Work Experiences of Nurses with Self-Identified Disabilities

Globally and in Canada, meaningful participation of disabled people in the labour market is a relatively new occurrence. While the literature about disabled people's experiences and perceptions related to employment is established, very little is known about disabled nurses' work experiences. The aim of this study was to produce a rich descriptive account of the practise experiences of disabled registered nurses (RNs) from their perspectives. The research aim was addressed through a qualitative descriptive study that explored the perspectives and experiences of study participants. In-depth, semi-structured interviews were conducted with 12 female RNs residing and working in the province of Ontario. Data was analyzed using conventional content analysis and presented as textual summaries organized under categories. The study found that participants' experiences of practising with a disability were a mix of positive and negative aspects strongly influenced by factors relating to workplace milieu such as interactions with others in the work environment. Participants identified a greater number of facilitators to practising with a disability than barriers; however, the barriers identified corresponded with actual or desired facilitators. The findings of this study contribute meaningfully to knowledge on the topic of disabled nurses' work experiences by confirming the findings of previous studies and addressing the scarcity of detailed accounts on the topic. Additionally, the study lends support to a more universal understanding of nurses' work experiences that is not US-centric. The findings signal that the organizations and institutions that employ disabled nurses need to be more responsive to their situations and address barriers impeding their success. In the context of education, the findings encourage self-reflection and actions that will support the success of disabled students and inculcate positive attitudes and behaviours towards disabled nurses. Lastly, the findings highlight several areas where further research could be undertaken to inform policy, educational curricula, and attitudes and behaviours related to disabled nurses

Exploring Simulation Utilization and Simulation Evaluation Practices and Approaches in Undergraduate Nursing Education

Simulation-based learning (SBL) is rapidly becoming one of the most significant teaching-learning-evaluation strategies available in undergraduate nursing education. While there is indication within the literature and anecdotally about the benefits of simulation, abundant and strong evidence that supports the effectiveness of simulation for learning and evaluation in nursing education is slow to emerge and has yet to be fully established. As the use of SBL increases in nursing education, the need to evaluate students appropriately, accurately, and in reliable ways intensifies. Furthermore, as nursing programs increasingly consider SBL as direct clinical replacement in the context of increased student enrolment and dwindling clinical placements, standardized evaluation must play a vital role. Our study investigated simulation utilization and simulation evaluation practices and approaches employed among undergraduate nursing educational programs in Ontario, Canada, using a mixed methods approach. Both quantitative and qualitative data were collected through a confidential online survey. The goal of our study is to establish a “picture” of current trends, practices, and approaches related to simulation that is employed within this entire province. An overview of the study findings and recommendations that have potential to make a substantial contribution to the growing evidence for best practices in the science of simulation will be discussed. Keywords: Simulation; Simulation-based Learning, Evaluation; Undergraduate Nursing Educatio

Impact of seasonal RTS,S/AS01E vaccination plus seasonal malaria chemoprevention on the nutritional status of children in Burkina Faso and Mali.

BACKGROUND: A recent trial in Burkina Faso and Mali showed that combining seasonal RTS,S/AS01E malaria vaccination with seasonal malaria chemoprevention (SMC) substantially reduced the incidence of uncomplicated and severe malaria in young children compared to either intervention alone. Given the possible negative effect of malaria on nutrition, the study investigated whether these children also experienced lower prevalence of acute and chronic malnutrition. METHODS: In Burkina Faso and Mali 5920 children were randomized to receive either SMC alone, RTS,S/AS01E alone, or SMC combined with RTS,S/AS01E for three malaria transmission seasons (2017-2019). After each transmission season, anthropometric measurements were collected from all study children at a cross-sectional survey and used to derive nutritional status indicators, including the binary variables wasted and stunted (weight-for-height and height-for-age z-scores below - 2, respectively). Binary and continuous outcomes between treatment groups were compared by Poisson and linear regression. RESULTS: In 2017, compared to SMC alone, the combined intervention reduced the prevalence of wasting by approximately 12% [prevalence ratio (PR) = 0.88 (95% CI 0.75, 1.03)], and approximately 21% in 2018 [PR = 0.79 (95% CI 0.62, 1.01)]. Point estimates were similar for comparisons with RTS,S/AS01E, but there was stronger evidence of a difference. There was at least a 30% reduction in the point estimates for the prevalence of severe wasting in the combined group compared to the other two groups in 2017 and 2018. There was no difference in the prevalence of moderate or severe wasting between the groups in 2019. The prevalence of stunting, low-MUAC-for-age or being underweight did not differ between groups for any of the three years. The prevalence of severe stunting was higher in the combined group compared to both other groups in 2018, and compared to RTS,S/AS01E alone in 2017; this observation does not have an obvious explanation and may be a chance finding. Overall, malnutrition was very common in this cohort, but declined over the study as the children became older. CONCLUSIONS: Despite a high burden of malnutrition and malaria in the study populations, and a major reduction in the incidence of malaria in children receiving both interventions, this had only a modest impact on nutritional status. Therefore, other interventions are needed to reduce the high burden of malnutrition in these areas. TRIAL REGISTRATION: https://www.clinicaltrials.gov/ct2/show/NCT03143218 , registered 8th May 2017

Seasonal Malaria Vaccination with or without Seasonal Malaria Chemoprevention.

