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Nanyonga MM, Kutyabami P, Kituuka O, Sewankambo NK. Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute. BMC Med Ethics 2024; 25:87. [PMID: 39123154 PMCID: PMC11312825 DOI: 10.1186/s12910-024-01085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. METHODS This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. RESULTS The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. CONCLUSION The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
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Affiliation(s)
- Mayi Mayega Nanyonga
- College of Health Sciences, School of Medicine, Department of Anatomy, Makerere University, Kampala, Uganda.
- Joint Clinical Research Center, Lubowa, Kampala, Uganda.
| | - Paul Kutyabami
- College of Health Sciences, School of Health Sciences, Department of Pharmacy, Makerere University, Kampala, Uganda
| | - Olivia Kituuka
- College of Health Sciences, School of Medicine, Department of Surgery, Makerere University, Kampala, Uganda
| | - Nelson K Sewankambo
- College of Health Sciences, School of Medicine, Department of Medicine, Makerere University, Kampala, Uganda
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Nanyonga MM, Kutyabami P, Kituuka O, Sewankambo NK. Exploration of Clinical Ethics Consultation in Uganda: A case study of Uganda Cancer Institute. RESEARCH SQUARE 2024:rs.3.rs-3853569. [PMID: 38343843 PMCID: PMC10854307 DOI: 10.21203/rs.3.rs-3853569/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Introduction Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESS) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence of mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda. Methodology This qualitative study utilized in-depth-interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers, who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook. Results There was no formal committee nor mechanism utilized to resolve ethical dilemmas at the UCI. The study uncovered six fora where ethical dilemmas were addressed: individual consultations, tumor board meetings, morbidity and mortality meetings, core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas. Conclusion The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
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Hameed S, Humayun A, Yaqoob M, Rehm MH. Patient Safety Culture: A Healthcare Provider's Prospect. Cureus 2023; 15:e49989. [PMID: 38179365 PMCID: PMC10766388 DOI: 10.7759/cureus.49989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION AND OBJECTIVE Safe care is a challenge around the globe, especially in developing countries. In resource-limited settings achieving patient safety is an additional complexity. Patient safety is now considered a significant public health concern worldwide. Despite a vital role in delivering quality care, little attention has been given to describe healthcare professionals' perceptions of the patient safety culture in Pakistan. This study aimed to assess the patient safety culture at a tertiary care public hospital in Lahore from the perspectives of doctors and nurses. METHODS During this cross-sectional study, data were collected from 290 nurses and doctors using a validated safety assessment survey tool of the Hospital Survey of Patient Safety Culture (HSOPSC). The respondent's demographic characteristics and study variables influencing patient safety culture were presented, and a chi-square test was applied to identify the variables influencing patient safety. RESULTS A total of 114 medical doctors (39.3%) and 176 registered nurses (60.7%) participated in assessing patient safety culture (PSC) across tertiary care public healthcare centers in Lahore. The dimensions of organizational learning and continuous improvement (90.6%) and teamwork within units (86.6%) were the highest. Other dimensions include feedback and communication about the error (71.8%), teamwork across units (74.9%), management support for patient safety (67.3%), supervisor/manager expectations, and actions promoting patient safety (64.6%), communication openness (64.5%), overall perceptions of patient safety (65.3%), frequency of events reported (58.7%), and handoffs and transitions (60.9%) showed moderate status. The dimensions of staffing (35.8%) and non-punitive response to errors (39.1%) had the lowest score. CONCLUSIONS The present public hospital survey results revealed that medical staff working in a healthcare setting have a less positive perception of patient safety culture.
