Case study describing access to palliative care in Pakistan

Around the world, cancer is a leading cause of death and the burden of cancer is expected to increase in low-and middle-income countries (LMICs), where 82% of the world’s population resides. In these countries, which include Pakistan, aspects of the culture and traditions, inaccessibility to diagnostic and treatment facilities impede access to palliative care. In many cases, people do not reach treatment facilities until they are at the stage when the person is at the end-of-life and is dying. This paints the picture of cancer as a deadly disease and as soon as it is diagnosed nothing can be done but to mourn. Little is understood about people’s experiences accessing palliative care in Pakistan. This study followed Yin’s methodology of case study research to describe how people accessed palliative care through Bait-ul-Sukoon Cancer Hospital and Hospice, the research setting (and bounded case) selected for this study. Theoretical propositions that guided the research were derived from the literature and my professional experience. Data collection occurred through unstructured observations, interviews of patients, family members and the health care provider, physical artifacts, and through my reflections. Four patients, three family members, and five healthcare providers were interviewed. Data analysis occurred simultaneously with data gathering and involved a reflexive analysis of the data. This study was guided by the theoretical propositions, the study objectives, and research questions that were derived from these propositions. Through this analysis process, two main themes were developed with subthemes to describe the case. I was also attentive to identity the rival cases, data that is contrary to the propositions. As the analysis progressed, linkages between the data were noted to see where the data were converging and diverging. The findings have described the suffering of people due in a large part to the late diagnosis of cancer. However, late diagnosis is also related to cultural beliefs, the social stigma of having cancer, the financial (and social) burden of seeking treatment, lack of education about cancer prevention and detection, healthcare system inadequacies and corruption, and healthcare providers’ knowledge deficits. Poverty underlies most of the suffering and is largely the reason for late diagnosis. Participants suggested that policy-level change was needed to meet palliative care needs, and enhance early diagnosis. Policy level change for poverty alleviation would improve the determinants causing obstructions in accessing palliative care and improve access to pain and symptom management. This research underscores that at present, military and defense funds are the focus of the budget priorities in Pakistan. This deprives the population of fulfilling the need for social development and the health of the people in the country, which ultimately ruins the health and quality of life of the individuals. As a result, individuals feel emotionally distressed at the prospects of little or no betterment of their lives, their children’s lives, and the generations that follow. These findings highlight the need for policy change by involving the stakeholders from social sectors, health, and education at the country level and through collaboration with the World Health Organization. Dissemination of these research findings, focusing on a public health approach and providing universal health coverage to all, is critically important for improving access to palliative care in Pakistan. This study identifies a clear need to educate healthcare providers about palliative care. Therefore, it is recommended that in LMICs palliative care should be included in medical and nursing curricula. The findings of this study suggest that nurses should work within the scope of their practice. This is also needed for their own safety and the safety of their patients. This requires close monitoring and supervision by the statutory bodies like the Pakistan Nursing Council. There are implications for policy change to provide universal access to health and to achieve sustainable development goals. Corruption is identified as one of the major hurdles in accessing health that must be controlled to start with and then be eradicated

Teachers’ and Parents’ perspective as how the Social Environment of immediate vicinity can affect the academic learning of a Child 4-6 years age group

In the process of human development environment plays a pivotal role. At the age of 4 -6 years, children\u27s immediate vicinity expands from home to school and in his social environment parents and teachers play a vital role. Therefore, in this study which was conducted in Phander district Ghizer, Northern areas; of Pakistan, employing descriptive research design five parents and five school teachers were enrolled. Participants shared their definition and understanding about social environment and immediate vicinity and its effects on academic learning. This research is part of Advanced Diploma in Human Development: Early Child Development Programme, Aga Khan University. Thus clearance was obtained from the University\u27s Ethics Review Committee. After approval of schools’ administration teachers were contacted and individual consent was obtained from all the study participants (n=10). Due to specific geographical area and population, its results cannot be generalized but it may provide some guidelines for future studies of similar nature

Fostering patient safety: Importance of nursing documentation

Background: Nurses are professionally accountable for assessing and documenting patients’ vital signs. Nurses failing to fulfill this responsibility position their patients at risk. This paper presents two real-life cases pertaining to patients’ safety resulting in fatal outcomes, leading to the professional, legal, and ethical liability of nurses as the providers of patient care. Objective: This paper focuses on the role of organizational culture in fostering patient safety specifically in monitoring and documentation of patients’ vital signs and early recognition of warning signs. Methodology: A comprehensive literature search was conducted using various databases, examining the significance of vital signs monitoring and documentation and early warning signs in patient safety. Relevant articles combining quantitative and qualitative data were analyzed. Results: By fostering an environment of honest reporting, healthcare organizations can enhance patient safety and improve the quality of care. This paper offers valuable insights and recommendations for developing effective strategies aligned with organizational policies and protocols. Conclusion: This paper serves as a valuable resource, encouraging healthcare professionals to reflect on their practices and the organizations to assess their contributions to creating a culture of safety. It also highlights the importance of reporting and disclosing adverse events as learning opportunities and outlines the role of ethics, professionalism, legislation, and organizational support in achieving patient safety