BACKGROUND: Malaria control remains a challenge in many parts of the Sahel and sub-Sahel regions of Africa. METHODS: We conducted an individually randomized, controlled trial to assess whether seasonal vaccination with RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria and whether the two interventions combined were superior to either one alone in preventing uncomplicated malaria and severe malaria-related outcomes. RESULTS: We randomly assigned 6861 children 5 to 17 months of age to receive sulfadoxine-pyrimethamine and amodiaquine (2287 children [chemoprevention-alone group]), RTS,S/AS01E (2288 children [vaccine-alone group]), or chemoprevention and RTS,S/AS01E (2286 children [combination group]). Of these, 1965, 1988, and 1967 children in the three groups, respectively, received the first dose of the assigned intervention and were followed for 3 years. Febrile seizure developed in 5 children the day after receipt of the vaccine, but the children recovered and had no sequelae. There were 305 events of uncomplicated clinical malaria per 1000 person-years at risk in the chemoprevention-alone group, 278 events per 1000 person-years in the vaccine-alone group, and 113 events per 1000 person-years in the combination group. The hazard ratio for the protective efficacy of RTS,S/AS01E as compared with chemoprevention was 0.92 (95% confidence interval [CI], 0.84 to 1.01), which excluded the prespecified noninferiority margin of 1.20. The protective efficacy of the combination as compared with chemoprevention alone was 62.8% (95% CI, 58.4 to 66.8) against clinical malaria, 70.5% (95% CI, 41.9 to 85.0) against hospital admission with severe malaria according to the World Health Organization definition, and 72.9% (95% CI, 2.9 to 92.4) against death from malaria. The protective efficacy of the combination as compared with the vaccine alone against these outcomes was 59.6% (95% CI, 54.7 to 64.0), 70.6% (95% CI, 42.3 to 85.0), and 75.3% (95% CI, 12.5 to 93.0), respectively. CONCLUSIONS: Administration of RTS,S/AS01E was noninferior to chemoprevention in preventing uncomplicated malaria. The combination of these interventions resulted in a substantially lower incidence of uncomplicated malaria, severe malaria, and death from malaria than either intervention alone. (Funded by the Joint Global Health Trials and PATH; ClinicalTrials.gov number, NCT03143218.)

Seasonal vaccination with RTS,S/AS01E vaccine with or without seasonal malaria chemoprevention in children up to the age of 5 years in Burkina Faso and Mali: a double-blind, randomised, controlled, phase 3 trial.

BACKGROUND: Seasonal vaccination with the RTS,S/AS01E vaccine combined with seasonal malaria chemoprevention (SMC) prevented malaria in young children more effectively than either intervention given alone over a 3 year period. The objective of this study was to establish whether the added protection provided by the combination could be sustained for a further 2 years. METHODS: This was a double-blind, individually randomised, controlled, non-inferiority and superiority, phase 3 trial done at two sites: the Bougouni district and neighbouring areas in Mali and Houndé district, Burkina Faso. Children who had been enrolled in the initial 3-year trial when aged 5-17 months were initially randomly assigned individually to receive SMC with sulphadoxine-pyrimethamine and amodiaquine plus control vaccines, RTS,S/AS01E plus placebo SMC, or SMC plus RTS,S/AS01E. They continued to receive the same interventions until the age of 5 years. The primary trial endpoint was the incidence of clinical malaria over the 5-year trial period in both the modified intention-to-treat and per-protocol populations. Over the 5-year period, non-inferiority was defined as a 20% increase in clinical malaria in the RTS,S/AS01E-alone group compared with the SMC alone group. Superiority was defined as a 12% difference in the incidence of clinical malaria between the combined and single intervention groups. The study is registered with ClinicalTrials.gov, NCT04319380, and is complete. FINDINGS: In April, 2020, of 6861 children originally recruited, 5098 (94%) of the 5433 children who completed the initial 3-year follow-up were re-enrolled in the extension study. Over 5 years, the incidence of clinical malaria per 1000 person-years at risk was 313 in the SMC alone group, 320 in the RTS,S/AS01E-alone group, and 133 in the combined group. The combination of RTS,S/AS01E and SMC was superior to SMC (protective efficacy 57·7%, 95% CI 53·3 to 61·7) and to RTS,S/AS01E (protective efficacy 59·0%, 54·7 to 62·8) in preventing clinical malaria. RTS,S/AS01E was non-inferior to SMC (hazard ratio 1·03 [95% CI 0·95 to 1·12]). The protective efficacy of the combination versus SMC over the 5-year period of the study was very similar to that seen in the first 3 years with the protective efficacy of the combination versus SMC being 57·7% (53·3 to 61·7) and versus RTS/AS01E-alone being 59·0% (54·7 to 62·8). The comparable figures for the first 3 years of the study were 62·8% (58·4 to 66·8) and 59·6% (54·7 to 64·0%), respectively. Hospital admissions for WHO-defined severe malaria were reduced by 66·8% (95% CI 40·3 to 81·5), for malarial anaemia by 65·9% (34·1 to 82·4), for blood transfusion by 68·1% (32·6 to 84·9), for all-cause deaths by 44·5% (2·8 to 68·3), for deaths excluding external causes or surgery by 41·1% (-9·2 to 68·3), and for deaths from malaria by 66·8% (-2·7 to 89·3) in the combined group compared with the SMC alone group. No safety signals were detected. INTERPRETATION: Substantial protection against malaria was sustained over 5 years by combining seasonal malaria vaccination with seasonal chemoprevention, offering a potential new approach to malaria control in areas with seasonal malaria transmission. FUNDING: UK Joint Global Health Trials and PATH's Malaria Vaccine Initiative (through a grant from the Bill & Melinda Gates Foundation). TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Ecology and ethnomedicine: Exploring links between current environmental crisis and indigenous medical practices