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Affiliation(s)
- Sajid Hameed
- Public Health, University Institute of Public Health, Faculty of Allied Health Sciences, The University of Lahore, Lahore, PAK
| | - Ayesha Humayun
- Public Health and Community Medicine, Shaikh Zayed Postgraduate Medical Institute, Lahore, PAK
| | - Muhammad Yaqoob
- Public Health, University Institute of Public Health, Faculty of Allied Health Sciences, The University of Lahore, Lahore, PAK
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Hosseini A, Ghasemi E, Nasrabadi AN, Sayadi L. Strategies to improve hidden curriculum in nursing and medical education: a scoping review. BMC MEDICAL EDUCATION 2023; 23:658. [PMID: 37691094 PMCID: PMC10494411 DOI: 10.1186/s12909-023-04652-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The importance of hidden curriculum cannot be neglected in education. Despite much research in the field, there have been limited studies on HC improvement in nursing and medical education. This scoping review aimed to determine the scope of strategies to improve HC in nursing and medical education. METHOD PubMed, EBSCO/Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Web of Science, Proquest and Persian-language databases of Magiran and SID were searched in January 2023 without a time filter. According to the PRISMA flow diagram, two independent reviewers selected the records that fit the inclusion and exclusion criteria via title and abstract screening. Next, the reviewers studied the full texts of the related articles. The data extracted from the selected articles were tabulated and ultimately synthesized. FINDINGS Out of the eight examined studies, published from 2017 to 2022, only one was in the field of nursing and seven were in medicine. The central strategies were implementing new curricula to replace the previous ones, utilizing team-based clinical clerkship, proposing a HC improvement model, implementation a case-based faculty development workshop, implementation longitudinal and comprehensive educational courses, and incorporating an educational activity into a small group program. CONCLUSION Students and faculty members familiarization on the topic of HC, implementing new curricula, utilizing team-based clerkship, and using comprehensive models were among the HC improvement strategies. Focusing on upgrading the learning environment, particularly the clinical settings, can also be helpful in HC improvement.
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Affiliation(s)
- Amin Hosseini
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ghasemi
- Community-Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- School of Nursing and Midwifery, Department of Medical Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Sayadi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Leslie K, Bourgeault IL, Carlton AL, Balasubramanian M, Mirshahi R, Short SD, Carè J, Cometto G, Lin V. Design, delivery and effectiveness of health practitioner regulation systems: an integrative review. HUMAN RESOURCES FOR HEALTH 2023; 21:72. [PMID: 37667368 PMCID: PMC10478314 DOI: 10.1186/s12960-023-00848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/23/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
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Affiliation(s)
- Kathleen Leslie
- Athabasca University, Athabasca, Canada.
- Canadian Health Workforce Network, Ottawa, Canada.
| | - Ivy Lynn Bourgeault
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | - Anne-Louise Carlton
- Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
| | - Madhan Balasubramanian
- College of Business, Government and Law, Flinders University, Adelaide, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Raha Mirshahi
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | | | - Jenny Carè
- University of Technology Sydney, Sydney, Australia
| | | | - Vivian Lin
- University of Hong Kong, Hong Kong, China
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Wang L, Li D, Wei W, Zhang T, Tang W, Lu Q. The impact of clinical nurses' perception of hospital ethical climates on their organizational citizenship behavior: A cross-sectional questionnaire survey. Medicine (Baltimore) 2022; 101:e28684. [PMID: 35089219 PMCID: PMC8797529 DOI: 10.1097/md.0000000000028684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/01/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As the main force in the development of healthcare, nurses have the longest contact time with patients in clinical practice, their perception of the hospital ethical climates affecting nurses' attitudes and related ethical issues. hospital ethical climates have become an essential environmental factor for nurses to make and implement ethical decisions. OBJECTIVE This study aims to investigate the current status of nurses' perception of the hospital ethical climates and the nurses' organizational citizenship behavior, exploring the impact of the nurse's perception of the hospital ethical climates on the nurses' organizational citizenship behavior. METHODS A cross-sectional survey adopted, random sampling and cluster sampling were used to select 624 nurses from August 2019 to February 2020. The hospital ethical climate scale and organizational citizenship behavior scale were used as the questionnaire. The data was analyzed by SPSS 21.0 software. On-the-job clinical nurses who had been employed in the hospital for more than 1 year were eligible. Nurses who were administratively punished by the hospital or health administrative authorities were excluded. RESULTS The average scores of hospital ethical climates were 4.30 (standard deviation: 0.44), with organizational citizenship behavior 4.42 (standard deviation: 0.42). The correlation coefficient between nurses' perception of hospital ethical climates and organizational citizenship behavior was 0.359 (P < .01). Nurses' perception of the relationship between managers, patients and nurses could explain 23.1% of altruistic toward colleagues; Nurses' perception of the relationship between nurses, hospital, doctors could explain 21.2% of organizational identification. Nurses' perception of the relationship between hospital, nurses and doctors could explain 12.3% of conscientiousness; Nurses' perception of the relationship between managers, doctors could explain 7.6% of interpersonal harmony. Nurses' perception of the relationship between managers, nurses and doctors could explain 6.6% of protection company resources. CONCLUSION There is a correlation between nurses' perceptions of hospital ethical climate and organizational citizenship behavior, nurses' perceptions of hospital ethical climate influencing nurses' organizational citizenship behavior in different ways. Managers should focus on the changes of nurses' perception of hospital ethical climates, to promote the nurse to make more beneficial behavior to the organization.
