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Akter S, Kabir H, Akter M. Urgent reforms needed in nursing education and practice in Bangladesh. Int Nurs Rev 2024. [PMID: 38934584 DOI: 10.1111/inr.13005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Shimpi Akter
- Department of Medical Studies, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Humayun Kabir
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Masuda Akter
- Faculty of Medicine, University of Dhaka, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
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Park JY, Pardosi JF, Islam MS, Respati T, Nurhayati E, Charania N, Chowdhury KIA, Seale H. Supporting patients and their carers to participate in infection prevention and control activities: The views of patients, family members, and hospital staff from Bangladesh, Indonesia, and South Korea. Am J Infect Control 2024; 52:200-206. [PMID: 37394183 DOI: 10.1016/j.ajic.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Hand hygiene reminders for healthcare workers (HCWs) are commonly used to empower patients. However, this approach overlooks the role of family carers in delivering direct contact care in Asian countries. Limited knowledge exists regarding empowerment strategies for patients and their family carers in infection prevention and control (IPC) recommendations. This study aimed to provide a comprehensive exploration of IPC empowerment within the context of family involvement in care provision across Bangladesh, Indonesia, and South Korea. METHODS In-depth interviews were conducted in 5 tertiary-level hospitals in Bangladesh, Indonesia, and South Korea. A total of 64 participants were interviewed through 57 interviews, including 6 group interviews, comprising 2 groups: (1) patients and their family and private carers; and (2) HCWs. RESULTS The study identified barriers to engaging patients and family carers in IPC measures. These included concerns about the patient-HCW hierarchical relationship, lack of knowledge about healthcare-associated infection, IPC, and patient zone, perceptions of IPC as a barrier to family connections, and disempowerment of patients in IPC due to family bonds. CONCLUSIONS This study provides diverse perspectives on IPC empowerment, revealing challenges faced by patients, family carers, and HCWs. The interlaced relationship established by social norms of family carer provision hinders the empowerment of family carers. Acknowledging the cultural influence on health care arrangements and its implication for IPC empowerment is crucial in mitigating these barriers.
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Affiliation(s)
- Ji Yeon Park
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Jerico Franciscus Pardosi
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Md Saiful Islam
- Emerging Infections Program, International Centre for Diarrhoeal Disease Research, Bangladesh; Department of Global Health Program, Kirby Institute, UNSW, Sydney, Australia
| | - Titik Respati
- Public Health Department, Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Eka Nurhayati
- Public Health Department, Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Nadia Charania
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | | | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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Park JY, Pardosi JF, Islam MS, Respati T, Chowdhury K, Seale H. What does family involvement in care provision look like across hospital settings in Bangladesh, Indonesia, and South Korea? BMC Health Serv Res 2022; 22:922. [PMID: 35841023 PMCID: PMC9286761 DOI: 10.1186/s12913-022-08278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Family members provide care whilst staying in the patient's room across a range of cultural settings, irrespective of resource availability in many Asian countries. This has been reported as a contributing factor to the spread of several outbreaks, including COVID-19. Despite these reports, very little is known about the risk of healthcare-associated infection (HAI) transmission related to the involvement of family and private carers in the clinical setting. As a starting point to understanding this issue, this study aimed to provide insights regarding the patient care activities undertaken by family and private carers and the guidance provided to these carers around infection control measures in hospitals located in Bangladesh, Indonesia, and South Korea. METHOD A qualitative study involving 57 semi-structured interviews was undertaken in five tertiary level hospitals across the selected countries. Two groups of individuals were interviewed: (1) patients and their family carers and private carers; and (2) healthcare workers, including doctors, nurses, hospital managers and staff members. Drawing upon the principles of grounded theory, an inductive approach to data analysis using thematic analysis was adopted. RESULTS Five main themes were generated from the analysis of the data: (1) expectation of family carers staying with a patient; (2) residing in the patient's environment: (3) caring activities undertaken by family carers; (4) supporting and educating family carers and (5) communication around healthcare-associated infection and infection prevention and control. CONCLUSION Based on the types of activities being undertaken, coupled with the length of time family and private carers are residing within the clinical setting, coupled with an apparent lack of guidance being given around IPC, more needs to be done to ensure that these carers are not being inadvertently exposed to HAI's or other occupational risks.