Recognizing early warning signs (EWS) in patients is critically important

Introduction: Monitoring vital signs is a basic indicator of a patient’s health status and allows prompt detection of delayed recovery or adverse effects and early intervention. Patients with adverse events during hospitalization often display clinical decline for several hours before the event is observed. Non-critical care Nurses’ inconsistent recognition and response to patient deterioration lead to an increase in the length of hospital stay, unexpected admissions to the ICU, and increased morbidity and mortality. Aim: The study aimed to assess the factors that facilitate or impede the detection of early warning signs among adult patients hospitalized in tertiary care settings. Training should be provided to improve nurses’ knowledge, practice and attitude toward early warning signs of deteriorating patients leading to enhanced clinical judgment, skills and decision-making in addressing alerts. Methodology: A literature search was carried out in various databases; these were Cumulative Index to Nursing and Allied Health Literature (CINHAL), Google Scholar, PubMed, Science Direct, and Sage. The search area was narrowed from 2017 to 2022. The keywords used were “prevalence” AND “unplanned ICU admission”, “the importance of early warning signs” “outcome failure in rescue” “patient deterioration, communication” “improvement in early detection” AND “patient outcome admission” AND “early warning signs” AND “Pakistan”. After the analysis process, around 33 articles that met the inclusion criteria and were most relevant to the scope and context of the current study were considered. Conclusion: Most of the studies had reviewed literature in a qualitative retrospective observational study, content analysis, mixed method, and quasi-experimental study. The literature review identified that long hours of shift, nurse staffing levels, missed vital signs, lack of nursing training and education, and communication impact nurses’ ability to recognize and respond to early warning signs

Factors that affect attachment between the employed mother and the child, infancy to two years

To explore a mother\u27s feeling of attachment and the affects her working status on the attachment relationship with her child, upon ethical clearance from the institutional ethics committee, in-depth interviews of nine participants were conducted. Mothers enrolled were those who resumed the employment within the first year of post-delivery and were having a child up to two years of age. Results revealed that maternal employment itself does not enhance or deteriorate attachment with the child. It is combinations of factors that revolve around it impact on their bond. Overall, maternal integration or the balance of the dual roles of employment and motherhood is critical in the development of a sound and secure attachment between the employed mother and the child

Health care professionals’ compliance to tracheal suctioning policy at a tertiary care hospital

Objective: To assess the compliance of tracheal suctioning practices against the standard guidelines of a tertiary care hospital, with regard to the participants’ professional characteristics.Methods: Using cross sectional study design, forty health care professionals (HCPs) were assessed twice, using a quantitative structured observational design, for tracheal suctioning practices, in one of the surgical care units of the tertiary care hospital. Tracheal suctioning policy which was used as a tool, its inter-rater reliability was tested and each step showed the Kappa value of 0.65 to 1.000. Data was analyzed using epidata info version 3.5.1 and SPSS version 19.Results: From a total of 80 observations, 30% showed compliance, 50% partial compliance whereas, 20% indicated non-compliance.Conclusion: The study results highlight the need for improving the overall compliance with the tracheal suctioning guidelines of evidence based practices to minimize the adverse effects and enhance patient safety related to tracheal suctioning practices. The current study also provides an opportunity to motivate the HCPs compliant in the practices of tracheal suctioning by appreciate their competence

Phasing out the general nursing diploma programme at Aga khan university school of nursing Karachi, Pakistan

Aga Khan University was established as medical complex in 1980 and in 1983 received charter as first private university in Pakistan. Thus nursing education moved under the umbrella of a university which allowed starting under graduate and graduate degree education and in light of global trends in nursing profession and staffing and financial impact of nursing education, 2010 was the last intake of university\u27s founding programme; general nursing diploma. Concerns; male vs female nurses and taking nursing education as an easy route to enter in higher education resulting in unattained staffing require deliberations by stake holder including Pakistan Nursing Council

The role of aga khan university in the development of nursing in Pakistan

Aga Khan University, Pakistan started as a school of nursing enrolled its first batch of General Nursing Diploma in 1980 and in 1983 chartered as the first private university uplifted the profile of nursing from diploma to doctorate. In 2010, the university phased-out its first program and shifted to a baccalaureate degree education in nursing. This path is now followed at the national level. Accordingly, since 2020 in Pakistan enrollment in nursing is through baccalaureate. This paper briefs about the role of Aga Khan University past four decades particular to nursing in the country

Early detection of breast cancer a need in LMICs

Breast cancer is the most common cancer in women both in Low-and-Middle-Income Countries (LMICs) like Nigeria, Pakistan and India and in High-Income Countries (HICs). These include Belgium, Denmark, France, the Netherlands, the United Kingdom, the United States, Australia, Germany, Italy, Australia, New Zealand, Switzerland, and Sweden. However, breast cancer related mortality is high in LMICs where the majority of the cases are diagnosed at the late stages of the disease. Factors contributing to late diagnosis include lack of awareness about breast cancer, poverty, cultural and religious beliefs, misconceptions about the disease, fear of mastectomy, women’s lack of autonomy in health-related decision making, lack of adequate diagnosis, and treatment facilities. Consequently, when diagnosed the disease is at the 3rd or 4th stage of cancer. Whereas, more than 90% of women are diagnosed early when they have a locoregional disease in HICs. The early diagnosis of cancer, combined with an accessible, and affordable effective treatment, results in improvements in both the stage of cancer at presentation and mortality from cancer

Ethical perspective of Cancer Pain Management

The world health organization reports that cancer is not only a problem in developed countries but also in low and middle income countries. It kills more than 7.5 million people in a year and there are 13 million new cases of cancer every year. Among the cancer patients 30- 50 percent are under active therapy, 70–90 percent patients at far advanced disease suffer significant pain which if not treated leads to anxiety and depression which may lead to suicide. Management of cancer pain is the duty and the ethical responsibility of health care personnel