Development and Psychometric Evaluation of Bilingual English-Urdu Pakistani Critical Thinking Disposition Scale.

Objective: To develop and test the psychometric properties of the Pakistani Critical Thinking Dispositions Scale. Methods: In the item generation phase, constructs of the scale were identified through an in-depth literature review and items were written to measure the constructs. Following this, input of the experts was obtained for content validity index. In the item reduction phase, psychometric properties were measured. Initially, the scale was administered to 580 study participants during May 2018-2020 after approval from the institutional review board. Data was analyzed through SPSS v21, AMOS v21 and Omega extension. Results: First phase identified 54-items for seven constructs including contextual perspective, perseverance, reflection, intellectual integrity, creativity, open-mindedness, and inquisitiveness. Second phase determined KMO test value of 0.974 and Bartlett's test (P-Value < 0.001). The second-order confirmatory factor analysis showed a good fit model explaining 73.37% total variance. Parsimony and baseline comparison indices were favorable. Alpha and Omega value of 42-items was 0.869. Conclusion: Pakistani Critical Thinking Dispositions scale owning seven constructs and 42-items is valid, reliable, and feasible to use in undergraduate nursing education. However, its utilization in other healthcare disciplines can be tested.

A Patient-Centered Self-Management Intervention to Improve Glycemic Control, Self-Efficacy and Self-Care Behaviors in Adults with Type 2 Diabetes Mellitus: A SPIRIT Compliant Study Protocol for Randomized Controlled Trial.

Background: The rising burden of type 2 diabetes mellitus (DM) and its associated complications is affecting the functional capacity of the individuals, their quality of life and demand for healthcare services with significant economic impact on health care systems and the national economies. Given the enormous health and economic impact, preventing type 2 DM progression and reducing the risk of complications require immediate attention. Evidence from western countries suggests that self-management can slow the progression of type 2 DM and minimize the risk of major complications lowering health-care costs. Effective self-management, however, demands patients' confidence and their full commitment to perform self-care tasks necessitating a patient-centered approach. This study aims to test the efficacy of a patient-centered self-management intervention to improve glycemic control, self-efficacy and self-care behaviors in adults with type 2 DM. Patients and Methods: The study will be carried out as a parallel arm, randomized, controlled trial in four public tertiary care hospitals in Faisalabad, Pakistan. A total of 612 patients with type 2 DM will be recruited and randomly assigned to two groups: a control and an intervention group. The intervention group will receive a patient-centered self-management intervention for eight weeks duration. Subjects will be followed up for three months. The primary outcome will be glycemic control (HbA1c), and secondary outcome variables will include self-efficacy and self-care behaviors all measured at three points in time (baseline, at the end of intervention and at three months follow-up). Discussion: This randomized controlled trial will provide critical information about the efficacy of patient-centered self-management intervention in improving HbA1c, self-efficacy and self-care behaviors. If successful, this evidence-based care intervention may be provided to all DM patients by updating hospital policies. Trial Registration: NIH: US National Library of Medicine clinicaltrials.gov Identifier: NCT05491252, Shifa Tameer e Millat University Protocol Record: 335-21. Registration date: August 08, 2022. Recruitment began: April 21, 2022. Recruitment completed: July 27, 2022. URL http://www.clinicaltrials.gov.

The effectiveness of patient-centered care vs. usual care in type 2 diabetes self-management: A systematic review and meta-analysis.

Background: Patient-centered care in diabetes self-management might be a significant factor in improving health outcomes of adults with type 2 diabetes, yet the supporting evidence is inadequate. This review aimed at assessing the effectiveness of patient-centered self-management care interventions on glycemic control (HbA1c) and self-care behaviors compared with usual care. Methods: CINAHL, PubMed, Cochrane Library, Google Scholar, and the HEC Digital Library were searched for studies in English language that assessed patient-centered self-management educational and/or behavioral interventions in adults aged 18 years or older with type 2 diabetes from 2005 to 2020. Interventional studies with at least 3 months of follow-up and reporting on self-care outcomes such as glycemic control (HbA1c) and self-care behaviors including diet control, physical activity, foot care, and medication adherence were included. Results: Of 168 identified records, 24 were found eligible comprising 20 RCTs and four QESs with total 4,083 participants. The meta-analysis involved 19 RCTs that provided enough information for a pooled estimate of HbA1c. Compared with the control group, patient-centered self-management interventions significantly lowered HbA1c, -0.56 (95% CI -0.79, -0.32). Stratified analysis for HbA1c with respect to various aspects of intervention showed larger effects in interventions employing both educational and behavioral components, -0.66 (95% CI -0.97, -0.34); spanned over shorter (<03 months) duration, -0.85 (95% CI -1.28, -0.43); administered by nurses, -0.80 (95% CI -1.44, -0.16); and delivered in community settings -0.70 (95% CI -1.14, -0.26). Conclusion: This systematic review provided evidence supporting the effectiveness of patient-centered self-management care interventions in improving glycemic control and self-care behaviors in adults with type 2 diabetes and identified key features of intervention contributing toward success.