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Affiliation(s)
- Lu Wang
- Shanghai Children's Hospital, Shanghai, China
| | - Dan Li
- Shanghai Children's Hospital, Shanghai, China
| | - Wanhong Wei
- Zhengzhou University, Zhengzhou, Henan, China
| | - Ting Zhang
- Shanghai Children's Hospital, Shanghai, China
| | | | - Qunfeng Lu
- Shanghai Children's Hospital, Shanghai, China
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Arkam J, Azhar S, Khan KS, Aman A. Patient safety attitudes of frontline healthcare workers in Lahore: A multicenter study. Pak J Med Sci 2022; 38:40-46. [PMID: 35035398 PMCID: PMC8713222 DOI: 10.12669/pjms.38.1.4964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate patient safety attitudes of the frontline health workers in hospitals of Lahore, Pakistan. Methods: A self-administered Safety Attitudes Questionnaire (SAQ) survey was deployed in five hospitals across Lahore, Pakistan (July 2019 to June 2020). A total of 1250 consecutive consenting nurses and postgraduate trainee physicians of under five years working experience were recruited. Assessment for each of the six subdomains (teamwork climate, safety climate, job satisfaction, stress recognition, perception of management, working conditions) was done on a 0-100 scale. Multivariate analyses examined their relationship with job cadre (nurses and physicians), duration of respondents’ work experience (< 2 years, 3 - 4 years, > 4 years), and hospital sector (private and public). Results: The response rate was 97% (1212 individuals; 765 nurses, 447 physicians). Nurses scored less than physicians in teamwork climate (-2.4, 95% CI -4.5 – -0.2, p=0.02) and stress recognition (-10.6, 95% CI -13.5 – -7.7, p<0.001), but more in perception of management (4.2, 95% CI 1.5 – 6.8, p=0.002) and working conditions (3.4, 95% CI 0.66 – 6.2, p=0.01). Increasing work experience was related to greater scores in all subdomains. Private hospitals scored generally higher than public ones. Conclusion: Duration of job experience was positively correlated with patient safety attitudes of hospital staff. These finding could serve as the baseline to shape staff perceptions by cadre in both public and private sector hospitals.
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Affiliation(s)
- Javed Arkam
- Prof. Javed Akram, MBBS, FRCP. Vice Chancellor, University of Health Sciences, Khayabaan e Jamia Punjab, Lahore 54000, Pakistan
| | - Shehnoor Azhar
- Dr. Shehnoor Azhar, BDS, MPH. Assistant Professor, Department of Public Health, Doctoral Candidate Public Health, University of Granada, Spain. University of Health Sciences, Khayabaan e Jamia Punjab, Lahore 54000, Pakistan. Distinguished Investigator, Department of Clinical Medicine & Public Health, University of Granada, Spain
| | - Khalid Saeed Khan
- Prof. Khalid Saeed Khan, FCPS, MRCGOB. Distinguished Investigator, Department of Clinical Medicine & Public Health, University of Granada, Spain
| | - Arifa Aman
- Dr. Arifa Aman, MBBS. Private Medical Practitioner, Lahore, Pakistan
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Jasemi M, Goli R, Zabihi RE, Khalkhali H. Educating ethics codes by lecture or role-play; which one improves nursing students' ethical sensitivity and ethical performance more? A quasi-experimental study. J Prof Nurs 2021; 40:122-129. [DOI: 10.1016/j.profnurs.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
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Yazdani S, Andarvazh MR, Afshar L. What is hidden in hidden curriculum? a qualitative study in medicine. J Med Ethics Hist Med 2020; 13:4. [PMID: 33088431 PMCID: PMC7569532 DOI: 10.18502/jmehm.v13i4.2843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 11/24/2022] Open
Abstract
The hidden curriculum is considered to be between the designed and experienced curricula. One of the challenges that medical educators face is to understand what students learn in real clinical settings. The aim of the present study was to answer this question: What is hidden in hidden medical curriculum? This study was a qualitative content analysis. Participants were selected through purposive sampling. Data collection was performed through unstructured interviews and continued until data saturation. Data were analyzed simultaneously with data collection using MAXQDA10 software. Data validity was confirmed based on the proposed Lincoln and Guba criteria. The main theme that emerged in this study was implicit learning. Professional ethics, spiritual, social and cultural issues, and clinical skills are the five major themes that were presented in this study. These themes and their subthemes are transferred during an implicit learning experience in hidden curriculum. Since a wide range of issues are mostly transferred by hidden curriculum, it is essential to have a dynamic approach to educational environments. This is especially important in clinical settings, as the process of learning is constantly happening in the backyard.