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Affiliation(s)
- J Y Park
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - J F Pardosi
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - M S Islam
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - T Respati
- Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - K Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - H Seale
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Ghazanfari MJ, Karkhah S, Maroufizadeh S, Fast O, Jafaraghaee F, Gholampour MH, Zeydi AE. Knowledge, attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study. J Tissue Viability 2022; 31:326-331. [DOI: 10.1016/j.jtv.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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Joarder T, Parvage MA, Rawal LB, Ahmed SM. A Policy Analysis Regarding Education, Career, and Governance of the Nurses in Bangladesh: A Qualitative Exploration. Policy Polit Nurs Pract 2021; 22:114-125. [PMID: 33461419 DOI: 10.1177/1527154420988003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurses, short in production and inequitable in the distribution in Bangladesh, require the government's efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully, we analyzed relevant policies on education, career, and governance of nurses in Bangladesh. We used documents review and qualitative methods such as key informant interviews (n = 13) and stakeholder analysis. We found that nursing education faced several backlashes: resistance from diploma nurses while attempting to establish a graduate (bachelor) course in 1977, and the reluctance of politicians and entrepreneurs to establish nursing institutions. Many challenges with the implementation of nursing policies are attributable to social, cultural, religious, and historical factors. For example, Hindus considered touching the bodily excretions as the task of the lower castes, while Muslims considered women touching the body of the men immoral. Nurses also face governance challenges linked with their performance and reward. For example, nurses have little voice over the decisions related to their profession, and they are not allowed to perform clinical duties unsupervised. To improve the situation, the government has made new policies, including upliftment of nurses' position in public service, the creation of an independent Directorate General, and improvement of nursing education and service. New policies often come with new apprehensions. Therefore, nurses should be included in the policy processes, and their capacity should be developed in nursing leadership and health system governance.
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Affiliation(s)
| | - Md Aslam Parvage
- National Institute of Mental Health and Hospital, Dhaka, Bangladesh
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Australia
| | - Syed Masud Ahmed
- Centre of Excellence for Health Systems and Universal Health Coverage, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Lebni JY, Toghroli R, Abbas J, Kianipour N, NeJhaddadgar N, Salahshoor MR, Chaboksavar F, Moradi F, Ziapour A. Nurses' Work-Related Quality of Life and Its Influencing Demographic Factors at a Public Hospital in Western Iran: A Cross-Sectional Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:37-45. [PMID: 33201756 DOI: 10.1177/0272684x20972838] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The quality of life as a concept beyond physical health stands one of the protuberant indexes, and various health-based studies required distinct measurements, which deemed necessary for their significant implications. The nurses fight at the front and play a leading role in providing services to patients at healthcare centers. They deserve a higher quality of life in catering to physical health services. This present study focuses on examining nurses' work-life quality standards and how demographic variables contribute to the hospital of Imam Reza in Kermanshah of Western Iran. METHODS This descriptive-analytical study recruited a sample of 271 nurses affiliated with Imam Reza Hospital and Kermanshah University of Medical Sciences by incorporating the stratified random sampling in 2019. This study used a two-part questionnaire to collect data from the targeted respondents. The first part presented the participants' demographic profiles, and the second part showed the nurses' work-related quality of life (WRQoL) on the scale developed by Van Laar et al. The study screened the data and performed analyses through the SPSS version-23. The research study conducted a descriptive analysis to measure mean and standard deviation with inferential statistics, including independent samples t-test and one-way ANOVA (P < 0.05). RESULTS The study findings specified that nurses' average quality of the work-life was at a moderate level 3.11 ± 0.47. Besides, results indicated that 57.50% of the nurses reported high standards of quality of work-life, 36.50% showed a modest and 5.20% revealed a lower level of work-life quality. The findings indicated that the quality of work-life significantly correlated with respondent'' age, marital status, education, work experience, position, department, shifts, and employment status (p < 0.05). CONCLUSION The findings of this research demonstrated that the nurses' quality of work-life was higher than the average standard. The results provide useful insight for nurses and hospital managers. The policymakers and health managers need to pay more attention to providing a better quality of work-life to the nurses.