Levels and Predictors of Self-Care Among Patients with Hypertension in Pakistan.

BACKGROUND: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan. METHODS: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol. RESULTS: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population. CONCLUSION: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.

Developing the Reliability and Validity of an Urdu Version-Self-Efficacy Scale for Breast Cancer Patients in Pakistan.

BACKGROUND AND PURPOSE: No suitable scale has been identified in literature that comprehensively measure self-efficacy of Pakistani breast cancer patients. The study aimed to develop a self-efficacy scale in Urdu language and determine its dimensions. METHODS: The scale was developed with input from experts and literature. It was administered, in cross-sectional phase of two pilot studies, on breast cancer patients receiving chemotherapy. Post hoc internal consistency reliability was computed and principal component analysis (PCA) was performed. RESULTS: U-SES comprised 17 questions. PCA revealed a total of five factors explaining cumulative variance of 68.7%. These factors were self-confidence, faith, coping, optimism, and decision making. Post hoc internal consistency (Cronbach's alpha) value was high (∞ = 0.87). CONCLUSION: The self-efficacy scale has acceptable validity and reliability and has potential to obtain information related to self-efficacy of cancer patients receiving chemotherapy.

The effect of individualized education with support on breast cancer patients' anxiety and depression during radiation therapy: A pilot study.

PURPOSE: This study was undertaken to determine the effects of individualized education with support intervention on breast cancer patients' anxiety and depression while undergoing radiation therapy (RT). Moreover, the intervention was assessed for its feasibility in the context of Pakistan. METHODS: A quasi-experimental design was used to conduct this study in RT department of a public hospital in Karachi. A total of 61 breast cancer patients receiving radiation as adjuvant therapy participated in the study. The experimental group (n = 31) received individualized education with support in the form of face-to-face sessions and information booklet prior to the commencement of RT. In addition, the nurse remained available for the consultation during the RT sessions and on telephone throughout the RT period. However, the control group received only information booklet. Patients' anxiety and depression were measured in both of the groups before the commencement of RT, and at the completion of RT by using the Aga Khan University Anxiety and Depression Scale (AKUADS). RESULTS: A significant reduction was found in the overall mean anxiety and depression scores of the experimental group (p = 0.000) from pre-test to post-test. The overall mean anxiety and depression scores of the control group showed no significant difference (p = 0.187). The effect size of the intervention was large (Cohen's d = 2.5). CONCLUSION: The intervention was effective in reducing anxiety and depression among breast cancer patients receiving RT. Replication of the study on a larger scale in multiple settings on other cancer patients is recommended.

Feed-forward: Paving ways for students' subsequent learning.

BACKGROUND: Written feedback assists students in refining their future academic work. However, students prefer having feed-forward instead of feedback by their instructors that are the comments provided to them on drafts prior to the actual assignment submission. The current literature describes two common ways to convey feed-forward: the foremost one is on outlines while the second is on drafts. However, no existing literature had been found yet for sufficient guidance on the ideal approach of feed-forward to facilitate students' subsequent learning. DESIGN: A Quasi-experimental study design was employed to determine the effectiveness of feed-forward on outline versus drafts. SETTING: Study was conducted in a private nursing institution in Karachi, Pakistan. PARTICIPANTS: 118 third-year undergraduate nursing students participated in the study. METHODS: Using consecutive sampling, 118 students were enrolled and equally divided in to two groups, each comprising of 59 students in the control and intervention arm. Control group received feed-forward through standard practice i.e. on their assignment outline while the intervention group received feed-forward on the draft of their scholarly paper. RESULTS: The performance of intervention arm had an upper hand over that of control wing as portrayed by their increased overall assignment and academic writing scores (of students on IELTs bands). The set outcomes also reflected better results in terms of the (reduced) frequency of visits to their instructors for clarification of written feedback. All in all, this research deduced that feed-forward on drafts is far more beneficial in contrast to that on an outline as it reinforces students' learning. CONCLUSION: The study findings affirmed that feed-forward is a useful strategy to enhance students' subsequent learning.