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Affiliation(s)
- Shahram Yazdani
- Professor, School of Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Andarvazh
- PhD Graduate of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Assistant Professor, Nasibeh School of Nursing and Midwifery, Educational Development Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Afshar
- Associate Professor, Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jafree SR. Determinants of depression in women with chronic disease: Evidence from a sample of poor loan takers from Pakistan. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2238-2251. [PMID: 32696988 DOI: 10.1002/jcop.22399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Depression is one of the most common mental health problems in Pakistani women, with prevalence rates estimated to be above 30%. Identification of the determinants of depression in chronically ill, poor, and debt-ridden women of the country is a neglected area. A quantitative survey using standardized tools was used to sample women from across Pakistan. It was found that women had higher odds of depression when they (a) perceived unfavorable self-health, (b) had less health decision-making power, (c) encountered difficulties in healthcare services, and (d) faced food insecurity. Key reforms are recommended to improve state protection policies, mental healthcare services, and cultural support for disadvantaged women in the country.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Pakistan
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Deem MJ, Stokes F. Culture and Consent in Clinical Care: A Critical Review of Nursing and Nursing Ethics Literature. ANNUAL REVIEW OF NURSING RESEARCH 2019; 37:223-259. [PMID: 30692159 DOI: 10.1891/0739-6686.37.1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raso A, Marchetti A, D'Angelo D, Albanesi B, Garrino L, Dimonte V, Piredda M, De Marinis MG. The hidden curriculum in nursing education: a scoping study. MEDICAL EDUCATION 2019; 53:989-1002. [PMID: 31144353 DOI: 10.1111/medu.13911] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/30/2018] [Accepted: 04/09/2019] [Indexed: 05/22/2023]
Abstract
CONTEXT The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers. METHODS A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach. RESULTS The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum. CONCLUSIONS The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values.
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Affiliation(s)
- Annalisa Raso
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio Medico University, Rome, Italy
| | - Daniela D'Angelo
- CNEC (Center for Clinical Excellence and Quality of Care), Istituto Superiore di Sanità, Rome, Italy
| | - Beatrice Albanesi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Lorenza Garrino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio Medico University, Rome, Italy
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Pasha SB, Qadir TF, Fatima H, Madadin M, Hussain SA, Menezes RG. Sanitary Worker's Death Unnerves Pakistan's Health Care Ethics to the Core. SCIENCE AND ENGINEERING ETHICS 2018; 24:1611-1616. [PMID: 28900845 DOI: 10.1007/s11948-017-9968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
Health care ethics is a sensitive domain, which if ignored, can lead to patient dissatisfaction, weakened doctor-patient interaction and episodes of violence. Little importance has been paid to medical ethics within undergraduate medical education in developing countries such as Pakistan. Three doctors in Pakistan are currently facing an official police complaint and arrest charges, following the death of a sanitary worker, who fell unconscious while cleaning a drain and was allegedly refused treatment as he was covered in sewage filth. The medical license of the doctors in question should be cancelled, if found guilty following a thorough investigation into the case. The 'right to life' has been universally assured by all moral, cultural and legal codes and no society can ever argue against the sacredness of a human life. It is quite clear that the aforesaid doctors' actions are not only against the core principles of the physicians' code, but also go against the doctrine of human rights. If serious efforts on an urgent basis are not made by the regulatory and governing bodies, one can definitely expect similar incidents for at least a few more decades before any noticeable change is seen.
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Affiliation(s)
- Syed Bilal Pasha
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Tooba Fatima Qadir
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Huda Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammed Madadin
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Syed Ather Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia.
