An integrative review on women living with obstetric fistula and after treatment experiences

Aims and objectives. To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. Background. Obstetric fistula is an injury most commonly resulting from a pro-longed labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women’s experience is required to inform holistic approaches for care and prevention. Design. An integrative review. Data sources. EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; Grey literature and websites of international organisa-tions such as Women’s Dignity Project and EngenderHealth. Keywords, inclusion and exclusion criteria were defined and 25 articles published from 2004–January 2015 were identified. Review method. The review was guided by Whittemore and Knafl’s revised ana-lytical framework. All articles were assessed for methodological quality and criti-cally analysed to elicit emergent themes and subthemes. Results. Three broad themes were identified: challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fis-tula repair. Conclusions. Living with a fistula presents multidimensional consequences affect-ing women, families and communities. Accessing treatment is difficult, and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being conti-nent, thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Postrepair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore, further research is required to support its benefits and for policy development to meet care provision for women with fistula

Intervention in health care teams and working relationships

Introduction: Communication is an intrinsic part of collaborative working but can be problematic when the complexities of professional and personal identities inhibit quality care provision. This paper investigates these complexities and recommends interventions to facilitate collaborative working.Methods: A qualitative comparative approach examined data collected from participants using purposive non-probability sampling. Perspectives were obtained from four professional groups (nurses, social workers, care managers, and police), from different organizations with different theoretical and practice frameworks, and from a fifth group (informal carers).Results: Curriculum change and leadership initiatives are required to address the complexities inhibiting collaborative working relationships. Integrating complexity theory, personality typology, and problem-based learning into the curriculum to understand behavioral actions will enable interventions to effect change and promote the centrality of those being cared for

Embracing a culture in conducting research requires more than nurses' enthusiasm

Aims This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations. Background Nurses' research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses' research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated. Methods A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore. Results A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived. Conclusions The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands

Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria

Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the “leaking” identity, “masu yoyon fitsari” (leakers of urine) identity, and the “spoiled” identity, causing stigmatization and psychological trauma. The “masu yoyon fitsari” identity, however, built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon, and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women’s identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women’s role

Journey for a cure: illness narratives of obstetric fistula survivors in North Central Nigeria

Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long-term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North-central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health-care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio-structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income-generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs

An exploratory study of a research culture development by administrators, lecturers and clinical specialists in nursing

Context: Escalating healthcare demands combined with diminishing resources underline the importance of ensuring nurses in leading roles, having the capacity to conduct evidence-based research to inform practice. Aims: This study explored the perceptions of research knowledge and experiences of nurses in administrative, teaching and clinical specialist positions to highlight gaps in research provision within educational institutions and healthcare organisations in Singapore. Design/Methods: A mixed-method exploratory descriptive design, using a questionnaire with open and closed questions was employed to obtain the views of nurses on their capacity in conducting research. Convenience sampling was employed in 3 research seminars in Singapore between July-August 2011. Results: Forty seven nurses were recruited and they confirmed good research knowledge and skills but indicated the need for enhanced educational preparation and organisational support to fully embrace a research culture. Conclusions: Research in nursing requires prioritisation and support in educational training and healthcare settings. Otherwise, conducting research would continue to be a lesser priority for nurses, even if they were in teaching or clinical positions which provided significant opportunities to lead or facilitate research. Given that role modeling enhances research culture in nursing, within education and clinical settings, nurses in leadership positions require confidence in conducting research. However, without prioritising research, and filtering this down through the nursing hierarchical system to promote a research culture, new knowledge to improve practice will remain elusive

Evidence of Natural Bluetongue Virus Infection among African Carnivores

Bluetongue is an International Office of Epizootics List A disease described as the century\u27s most economically devastating affliction of sheep. Bluetongue (BLU) viruses were thought to infect only ruminants, shrews, and some rodents, but recently, inadvertent administration of BLU virus-contaminated vaccine resulted in mortality and abortion among domestic dogs. We present evidence of natural BLU virus infection among African carnivores that dramatically widens the spectrum of susceptible hosts. We hypothesize that such infection occurred after ingestion of meat and organs from BLU virus infected prey species. The effect of BLU virus on endangered carnivores such as the cheetah and African wild dog requires urgent investigation. Also, the role of carnivores in the epizootiology of this disease needs elucidation

Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as, women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care; and these contribute to the increased incidences of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria

Interprofessionalism in health and social care : working towards an inclusive framework

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