[Show abstract][Hide abstract] ABSTRACT: Purpose
In 2009 we conducted a study to explore Ugandan nurses’ practice of universal precautions while caring for persons living with HIV. During our interviews about universal precautions, nurses’ also shared their experience with post-exposure prophylaxis (PEP) following needle-stick injuries. We present findings related to nurses’ understanding of PEP and their experience with, and reporting of, needle stick injuries.
Nurses have high rates of exposure to blood-borne pathogens. Although there is minimal risk of the transmission of blood-borne pathogens from health care workers (HCWs) to patients and vice versa, post-exposure prophylaxis, has become routine following the occupational exposure of HCWs to HIV.
Focused ethnography was used to guide the data collection and in-depth interviews were used to collect the data between October and November 2009.
Sixteen nurses from a variety of units in a large teaching hospital participated. Needle-stick injuries were a fairly common occurrence, but written policies were frequently inaccessible to nurses and they did not have adequate knowledge of PEP. Some nurses were reluctant to report injuries and avoided following PEP procedures due to lack of knowledge about PEP, concerns about anti-retroviral side effects and the stigma associated with PEP. Participants were aware of PEP however there was a wide variation in their understanding of the procedure to follow after a needle-stick injury.
Employers have a responsibility to update PEP guidelines and to orientate HCWs to these. Educators must ensure that undergraduate nurses have a comprehensive understanding of universal precautions and current practice for PEP.
International Journal of Africa Nursing Sciences 12/2014; 1. DOI:10.1016/j.ijans.2014.05.003
[Show abstract][Hide abstract] ABSTRACT: Background: International experiences provide a rich, transformative learning opportunity and are fundamental to the internationalization of universities that is occuring globally. To date there has been limited research to evaluate the experiences of, and benefits to, faculty members who participate in an international experience. In the current paper, we report findings from the evaluation of a Visiting Scholar Program (VSP) between the University of São Paulo at Ribeirão Preto College of Nursing (EERP-USP), Brazil and the Faculty of Nursing, University of Alberta (UA), Canada. The VSP was initiated in 2004, with a generous donation from a private donor, as one component of a broader partnership between the two university schools of nursing. Methods: The evaluation of the VSP program was carried out between January and June 2011 using a qualitative approach. An interpretative descriptive design was used for the study and in-depth interviews were used to collect the data. At the UA, 17 individuals affiliated with the Brazil project participated in an interview and two provided email feedback. At EERP-USP, 12 former scholars, one graduate student, two staff members responsible for the International Cooperation Office, and a former Dean participated in the evaluation. Results: Several key themes emerged during the analysis of the interviews. The program was highly successful from the perspective of both scholars and supervisors alike. The commitment to internationalization at each site, the well-established partnership between EERP-USP and UA, and the financial resources available all contributed to the provision of a supportive, enabling environment for the scholars to develop their own research capacity and for both scholars and supervisors to build new research networks. Participants commented on the importance of personal relationships and convergent research interests between scholars and the supervisors. Several challenges related to language, length of the program, and at times, inadequate pre-planning between the scholar and supervisor were identified by participants. Conclusion: Overall the leadership team at each site and the scholars and supervisors believed that the VSP was successful. Despite several challenges, supervisors and scholars alike benefited from ongoing relationships and were appreciative of the opportunities for professional growth and research development that participation in the VSP program provided. Recommendations for future similar programs include: commitment to internationalization; a well-established Published by Sciedu Press 253 partnership between the two sites; sufficient financial resources; language training; a 12 month program if possible; good fit between scholar and supervisor; and pre-planning.
[Show abstract][Hide abstract] ABSTRACT: There is limited literature describing the methodological and pragmatic considerations that arise when conducting participatory action research utilizing Photovoice with children, particularly within sub-Saharan Africa. We provide a case example of these considerations based on a qualitative exploratory design that was conducted in June 2010 with 13 children between the ages of 12 and 18 years who were orphaned and living with HIV in a group home setting in Western Uganda. The main purpose of this study was to explore the children’s experiences while including them in a participatory way utilizing Photovoice to share their stories, define their issues, and propose their own solutions. Conducting research in another country where language and culture are different from the researchers’ can pose many unique methodological, epistemological, and ethical challenges. These issues are discussed by reflecting on the process of the study. Key lessons will also be discussed regarding the methodological and pragmatic considerations with the aim of providing new insights for researchers who want to conduct research in a cross-cultural and multilingual setting. http://sgo.sagepub.com/content/4/2/2158244014530997
SAGE Open 05/2014; 4(April-June):1-10. DOI:10.1177/2158244014530997
[Show abstract][Hide abstract] ABSTRACT: Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decision-makers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.
The International Journal of Qualitative Methods 05/2014; 13(1):151.
[Show abstract][Hide abstract] ABSTRACT: Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.
Qualitative Health Research 06/2013; 23(8). DOI:10.1177/1049732313494019 · 2.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The global HIV and AIDS pandemic continues to devastate the health systems of Sub-Saharan Africa and the Caribbean, deepening the health human resources crisis and challenging delivery of essential health services. Nurses and midwives form the majority of the healthcare workforce in much of the world. An innovative five year program of research and capacity-building with a participatory action research approach involved Canada, Kenya, Jamaica, Uganda, and South Africa. Partner countries each established leadership hubs in three districts to address issues of equity and effectiveness of HIV/AIDS health services and policies. A quasi-experimental design with mixed methods data collection was used to compare changes in HIV/AIDS clinical practice, stigma, and health human resource policies between intervention and control districts. This presentation will describe this leadership hub intervention and highlight successes and challenges.
