RESUMO
Objectives: The purpose of the study was to identify the sequence of violence that ensues after breaking bad news and develop a contextual model of breaking bad news and develop a model contextual for Pakistan
Methods: A qualitative exploratory study was conducted using Six FGDs and 14 IDIs with healthcare providers working in the emergency and the obstetrics and gynecology departments of tertiary care hospitals of Karachi, Pakistan. Data was transcribed and analyzed to identify emerging themes and subthemes using thematic content analysis
Results: Impatience or lack of tolerance, lack of respect towards healthcare providers, unrealistic expectations from healthcare facility or healthcare staff were identified as main reasons that provoked violence after breaking bad news. A conceptual five step model was developed to guide communication of bad news by the health care providers. On initial testing the model was found to be effective in deescalation of violence
Conclusion: Communication of bad news requires application of specific approaches to deal with contextual challenges for reducing violence against healthcare
RESUMO
To identify the gaps in information on rabies and post exposure prophylaxis [PEP] in relation to categorization of wound severity, wound washing and appropriate use of vaccine and rabies immunoglobulin after exposure, and define actions that should be taken at dog bite management centres for prevention of rabies occurring after animal bites. Cross-sectional survey. A multicentre study across Pakistan conducted from 1st July 2007 to 31st January 2008. A pre-tested questionnaire was distributed to the respective medical officers in 6 dog bite management centres across Pakistan from 1st July 2007 to 31st January 2008. Information was obtained about demographics of dog bite victims, the timing and type of PEP administered and their responses to the injury. Out of 519 completed questionnaires the mean age of dog bite victims was 24 years. Over one-third were less than 18 years of age; male/female ratio was 4.9:1; 43% lived in rural Pakistan; 67.8% were classified as lower socioeconomic class; 98% animal bites were from dogs, of which 92.5% were first time bites. 45.5% wounds were classified as Category I [no risk], 42.7%, Category II [moderate risk] and 11.9% Category III [severe risk]. Tissue culture vaccine [TCV] was used 54% by intramuscular route and 45% by intradermal route. Only 118 [22.9%] patients received rabies immunoglobulin [RIG]. Critical analysis of the results reveals serious gaps in understanding of wound severity classification and correct application of PEP with vaccine and RIG. There is a dire need for improved awareness and understanding of dog bite management among health care givers in order to prevent rabies deaths