‘Competent, but not allowed to blossom’: Midwifery-trained registered nurses’ perceptions of their service: A qualitative study in Sri Lanka

Objective: To explore midwifery-trained registered nurses’ perceptions of their own profession as maternity care providers and how they identify their role, tasks, and responsibilities within a multi-professional team. Design: An exploratory qualitative study using focus group discussions and qualitative content analysis. Setting: Three selected tertiary care hospitals in the Capital Province in Sri Lanka. Participants: Twenty-two midwifery-trained RNs working in intra-partum and postpartum units. Findings: The overriding theme of the analysis was identified as ‘competent but not allowed to blossom fully in their practice’, based on two main categories: ‘provision of competent care’ and ‘working with disappointments’. Each main category had four subcategories: ‘acting with compassion’, ‘cooperation in emergencies’, ‘exceeding one’s boundaries’, ‘taking full responsibility’ and ‘deprived of utilizing special knowledge and skills’, ‘role confusion with other professional groups’, ‘lack of professional identity’, and ‘not being appreciated by others’, respectively. Conclusion: Midwifery-trained RNs conveyed a deep sense of disappointment regarding their profession as maternity care providers in Sri Lanka. Midwifery-trained RNs’ perceptions of their high proficiency are incongruent with their low sense of identity and belongingness within the multi-professional hospital-based maternity care team. This phenomenon warrants further study, considering its implications for team work and patient safety

Seroprevalance of dengue viral infections and serotype specific t cell responses in healthy individuals in Colombo, Sri lanka

Objective: Although dengue viral infections cause dengue haemorrhagic fever and fatalities in some individuals, it is a mild /asymptomatic infection in the majority of infected individuals. Therefore, we set out to determine silent dengue transmission in the community. Methods: 236 healthy individuals aged 5-80 years recruited from community to test the presence of anti-dengue virus(DV)antibodies. Ex vivo and cultured ELISpot assays for serotype specific (SS)DV peptides, DEN3 NS3 and non-dengue viral peptides were done in 47/263 individuals. Cultured ELISpots for SS responses done in 3 individuals < 20 years, in 20 for  20-40years  age and in 24 aged >40years. Results: The seropositivity rates for DV-specific antibodies were 40%,62.5%,100% at 10,20,40 years of age respectively. A significant(p=0.001) and positive correlation observed with  age and DV- seropositivity (Spearman r =0.8365,95%CI 0.55-0.95).  SS T cell responses detected in all seropositive individuals(n=44) but absent in all dengue seronegative (n=3) individuals. SS responses seen in only 1 person of the <20 age group who responded to SS peptides of DEN-2. 3/20(25%), 6/20(40%), 3/20(25%) and 5/20(30%) of individuals between 2-40 years responded to at least one SS peptide of DEN-1, DEN-2, DEN3 and DEN-4 peptides respectively. 12/24(50%), 5/24(33%), 12/24(50%) and 6/24(25%) of individuals aged >40 years responded to at least one SS peptide of DEN-1, DEN-2, DEN-3 and DEN-4 peptides respectively. Conclusions: Seropositivity rates to the DV significantly rises with age, almost 100% at 40 years of age. The SS T cell responses to DEN-1 and DEN-3 SS peptides were more frequent aged >40 years.

Perceived Risk of Dengue in Ones’ Living Environment as a Determinant of Behavior Change through Social Mobilization and Communication: Evidence from a High Risk area in Sri Lanka

Background: The aim of this study was to assess community knowledge and behavioral impact of the social mobili­zation and communication strategy applied in a dengue high-risk area in Sri Lanka. Methods: A group of adults visiting selected primary care facilities in Colombo district were interviewed to collect socio-demographicdata, attributes of knowledge regarding dengue and the responsive behaviors adopted by them following the dengue control program though the media and social marketing campaigns. These attributes were clas­sified as `good ', `fair,' or `poor' by developing a composite scale for analysis and interpretation of data. Results: The primary source of information was television in the majority. The overall knowledge of the disease, vector and control methods was poor. The overall level of contribution to dengue control activities was good. Conclusion: Awareness of the disease and its complications had not contributed to favorable behavior changes.  While the social mobilization and behavior change campaign in Sri Lanka had low impact on knowledge and be­haviors, a better understating of community perceptions of DF and how these perceptions are formulated within the social and cultural context; would be useful to improve uptake. This knowledge would be valuable for program plan­ners to strengthen dengue control activities in SL and other similar settings across the region