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Affiliation(s)
- Javad Yoosefi Lebni
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Razie Toghroli
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Jaffar Abbas
- Antai College of Economics and Management, School of Media and Communication, Shanghai Jiao Tong University, Shanghai, China
| | - Neda Kianipour
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazila NeJhaddadgar
- Department of Health Promotion and Education, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Reza Salahshoor
- Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fakhreddin Chaboksavar
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farideh Moradi
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Ziapour
- Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Biswas D, Hossin R, Rahman M, Bardosh KL, Watt MH, Zion MI, Sujon H, Rashid MM, Salimuzzaman M, Flora MS, Qadri F, Khan AI, Nelson EJ. An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions. Soc Sci Med 2020; 260:113185. [PMID: 32712557 PMCID: PMC7502197 DOI: 10.1016/j.socscimed.2020.113185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Diarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care. METHODS The study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management. RESULTS Normalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between 'what should be done' and 'what can be done' was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards. CONCLUSION This study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections.
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Affiliation(s)
- Debashish Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raduan Hossin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kevin Louis Bardosh
- Center for One Health Research, School of Public Health, University of Washington, USA; Department of Anthropology, University of Florida, USA
| | | | - Mazharul Islam Zion
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Hasnat Sujon
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Md Mahbubur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Salimuzzaman
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Government of Bangladesh, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Eric J Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, USA.
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Unicomb L, Horng L, Alam MU, Halder AK, Shoab AK, Ghosh PK, Islam MK, Opel A, Luby SP. Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey. Am J Trop Med Hyg 2019; 99:916-923. [PMID: 30152311 DOI: 10.4269/ajtmh.18-0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a nationally representative cross-sectional study of 875 health-care facilities (HCFs) to determine water, sanitation, and health-care waste disposal service levels in Bangladesh for doctors, staff, and patients/caregivers in 2013. We calculated proportions and prevalence ratios to compare urban versus rural and government versus other HCFs. We report World Health Organization (WHO)-defined basic HCF service levels. The most common HCF was nongovernmental private (80%, 698/875), with an average of 25 beds and 12 admissions per day. There was an improved water source inside the HCF for doctors (79%, 95% confidence intervals [CI]: 75, 82), staff (59%, 95% CI: 55, 64), and patients/caregivers (59%, 95% CI: 55, 63). Improved toilets for doctors (81%, 95% CI: 78, 85) and other staff (73%, 95% CI: 70, 77) were more common than for patients/caregivers (54%, 95% CI: 50, 58). Forty-three percentage (434/875) of HCFs had no disposal method for health-care waste. More urban than rural and more government than other HCFs had an improved water source on the premises and improved toilets for staff. WHO-defined basic service levels were detected in > 90% of HCFs for drinking water, among 46-77% for sanitation, and 68% for handwashing at point of care but 26% near toilets. Forty-seven percentage of HCFs attained basic health-care waste management service levels. Patient/caregiver access to water, sanitation, and hygiene facilities is inadequate in many HCFs across Bangladesh. Improving facilities for this group should be an integral part of accreditation.
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Affiliation(s)
- Leanne Unicomb
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Horng
- Stanford University, Stanford, California
| | - Mahbub-Ul Alam
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amal K Halder
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul K Shoab
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Probir K Ghosh
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Melberg A, Diallo AH, Storeng KT, Tylleskär T, Moland KM. Policy, paperwork and ‘postographs’: Global indicators and maternity care documentation in rural Burkina Faso. Soc Sci Med 2018; 215:28-35. [DOI: 10.1016/j.socscimed.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
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Barron AM, Moran J, Nina SS, Harlow J, Gyawali M, Hossain F, Brezina M, Callahan C, Curran J, Danielson C, Fitzgerald E, Foster J, Erhardt E, Shaughnessy C, Yeh AC, Dey BR. Building Specialized Nursing Practice Capacity in Bangladesh: An Educational Program to Prepare Nurses to Care for Oncology and Bone Marrow Transplant Patients in Dhaka, Bangladesh. J Glob Oncol 2018; 4:1-6. [PMID: 30222084 PMCID: PMC6223378 DOI: 10.1200/jgo.2016.006486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 2012, the Minister of Health and other leaders in the Bangladesh government
approached Massachusetts General Hospital to establish the country’s
first bone marrow transplant program at Dhaka Medical College Hospital to serve
the needs of the people of Bangladesh. Stated goals of this collaboration
included a broad focus on the care of oncology patients with a specific emphasis
on care of patients with hematologic malignancies and of women with gynecologic
cancers. The purpose of this article is to describe the international nursing
collaboration between Massachusetts General Hospital, Simmons College, the AK
Khan Healthcare Trust in Dhaka, and Dhaka Medical College Hospital that was
established to share nursing knowledge and to build specialized professional
nursing capacities to deliver high-quality cancer care in the public sector.