Hubs were comprised of community representatives and stakeholders including nurses, midwives, researchers and decision makers. Training focused on essential skills for active participation in policy and decision-making, with capacity needs assessed through the ARAR (ability, resources, authority, and responsibility) lens. Hubs implemented evaluation projects examining institutional policy gaps. Sharing the program’s research findings with hubs was a basis for preparing policy briefs for local health officials, and action plans to improve HIV/AIDs-related care. Successes include nurses and midwives beginning to self-identify change agents with confidence, skills, and a sense of responsibility to influence health systems change, and hub sustainability plans for the post-project period. Challenges included heavy workloads, an initial lack of institutional support for hub research-related activities, and socio-political influences.
The leadership hub intervention is a promising approach that engages nurses, midwives and local decision-makers in developing and implementing action plans adapted to local constraints. Post-intervention data collection, planned for 2012, will be used to assess the impact of hubs on HIV/AIDS care.
Learning Objectives: 1. Identify innovative approaches that enabled nurses and midwives across participating lower and middle-income countries to take leadership roles in implementation of research and improving clinical practices and policies for HIV and AIDS; 2. Describe successes and challenges with translating research knowledge for leadership hubs of nurses, researchers, decision makers, and community members, and engaging them in research and policy cycles; 3. Articulate opportunities for linking hubs with decision makers at district, provincial, and national levels, and internationally with other hubs. 4. Discuss strategies used to develop sustainable hub networks at local, national and international levels.
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13th World Congress on Public Health World Health Organization; 04/2012
[Show abstract][Hide abstract] ABSTRACT: Institutional supports and capacity-building efforts are needed to foster a critical mass of nurses in lower- and middle-income countries to actively lead research and evaluate change models. An enabling environment has individual, institutional, and national and international dimensions that support nurses’ efforts to generate evidence and contribute their experience at the research-policy interface. Necessary elements include: educational preparation, training opportunities, mentorship programs, interdisciplinary collaboration, funding for nursing research, and a participatory action research approach.
13th World Congress on Public Health World Health Organization; 04/2012
[Show abstract][Hide abstract] ABSTRACT: As we move into the 21st century, our roles as nurses are becoming more complex. Inequities in health within and across nations demand that nursing students examine the interconnectedness between local and global health challenges and contribute to the development and implementation of solutions to these challenges. In this article, we examine concepts related to global citizenship, globalization, social responsibility, and professionalism and link them to curricular innovation in nursing education. We argue that the development of global citizenship is a fundamental goal for all nursing students and that to achieve this, nurse educators must move beyond the creation of international placement opportunities or the use of global examples within existing courses. Nurse educators must develop strategies and design innovative curricula to provide opportunities for all students to become engaged with the concept of global citizenship and the role of nurses in a global world.
ANS. Advances in nursing science 07/2010; 33(3):E1-E11. DOI:10.1097/ANS.0b013e3181eb416f · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Critical qualitative methodology provides a strategy to examine the human experience and its relationship to power and truth. Cultural safety is a concept that has been applied to nursing education and practice and refers to interactions that acknowledge and respect the unique cultural background of patients. It recognizes power inequities between caregivers who belong to dominant cultures and patients who may belong to oppressed groups. Culture is interpreted from a critical constructivist perspective as a fluid relational process that is enacted contextually. The purpose of this paper is to examine the congruence between and among critical methodology, cultural safety, and the conduct of nursing research in low- and middle-income countries by nurses from high-income countries. It is argued that if cultural safety is important and relevant to education and practice, then it might be appropriate to address it in research endeavors.
[Show abstract][Hide abstract] ABSTRACT: The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa.
To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people.
A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions.
Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients' wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues.
The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.
International journal of nursing studies 12/2009; 47(6):723-31. DOI:10.1016/j.ijnurstu.2009.11.010 · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.
[Show abstract][Hide abstract] ABSTRACT: In this article the authors present findings from a qualitative research study carried out with Ugandan nurses from September 2003 until June 2004. They highlight the process and philosophical basis of participatory action research (PAR) by reflecting on the challenges, opportunities, outcomes, and ethical issues encountered during the conduct of the research. In this study PAR fostered a climate in which nurses could engage in collective reflection on their practice, make sense of their experiences, and thereby change their understanding of their work.
[Show abstract][Hide abstract] ABSTRACT: We conducted a qualitative study of women who were caregivers for HIV/AIDS-affected spouses in Bumbu Zone, Kinshasa, Democratic Republic of Congo in 2003. Twelve caregiving women, six home/based care workers and five key informants were interviewed via focus group discussions. Most women reported huge problems in providing care to their spouses due to psychological, social and economic factors. The secrecy around HIV/AIDS issues and care was a significant theme in the findings. The self-reported health status of the caregivers indicated poor health.
World health & population 02/2006; 8(3):4-13. DOI:10.12927/whp.2006.18053
[Show abstract][Hide abstract] ABSTRACT: The Millennium Development Goals set an agenda for advancing global health in the 21st century. Nurses have a pivotal role to play in the pursuit of global health and equity, including achieving the goals, but their capacity to contribute has been largely untapped. In this article, the authors examine strategies to mitigate inequities in global health within an international development framework, threats to achieving equity in health and the implications of these issues for nurses and nursing.
[Show abstract][Hide abstract] ABSTRACT: Equity is considered one of the prerequisites and conditions for health. The pursuit of global health and equity is a relevant goal for nursing, based on the belief that health is a core phenomenon of interest to the discipline. In this article, the first in a two-part series, global health, equity and globalization are analysed. In addition, factors that contribute to global health inequity, including their relevance for nurses and nursing, are examined.