Midwifery trained registered nurses’ perceptions of their role in the labor unit

Introduction: A Midwifery Trained Registered Nurse (MTRN) is a member of the multiprofessional maternity health care team in Sri Lanka. Her contribution to the maternity care team is poorly understood, often undermined, and undefined. In the context of low- and middle-income settings where traditional midwives play a crucial role in domiciliary care, the MTRNs role as a member of the multi-professional hospital-based maternity care team has not been well-described. Objective: The study aimed to describe MTRNs’ perceptions of their role in the Labor Unit within the multi-professional maternity health care team at five tertiary care hospitals in the Capitol Province of Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted among 186 MTRNs working in labor rooms in the study setting. All MTRNs in the selected hospitals were invited and included in the sample. A postal survey was carried out using a pre-evaluated, pretested self-administered questionnaire, and descriptive statistics were derived. Results: All respondents were females, aged 27 to 60 years (Mean±SD: 40±8.3 years). The majority (66%) was less than 45 years old. Almost all (&gt;96%) MTRNs perceived 12 tasks of the listed tasks as their primary responsibility. Regarding other tasks, they perceived a high degree of overlap between their role and those of the doctors and midwives. Although almost all MTRNs rated the level of interprofessional collaboration from Registered Nurses (RNs) and doctors as average to good, nearly half (49%) of them rated support from midwives ranging from very poor to average. Conclusion: A high degree of perceived overlap between MTRNs’ tasks with those of the other members of the maternity care team can cause role confusion, conflicts, and poor patient care. MTRNs’ role in the Labor Unit within the multi-professional maternity health care team was controversial. Clarifying the MTRNs scope of practice will help improve interprofessional understanding of roles and responsibilities and collaboration.Financial support was provided by the World Class University Project of the University of Sri Jayewardenepura (Grant No-Ph.D./13/2012).</p

Intimate partner violence in the post-war context: Women's experiences and community leaders' perceptions in the Eastern Province of Sri Lanka.

BACKGROUND:Exposure to armed conflict and/or war have been linked to an increase in intimate partner violence (IPV) against women. A substantial body of work has focused on non-partner rape and sexual violence in war and post-war contexts, but research about IPV is limited, particularly in Asian settings. This paper presents the finding of a study conducted in the Eastern Province of Sri Lanka. The study explored women's experiences of and responses to IPV as well as how health and social service providers perceive the problem. It also explored the IPV-related services and supports available after the end of a 30-year civil war. METHOD:We conducted in-depth, qualitative interviews with 15 women who had experienced IPV and 15 service providers who were knowledgeable about IPV in the Eastern Province of Sri Lanka. Interviews were translated into English, coded and organized using NVivo8, and analyzed using inductive thematic analysis. RESULTS:Participants described IPV as a widespread but hidden problem. Women had experienced various forms of abusive and controlling behaviours, some of which reflect the reality of living in the post-war context. The psychological effects of IPV were common, but were often attributed to war-related trauma. Some men used violence to control women and to reinstate power when their gender roles were reversed or challenged due to war and post-war changes in livelihoods. While some service providers perceived an increase in awareness about IPV and more services to address it, this was discordant with women's fears, feelings of oppression, and perception of a lack of redress from IPV within a highly militarized and ethnically-polarized society. Most women did not consider leaving an abusive relationship to be an option, due to realistic fears about their vulnerability to community violence, the widespread social norms that would cast them as outsiders, and the limited availability of related services and supports. IMPLICATIONS:These findings revealed the need for more research about IPV in post-war contexts. Women's experiences in such contexts are influenced and may be masked by a complex set of factors that intersect to produce IPV and entrap women in violence. A more nuanced understanding of the context-specific issues that shape women's experiences of IPV- and community responses to it-is needed to develop more comprehensive solutions that are relevant to the local context