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Jafree SR, Zakar R, Zakar MZ, Fischer F. Assessing the patient safety culture and ward error reporting in public sector hospitals of Pakistan. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s40886-017-0061-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Jafree SR. Workplace violence against women nurses working in two public sector hospitals of Lahore, Pakistan. Nurs Outlook 2017; 65:420-427. [PMID: 28343713 DOI: 10.1016/j.outlook.2017.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cultural and structural forces help sustain workplace violence (WPV) against feminized professions like nursing in Pakistan. PURPOSE The purpose of this study was to identify the prevalence and patterns of workplace violence (WPV) against women nurses (more than 95% of entire nursing population) in two hospitals of Pakistan. METHODS A standardized international survey developed by the World Health Organization was used to collect cross-sectional data. Descriptive statistics, chi-square tests, and multivariate regression were used for data analysis. A total of 309 nurse respondents were sampled from two public sector tertiary care hospitals of Lahore. RESULTS Findings show that 73.1% of nurses reported experiencing some sort of violence in the last 12 months; with 53.4% suffering from physical violence, 57.3% from verbal violence, and 26.9% from sexual violence. The main perpetrators were reported to be male coworkers, patients, and attendants. Higher risk for WPV includes single status, non-Punjabi provincial belonging, Islamic faith, staff and student nurse designations, temporary government contract, and working additional hours in the evening and night. The primary response to violence included not doing anything and remaining silent. It was also reported that nurse victims experienced moderate levels of emotional grievances after facing violence. CONCLUSION The results of this study suggest that public sector hospitals in the region need to improve their policy for the protection and monitoring of WPV against female nurses. Reporting and counseling bodies need to be installed to encourage both complaints and the seeking of medical attention after victimization.
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Affiliation(s)
- Sara Rizvi Jafree
- Forman Christian College, A Chartered University, Lahore, Punjab, Pakistan.
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Esteghamati A, Baradaran H, Monajemi A, Khankeh HR, Geranmayeh M. Core components of clinical education: a qualitative study with attending physicians and their residents. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2016; 4:64-71. [PMID: 27104200 PMCID: PMC4827758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students' knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents' learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings. METHODS This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences. RESULTS The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics). They see some of their attending physicians as role models. CONCLUSION Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents' learning by means of appropriate workplace planning and by considering the components involved in clinical learning.
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Affiliation(s)
- Alireza Esteghamati
- Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Baradaran
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Monajemi
- Department of Philosophy of Science, Institute for Humanities and Cultural Studies, Tehran, Iran
| | - Hamid Reza Khankeh
- Department of Health in Emergency and Disaster, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; ; Department of Clinical Science and education, Karolinska Institute, Stockholm, Sweden
| | - Mehrnaz Geranmayeh
- Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Jafree SR, Zakar R, Zakar MZ, Fischer F. Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan. BMC Health Serv Res 2016; 16:3. [PMID: 26728071 PMCID: PMC4700678 DOI: 10.1186/s12913-015-1252-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background There is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses. Methods The authors used the “Practice Environment Scale-Nurse Work Index Revised” to measure the six dimensions of organizational culture. Seven questions were used from the “Survey to Solicit Information about the Culture of Reporting” to measure error reporting culture in the region. Overall, 309 nurses participated in the survey, including female nurses from all designations such as supervisors, instructors, ward-heads, staff nurses and student nurses. We used SPSS 17.0 to perform a factor analysis. Furthermore, descriptive statistics, mean scores and multivariable logistic regression were used for the analysis. Results Three areas were ranked unfavorably by nurse respondents, including: (i) the error reporting culture, (ii) staffing and resource adequacy, and (iii) nurse foundations for quality of care. Multivariable regression results revealed that all six categories of organizational culture, including: (1) nurse manager ability, leadership and support, (2) nurse participation in hospital affairs, (3) nurse participation in governance, (4) nurse foundations of quality care, (5) nurse-coworkers relations, and (6) nurse staffing and resource adequacy, were positively associated with higher odds of error reporting culture. In addition, it was found that married nurses and nurses on permanent contract were more likely to report errors at the workplace. Conclusion Public healthcare services of Pakistan can be improved through the promotion of an error reporting culture, reducing staffing and resource shortages and the development of nursing care plans.
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Affiliation(s)
- Sara Rizvi Jafree
- Institute of Social and Cultural Studies, Sociology Department, University of the Punjab, Lahore, Pakistan.
| | - Rubeena Zakar
- Institute of Social and Cultural Studies, University of the Punjab, New Campus, University of the Punjab, Lahore, Pakistan.
| | - Muhammad Zakria Zakar
- Institute of Social and Cultural Studies, Faculty of Behavioral and Social Sciences, New Campus, University of the Punjab, Lahore, Pakistan.
| | - Florian Fischer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, P.O. Box 100131, 33501, Bielefeld, Germany.
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