Ladies without lamps: nurses in Bangladesh

A Policy Analysis Regarding Education, Career, and Governance of the Nurses in Bangladesh: A Qualitative Exploration

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.

Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method

OBJECTIVE

This study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.

DESIGN

Mixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).

SETTING

Study was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project.

PARTICIPANTS

18 physicians and 51 nurses, males and females.

PRIMARY OUTCOME MEASURES

Workload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated.

RESULTS

Physicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses' time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need.

CONCLUSIONS

It is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.

Barriers to quality of work life among Bangladeshi nurses: a qualitative study

AIM

To explore and provide understanding of the barriers to quality of work life among registered nurses in Bangladesh.

BACKGROUND

Globally, there is growing interest in the working environments of nurses, especially at a time of nursing shortages and with the focus on safety and care quality in health systems. In a low socio-economic country like Bangladesh, nurses struggle in a grossly underfunded healthcare system to deliver care to the people but no studies have been conducted on their quality of work life.

METHODS

This qualitative descriptive study was conducted at three Bangladeshi tertiary hospitals in May 2015-January 2016. Three focus group discussions were held with 30 registered nurses exploring their perceived barriers to quality of work life. Data were analysed with content analysis.

FINDINGS

Seven barriers to their work-life arose: heavy workloads; lack of government accommodation and transportation; poor health status; lack of support from nursing supervisors; lack of promotion opportunities; incomplete hospital policies and procedures; and lack of night shift and risk allowances.

DISCUSSION

Participants described many issues and barriers impacting on their work-life. They perceived little reward for their hard work, felt that their health suffered from their working conditions and described a low QWL.

CONCLUSION AND POLICY IMPLICATIONS

Findings provide information for nursing and health policymakers and leaders to reduce barriers to improve work-life quality among nurses that can contribute better to quality of nursing care, and nursing retention and satisfaction. Work policies and practices, and funding and other resources need to be scrutinized to ensure better working conditions for Bangladeshi nurses.

LIMITATIONS

Interviews were conducted with nurses only in tertiary hospitals in the Bangladeshi capital, and understanding of barriers to work-life quality of nurses in other health settings and regions needs to be explored.

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

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.

Factors predicting quality of work life among nurses in tertiary-level hospitals, Bangladesh

AIM

This study examined the level of quality of work life and predictability of years of education, monthly income, years of experience, job stress, organizational commitment and work environment on quality of work life among nurses in tertiary-level hospitals in the People's Republic of Bangladesh.

BACKGROUND

There is an acute shortage of nurses worldwide including Bangladesh. Quality of work life is important for quality of patient care and nurse retention. Nurses in Bangladesh are fighting to provide quality care for emerging health problems for the achievement of sustainable development goals.

METHODS

We collected data from 288 randomly selected registered nurses, from six tertiary-level hospitals. All nurses were requested to fill questionnaire consisted of Demographic Data Sheet, Quality of Nursing Work Life Survey, Expanded Nursing Stress Scale, Questionnaire of Organizational Commitment and Practice Environment Scale of the Nursing Work Index. Data were analysed by descriptive statistics and multiple regression.

RESULTS

The quality of work life as perceived by nurses in Bangladesh was at moderate level. Monthly income was found as the best predictor followed by work environment, organizational commitment and job stress.

DISCUSSION

A higher monthly income helps nurses to fulfil their personal needs; positive work environment helps to provide quality care to the patients.

LIMITATION

Quality of work life and predictors measured by self-report only may not reflect the original picture of the quality of work life among nurses.

CONCLUSION AND POLICY IMPLICATIONS

Findings provide information for nursing and health policymakers to develop policies to improve quality of work life among nurses that can contribute to quality of nursing care. This includes the working environment, commitment to the organization and measures to reduce job stress.

Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India

CONTEXT

Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training.

AIM

The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care.

METHODS

Qualitative ethnography.

SETTING

The study was conducted at a government cancer hospital in urban South India.

SAMPLE

Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study.

DATA COLLECTION

Data were collected over 9 months (September 2011- June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews.

ANALYSIS

Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns.

RESULTS

Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training.

CONCLUSIONS

Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.

Nursing education in Bangladesh: a social business model

INTRODUCTION AND AIM

The aim of this project was to develop a quality nurse education programme in Bangladesh. A sustainable social business financial model was used. The project is a collaboration between Glasgow Caledonian University and the Grameen Health Care Trust. It contributes to the UN development agenda, eradication of poverty, sustainability and the development of global partnerships.

BACKGROUND

There is an acute shortage of nurses in Bangladesh but many young women who wish to become nurses are unable to do so. Women are discriminated against, have few leadership opportunities and poverty affects large proportions of rural society.

DEVELOPMENT

The collaboration between the University and the Trust provides the necessary input to ensure a quality nursing programme. A business plan was developed, competency-based teaching introduced, infrastructure and financial management processes were set-up and an evaluation framework was put in place.

EVALUATION

The systems evaluation framework monitors the financial status of the College and the effects of the programme on students. The social business model, providing access to educational loans, has enabled 118 students to graduate into employment. The College is currently on target to be financially sustainable by 2016.

DISCUSSION

This project outlines a business model that tackles poverty, gender equality and contributes to the human resource deficit. Young women are equipped as change agents and leaders.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY

The social business model provides a mechanism for releasing funds for education to those who are impoverished. It provides a viable option for increasing the number of well-educated nurse leaders in developing countries.

The significance of communities of practice: Norwegian nursing students' experience of clinical placement in Bangladesh

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.

Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases

Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.

Silent saviours: family members in a Bangladeshi hospital

This paper is based on a larger ethnographic study that was conducted in a public hospital in Bangladesh and explores the experiences of family members who have kin in the hospital. The paper shows that family members are an integral part of the informal organisation of the Bangladeshi hospital. The obvious presence of family members in the ward has both structural and cultural dimensions. On one hand, it demonstrates the scarcity of manpower in the hospital, which is a result of general poverty in the country, and on the other hand, it manifests the deep cultural value of family in Bangladeshi life. The paper also shows how the hospital is an ambiguous space where both biomedical and domestic practices function simultaneously.

Dealing with the patient's body in nursing: nurses' ambiguous experience in clinical practice

The core of nursing in western countries is interaction with the patient and with his/her body in particular. As all nursing practices revolve around caring for the patient's body, nurses need to understand the frailty of the body, the intimacy surrounding it, the story it tells, as well as the discomfort and difficulties both illness and close contact can generate in the nurse-patient relationship. With this study, we wanted to explore the ward experiences of a small group of nurses in their day-to-day interaction with patients and their bodies, to highlight their perceptions and possible difficulties in providing care. We collected qualitative data from in-depth interviews with 14 nurses working in departments of general internal medicine, neurology, and geriatrics. The interviews were conducted between April and June 2006 and interpreted using an interpretive phenomenological approach. Analysis of the interview transcripts revealed that while the nurses recognize the centrality of the body in nursing, they also expressed a certain ambiguity toward it: being able to improve a patient's well-being through attentive care to the body is a major source of job satisfaction, but various coping and defense strategies are deployed to overcome care-giving situations that elicit avoidance or refusal reactions to the patient's body.