The paper seeks to examine links between ecosystems and the practice of ethnomedicine. The objective is to discuss the interrelationships between the current ecological crisis and the changes occurring in the practice of ethnomedicine. The paper first explores the extent to which ethnomedicine depends on the natural environment. This is followed by a discussion of the impact that ecological degradation and destruction has had on ethnomedical practices. The rest of the paper is devoted to an examination of how the practice of ethnomedicine contributes, on the one hand, to ecological degradation and, on the other hand, to ecological conservation and preservation.ethnomedicine ecosystems resources degradation preservation

Using Popular Nursing Literature Critique to Help Nursing Students Explore Their Perceptions of Disability

Objectives: Disabled people have a history of disadvantage, discrimination, and disempowerment that continues to present day. Despite strong critique and activism by disabled people, popular understandings of disability as necessarily tragic, medically based, and individualistic requiring ‘fixing’ persist among health professionals.  Recent research demonstrates that health professional students often harbour negative attitudes that may directly affect their relationships with and care provided to disabled clients (Sabin & Akyol, 2010; Scullion, 1999). Further, personal accounts and research evidence suggests that the relationship between healthcare providers and disabled people is often unsatisfactory (Sabin & Akyol, 2010; Seccombe, 2007; Scullion, 1999).Methods: Nursing education has a responsibility to ensure that nursing practice with disabled people is enabling rather than disabling (Scullion, 1999a, 1999b, 2000; Sabin & Akyol, 2010). A key strategy is to imbed within curricula opportunities for students to engage in the processes of critical thinking towards and analysis of disability and the experiences of disabled people. This poster describes an approach to teaching-learning in which critique of ‘popular culture’ nursing literature is used to support student exploration of messaging about disability.Results and Conclusions: The purpose and description of the assignment, authors’ experiences, and outcomes for both teachers and learners will be presented. Application beyond nursing to other health professions will be described.ReferencesSabin, H. & Akyol, A. D. (2010). Evaluation of nursing and medical students' attitudes towards people with disabilities. Journal of Clinical Nursing, 19, 2271­2279.Scullion, P. A. (1999). Conceptualizing disability in nursing: Some evidence from students and their teachers. Journal of Advanced Nursing, 29, 648­657.Scullion, P. A. (2000). Enabling disabled people: Responsibilities of nursing education. British Journal of Nursing, 9(15), 1010-1015.Seccombe, J. A. (2007). Attitudes towards disability in an undergraduate nursing curriculum: A literature review. Nurse Education Today, 27, 459­465

Space, Culture and Society in Africa.

15 Papers presented at the Symposium, March 29-30, 1996.Includes bibliographical references

The Anti-Circumsporozoite Antibody Response of Children to Seasonal Vaccination With the RTS,S/AS01(E) Malaria Vaccine

A trial in young African children showed that combining seasonal vaccination with the RTS,S/AS01E vaccine with seasonal malaria chemoprevention reduced the incidence of uncomplicated and severe malaria substantially compared to either intervention given alone. This paper reports the anti-circumsporozoite antibody response to seasonal RTS,S/AS01E vaccination in children in this trial. Sera from a randomly selected sub-set of children collected before and one month after three priming doses of RTS,S/AS01E and before and one month after two seasonal booster doses were tested for anti-circumsporozoite antibodies by ELISA. The association between post vaccination antibody titer and incidence of malaria was explored. A strong anti-circumsporozoite antibody response to three priming doses of RTS,S/AS01E was seen (Geometric Mean Titer, GMT 368.9 EU/ml) but titers fell markedly prior to the first booster dose. A strong antibody response to an annual, pre-malaria transmission season booster dose was observed in primed children but this was lower than after the primary vaccination series and lower after the second than after the first booster dose (ratio of geometric mean rise 0.66 [95% CI: 0.57, 0.77]). Children whose antibody response was in the upper tercile post-vaccination had a lower incidence of malaria during the following year than children in the lowest tercile (hazard ratio 0.43 [95% CI 0.28,0.66]. Seasonal vaccination with RTS,S/AS01E induced a strong booster antibody response which was lower after the second than after the first booster dose. However, the diminished antibody response to the second booster dose was not associated with diminished efficacy