Over the past 3 years, through the educational programs that have been developed
within this collaboration—the Enhanced Specialized Nurse Training
Program—the Bangladeshi nurses have received continuing professional
development based on Western standards of nursing and have been offering nursing
care to patients who have undergone chemotherapy and bone marrow
transplantation. The challenges, opportunities, and outcomes of this
international collaboration have been highly rewarding and mutually
beneficial.
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Affiliation(s)
- Anne-Marie Barron
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Jenna Moran
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Shabnam Sultana Nina
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Jason Harlow
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Meena Gyawali
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Farhad Hossain
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Mark Brezina
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Caroline Callahan
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Judy Curran
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Colleen Danielson
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Ellen Fitzgerald
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Judy Foster
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Emily Erhardt
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Christine Shaughnessy
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Albert C Yeh
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
| | - Bimalangshu R Dey
- Anne-Marie Barron, Simmons College School of Nursing and Health Science; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, Emily Erhardt, Christine Shaughnessy, and Albert C. Yeh, Massachusetts General Hospital; Jenna Moran, Mark Brezina, Caroline Callahan, Judy Curran, Colleen Danielson, Ellen Fitzgerald, Judy Foster, and Bimalangshu R. Dey, Massachusetts General Hospital Bone Marrow Transplant Program; Jason Harlow, Massachusetts General Hospital Center for Global Health; Bimalangshu R. Dey, Massachusetts General Hospital Cancer Center, Boston, MA; and Shabnam Sultana Nina, Meena Gyawali, and Farhad Hossain, AK Khan Healthcare Trust, Dhaka, Bangladesh
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Lavander P, Meriläinen M, Turkki L. Working time use and division of labour among nurses and health-care workers in hospitals - a systematic review. J Nurs Manag 2016; 24:1027-1040. [DOI: 10.1111/jonm.12423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Päivi Lavander
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Merja Meriläinen
- Oulu University Hospital, the Northern Ostrobothnia District; Finland
| | - Leena Turkki
- Research Unit of Nursing Science and Health Management; Faculty of Medicine; University of Oulu; Finland
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Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey. J Hosp Infect 2016; 94:286-294. [PMID: 27665311 PMCID: PMC5495692 DOI: 10.1016/j.jhin.2016.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/16/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. AIM To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. METHODS The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. FINDINGS More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). CONCLUSION Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities.
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Jørgensen W, Hadders H. The significance of communities of practice: Norwegian nursing students' experience of clinical placement in Bangladesh. Nurs Open 2015; 2:36-46. [PMID: 27708799 PMCID: PMC5047308 DOI: 10.1002/nop2.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM The purpose of this study was to gain understanding of Norwegian students' experience of learning in clinical placement in Bangladesh without formal one-to-one supervision, by a personal mentor in the ward. DESIGN Using focus group interviews with bachelor nursing students we explored the significance of 'communities of practice' in nursing practicum abroad, socialization and knowledge transfer. METHOD Seven third year bachelor nursing students enrolled in a clinical placement programme in Bangladesh participated in focus group interviews prior to their departure to Bangladesh, during their stay in Bangladesh and after their return to Norway. RESULTS The Students' marginality and 'peripheral participation' triggered insight and reflection. The challenging but advantageous position of the peripheral students was heightened further due to the lack of one-to-one supervision in the clinic. Their previous experience with problem based learning and group learning was an asset that made them more resilient and helped them to cope.