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan.

BACKGROUND: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). OBJECTIVES: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. METHODS: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. RESULTS: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. CONCLUSIONS: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan.

Experiences of the Breast Cancer Patients Undergoing Radiotherapy at a Public Hospital Peshawar Pakistan.

OBJECTIVE: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan. METHODS: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually. RESULTS: Four main categories emerged from data analysis, which were: feelings and perceptions of the patients, their challenges, coping strategies, and teaching and informational needs. CONCLUSIONS: Women undergoing RT in this culture experience more intense psychological effects, as compared to the physical effects. Keeping in mind, the magnitude of the emotional stress experienced by the participants, recommendations for policy reforms, and training for female RT staff are suggested based on findings of this research.

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care [PHC]. Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making [from the Department of Health] and implementation-level stakeholders [mental health and public health professionals and primary care staff] from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results: Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions: The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan

Contexte : Au Pakistan, la prévalence des troubles de santé mentale est élevée, mais les services de santé mentale visant à prendre en charge ces troubles ne sont pas bien développés. Afin de fournir des services de santé mentale efficaces, l'Organisation mondiale de la Santé met l'accent sur l'intégration de la santé mentale dans les soins de santé primaires. Objectifs : La présente étude visait à évaluer les points de vue des parties prenantes clés au sujet de l'intégration de la santé mentale dans les soins de santé primaires à Karachi [Pakistan]. Méthodes : Une étude exploratoire qualitative a été conduite entre juin et septembre 2013 parmi 15 parties prenantes chargées de la prise de décisions [relevant du Département de la Santé] et de la mise en œuvre [professionnels de la santé mentale et de la santé publique et équipes de soins primaires] issues des secteurs public et privé. Des entretiens approfondis en face-à-face ont été menés en recourant à un guide d'entretiens semi-structurés. Les données ont été recueillies jusqu'à saturation théorique, et une analyse de contenu conventionnelle a été réalisée. Résultats : Bien que les parties prenantes soutiennent dans leur ensemble l'intégration de la santé mentale aux soins de santé primaires, certaines d'entre elles ont émis des réserves. La première concernait le manque de soutien perçu au sein de ce système en ce qui concerne l'allocation des ressources et l'acceptation par la communauté. Ensuite venait le manque de ressources humaines dans le domaine de la santé mentale. En outre, il est probable de rencontrer une résistance au niveau des soins de santé primaires, les équipes étant déjà surchargées par d'autres services de soins préventifs. Conclusions : Cette étude suggère qu'un engagement politique fort, des ressources humaines et financières suffisantes et un plaidoyer énergique sont requis en vue de l'intégration de la santé mentale aux soins de santé primaires au Pakistan

الخلفية: تنتشر اضطرابات الصحة النفسية على نطاق واسع في باكستان، إلا أن خدمات الصحة النفسية المقدمة للتصدي لتلك الاضطرابات ليستمتطورة بشكل كاف. ولتوفير خدمات صحة نفسية فعالة، تشدد منظمة الصحة العالمية على دمج الصحة النفسية في الرعاية الصحية الأولية.الأهداف: هدفت هذه الدراسة إلى تقييم آراء الأطراف المعنية الرئيسية بشأن دمج الصحة النفسية في الرعاية الصحية الأولية في كراتشي بباكستان.طرق البحث: أُجريت دراسة كيفية استكشافية في الفترة ما بين يونيو/حزيران إلى سبتمبر/أيلول 2013 شملت 15 طرفاً من الأطراف المعنية علىمستوى صنع القرار )من إدارة الصحة( والتنفيذ )المختصين في مجال الصحة النفسية والصحة العمومية وموظفي الرعاية الأولية( من القطاعين العاموالخاص على حدٍ سواء. وأُجريت مقابلات مباشرة ومعمقة باستخدام دليل شبه منظم لإجراء المقابلات. وجُعت بيانات إلى أن تم بلوغ مستوى التشبع النظري وأجري تحليل تقليدي للمحتوى.النتائج: برغم إبداء جميع الأطراف المعنية بوجه عام دعمها لدمج خدمات الصحة النفسية في الرعاية الصحية الأولية، فقد أُبدي عدد من التحفظات.وتمثل التحفظ الأول في نقص الدعم داخل المنظومة من حيث تخصيص الموارد والقبول المجتمعي لذلك. أما التحفظ الثاني فتمثل في نقص المواردالبشرية في مجال الصحة النفسية. وفضلاً على ذلك، من المرجح حدوث مقاومة على مستوى الرعاية الصحية الأولية حيث يعاني العاملون فيها منثقل العبء الملقى على عاتقهم بالفعل من أثر تقديم خدمات الرعاية الوقائية الأخرى.الاستنتاجات: تشير الدراسة إلى الحاجة إلى وجود التزام سياسي قوي وموارد بشرية ومالية كافية وأنشطة مناصرة قوية لدمج الصحة النفسية في الرعاية الصحية الأولية في باكستان

