported in Pakistan in 2011. Domestic violence is perhaps the most important element of the set of violence against women resulting in far-reaching implications on their health, including physical as well as psychological, and on overall gender status. This paper is going to highlight the dynamics and implications of domestic violence in local context through the case study approach

Health problems among school age children and proposed model for school health promotion

Background: Young school going children are at high risk of acquiring communicable and non-communicable diseases and the situation is alarming in low and middle income countries (LMICs). The prospects are further worsened by poverty and inadequate water and sanitation facilities. This all significantly affect young children’s cognitive, motor and socio-emotional development. Concept of health promoting schools (HPS) has long been advocated where schools are viewed as healthy settings for living, learning and working. Countries around the world have implemented diverse components of HPS, which are delivering promising results.Current State and Proposed Model: The paper attempts to highlight the need for school health promotion, and reports on the health promotion activities being carried out in a peri-urban school settlement in Pakistan by the Rural Educational Promotion and Development Society (REPDS), Pakistan in collaboration with Aga Khan University (AKU), Pakistan. Health program at the school was conceptualized in light of the WHO’s HPS model and is comprised of four major components: (1) school health services mainly include, treatment of minor ailments to children and school staff, health screening of children and health education activities, (2) community links and partnerships to promote health of children and collaboration with local NGO to deliver eHealth services, (3) capacity building of teachers to undertake basic health assessments of children, and (4) school physical environment to offer conducive atmosphere to all members of the school community.Conclusions: The health and education sectors in LMICs need to assess the health needs of the young children in their settings so as to adapt the school health promotion programs in order to enhance children’s overall well-being

Teaching experience and reflection

The standard of education can be improved if educators actively assess themselves or have someone else evaluate their teaching skills. Reflection on multiple aspects of teaching can be used as a powerful tool for worldwide educationists. Teaching, particularly in nursing discipline, strives to move beyond the simple divulgence of facts and knowledge. It widens student’s horizons, stimulates their intellects, and teaches them to become self directed. This manuscript is a qualitative review of observations in a class of nursing with context to teaching skills and its impact on students’ interest in learning during the class. The authors have used their reflections to discuss the ways to improve teaching methodology and related them with various teaching learning theories