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Affiliation(s)
- Wanja Jørgensen
- Faculty of NursingSør‐Trøndelag University CollegeTrondheim7004Norway
| | - Hans Hadders
- Faculty of NursingSør‐Trøndelag University CollegeTrondheim7004Norway
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Odendaal WA, Lewin S. The provision of TB and HIV/AIDS treatment support by lay health workers in South Africa: a time-and-motion study. HUMAN RESOURCES FOR HEALTH 2014; 12:18. [PMID: 24708871 PMCID: PMC3978134 DOI: 10.1186/1478-4491-12-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Lay or community health workers (LHWs) are an important human resource in primary health care, and contribute to improving access to care. However, optimal use of LHWs within the health system is often hampered by a poor understanding of how this cadre organizes its work. This study aimed to better understand how LHWs organize and structure their time in providing treatment and adherence support to people on TB treatment and/or antiretroviral therapy (ART) in South Africa. METHODS Fourteen LHWs participated across three low-income peri-urban communities in Cape Town. Each LHW was observed by a researcher for one day, and data collected on each activity and the time spent on it. Data were summarized in the following categories: travel to the patient's home, waiting time and patient contact time. RESULTS Ninety-seven attempted visits to patients were observed, and patients were located in 69 of these. On average, LHWs conducted six visits per day, each lasting an average of nine minutes. Forty-six percent of the observed time was spent with patients, with the balance spent on 'non-contact' activities, including walking to and waiting for patients. The average walking time between patients was 8 minutes (range: 3 to 15 minutes). Activities during visits comprised medical care (that is ensuring that medication was being taken correctly and that patients were not experiencing side-effects) and social support. Other tasks included conducting home assessments to determine risks to treatment adherence, and tracing patients who had defaulted from treatment. CONCLUSIONS Because of their tasks and working environment, LHWs providing support to people on TB treatment and ART in South Africa spend a substantial proportion of their time on 'non-contact' activities. Programme managers need to take this into account when developing job descriptions and determining patient case-loads for this cadre. More research is also needed to explore whether these findings apply to other tasks and settings. Strategies should be explored to mitigate the challenges that LHWs experience in locating and supporting patients, including the use of new technologies, such as mobile phones.
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Affiliation(s)
- Willem A Odendaal
- Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC) and Department of Psychology, University of Stellenbosch, P O Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC) and Global Health Unit, Norwegian Knowledge Centre for the Health Services, St Olavs plass, PO Box 7004, N-0130 Oslo, Norway
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Islam MS, Luby SP, Sultana R, Rimi NA, Zaman RU, Uddin M, Nahar N, Rahman M, Hossain MJ, Gurley ES. Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control. Am J Infect Control 2014; 42:305-10. [PMID: 24406254 PMCID: PMC4681270 DOI: 10.1016/j.ajic.2013.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Background Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers' activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Methods Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Results Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Conclusion Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers' knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers.
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Affiliation(s)
- M Saiful Islam
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
| | - Stephen P Luby
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh; Global Disease Detection Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebeca Sultana
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nadia Ali Rimi
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Rashid Uz Zaman
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Main Uddin
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nazmun Nahar
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - M Jahangir Hossain
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Tyer-Viola LA, Timmreck E, Bhavani G. Implementation of a Continuing Education Model for Nurses in Bangladesh. J Contin Educ Nurs 2013; 44:470-6. [PMID: 23964673 DOI: 10.3928/00220124-20130816-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/17/2013] [Indexed: 11/20/2022]
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Gross K, Pfeiffer C, Obrist B. "Workhood"-a useful concept for the analysis of health workers' resources? An evaluation from Tanzania. BMC Health Serv Res 2012; 12:55. [PMID: 22401037 PMCID: PMC3330008 DOI: 10.1186/1472-6963-12-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 03/08/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International debates on improving health system performance and quality of care are strongly coined by systems thinking. There is a surprising lack of attention to the human (worker) elements. Although the central role of health workers within the health system has increasingly been acknowledged, there are hardly studies that analyze performance and quality of care from an individual perspective. Drawing on livelihood studies in health and sociological theory of capitals, this study develops and evaluates the new concept of workhood. As an analytical device the concept aims at understanding health workers' capacities to access resources (human, financial, physical, social, cultural and symbolic capital) and transfer them to the community from an individual perspective. METHODS Case studies were conducted in four Reproductive-and-Child-Health (RCH) clinics in the Kilombero Valley, south-eastern Tanzania, using different qualitative methods such as participant observation, informal discussions and in-depth interviews to explore the relevance of the different types of workhood resources for effective health service delivery. Health workers' ability to access these resources were investigated and factors facilitating or constraining access identified. RESULTS The study showed that lack of physical, human, cultural and financial capital constrained health workers' capacity to act. In particular, weak health infrastructure and health system failures led to the lack of sufficient drug and supply stocks and chronic staff shortages at the health facilities. However, health workers' capacity to mobilize social, cultural and symbolic capital played a significant role in their ability to overcome work related problems. Professional and non-professional social relationships were activated in order to access drug stocks and other supplies, transport and knowledge. CONCLUSIONS By evaluating the workhood concept this study highlights the importance of understanding health worker performance by looking at their resources and capacities. Rather than blaming health workers for health system failures, applying a strength-based approach offers new insights into health workers' capacities and identifies entry points for target actions.
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Affiliation(s)
- Karin Gross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Cockcroft A, Milne D, Oelofsen M, Karim E, Andersson N. Health services reform in Bangladesh: hearing the views of health workers and their professional bodies. BMC Health Serv Res 2011; 11 Suppl 2:S8. [PMID: 22375856 PMCID: PMC3332567 DOI: 10.1186/1472-6963-11-s2-s8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background In Bangladesh, widespread dissatisfaction with government health services did not improve during the Health and Population Sector Programme (HPSP) reforms from 1998-2003. A 2003 national household survey documented public and health service users' views and experience. Attitudes and behaviour of health workers are central to quality of health services. To investigate whether the views of health workers influenced the reforms, we surveyed local health workers and held evidence-based discussions with local service managers and professional bodies. Methods Some 1866 government health workers in facilities serving the household survey clusters completed a questionnaire about their views, experience, and problems as workers. Field teams discussed the findings from the household and health workers' surveys with local health service managers in five upazilas (administrative sub-districts) and with the Bangladesh Medical Association (BMA) and Bangladesh Nurses Association (BNA). Results Nearly one half of the health workers (45%) reported difficulties fulfilling their duties, especially doctors, women, and younger workers. They cited inadequate supplies and infrastructure, bad behaviour of patients, and administrative problems. Many, especially doctors (74%), considered they were badly treated as employees. Nearly all said lack of medicines in government facilities was due to inadequate supply, not improved during the HPSP. Two thirds of doctors and nurses complained of bad behaviour of patients. A quarter of respondents thought quality of service had improved as a result of the HPSP. Local service managers and the BMA and BNA accepted patients had negative views and experiences, blaming inadequate resources, high patient loads, and patients' unrealistic expectations. They said doctors and nurses were demotivated by poor working conditions, unfair treatment, and lack of career progression; private and unqualified practitioners sought to please patients instead of giving medically appropriate care. The BMA considered it would be dangerous to attempt to train and register unqualified practitioners. Conclusions The continuing dissatisfaction of health workers may have undermined the effectiveness of the HPSP. Presenting the views of the public and service users to health managers helped to focus discussions about quality of services. It is important to involve health workers in health services reforms.
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Health Psychology. INTERNATIONAL AND CULTURAL PSYCHOLOGY 2011. [PMCID: PMC7121535 DOI: 10.1007/978-1-4614-0073-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The chapter draws parallels and contrasts between the study of health in North American and other industrialized countries and health of people living in developing countries, which comprise 80% of the world’s population. Lessons are provided for three common health problems where psychologists play a major role within multidisciplinary teams. The lessons use published journal articles, web sites of international organizations, and the author’s personal experiences living and working in developing countries. One topic concerns the large number of women who unnecessarily die in childbirth and the non-medical reasons. The second is environmental health, which includes sources of clean water, waste disposal, and personal hygiene. Solving this problem requires behavior change. The third concerns child hunger and its disabling effects on cognitive development. The focus of this chapter is on examining the health problem within context and identifying solutions that work and do not work. Background is provided for the novice, so students learn the larger picture into which these issues fit, and how to apply the same analysis to other health problems.
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Berland A, Richards J, Lund K. A Canada-Bangladesh partnership for nurse education: case study. Int Nurs Rev 2010; 57:352-8. [DOI: 10.1111/j.1466-7657.2010.00813.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
In this article, I explore the experiences and concerns of Bangladeshi nurses. I have based this on a larger ethnographic study that was conducted in a ward of a government teaching hospital in Bangladesh. The study shows how the values and norms of Bangladeshi society have shaped the life of Bangladeshi nurses, that they do scarcely any nursing work, and that they suffer from various negative social images. I argue, through this article, that the role, image, and concerns of Bangladeshi nurses have changed dramatically from the ideal image of nursing, and are dissimilar from the ways nursing is practiced in many other parts of the world.
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Affiliation(s)
- Shahaduz Zaman
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
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Hadley MB, Blum LS, Mujaddid S, Parveen S, Nuremowla S, Haque ME, Ullah M. Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh. Soc Sci Med 2006; 64:1166-77. [PMID: 16890336 DOI: 10.1016/j.socscimed.2006.06.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Indexed: 11/16/2022]
Abstract
In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.
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Affiliation(s)
- Mary B Hadley
- Ministry of Health/DFID, Copperbelt Province, Zambia.
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