Women Experiences of Using External Breast Prosthesis after Mastectomy.

OBJECTIVE: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. METHODS: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. RESULTS: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. CONCLUSIONS: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women's physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers' support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints.

Quality of Life and Its Determinants in Adult Cancer Patients Undergoing Chemotherapy Treatment in Pakistan.

OBJECTIVE: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals' well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients' survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. METHODS: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. RESULTS: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. CONCLUSIONS: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients.

The effect of individualized patient education, along with emotional support, on the quality of life of breast cancer patients - A pilot study.

PURPOSE: This study aimed to determine the effect of individualized patient education along with emotional support on the quality of life (QoL) of breast cancer patients undergoing chemotherapy. It also aimed to determine the intervention's feasibility in the Pakistani context. METHODS: A quasi-experimental design, with pre- and post-test, in two groups, via time block, was used. The study was conducted at a public hospital in Karachi with a sample of 50 patients; 25 patients each in the intervention and control group. The intervention was delivered over a period of six weeks. It comprised verbal and written patient education, availability of a nurse during patients' chemotherapy administration and over the telephone, and a telephone follow-up of the patients by the nurse. patients' QoL was assessed at baseline and at the sixth week of receiving chemotherapy. RESULTS: Tests indicated a significant improvement in the overall QoL, breast cancer subscale scores, and the physical and emotional well-being of the intervention group, as compared to the control group. The intervention effect size was moderate (0.655) for the QoL. CONCLUSION: The intervention was found to be effective in improving patients' QoL. However, a larger study, in a multi-center setting, is recommended to ascertain the findings of this pilot study.

Practice of written feedback in nursing degree programmes in Karachi: the students' perspective.

OBJECTIVE: To identify students' perceptions about the practices of provision and utilization of written feedback in the nursing degree programmes in Karachi. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Nine Nursing Institutions in Karachi, Pakistan were selected for the study, from February to October 2011. METHODOLOGY: The sample consisted of 379 second year nursing students from nine institutions in Karachi. The data was collected through a modified Assessment Experience Questionnaire (AEQ) developed by Gibbs and Simpson. The data obtained through AEQ was analyzed in the SPPS. RESULTS: Students reported wide variations in the practices related to written assignments, and the provision of written feedback. Although 80% of the students, reported receiving written feedback with or without oral feedback, 20% of them, received only verbal feedback on their assignments. For 44 - 46% of the students, the quality, quantity, timing, and utilization of feedback was below the reference scores, which is indicative of negative perceptions. Only 40% reported receiving feedback on regular basis. Assignment guidelines were not always provided in a written form. In most cases, the guidelines were ambiguous as well as the feedback was not always reflective of the guidelines. CONCLUSION: The findings have implications for teachers, students, and institutions similar to the context of this study. Teachers need to be aware of the role and the impact of written feedback on students' learning and develop competence for giving effective feedback. Finally, institutional commitment and policies are needed to promote the practices of written feedback.

Co-supervision of doctoral students: enhancing the learning experience.

Abstract The purpose of this paper is to examine the advantages and challenges of co-supervision of doctoral students, as found in the literature and from our experiences. We define co-supervision and then discuss the process in detail. Examples are based on experiences of co-supervision from faculty perspectives as well as from the point of view of a former doctoral student. We propose that the advantages of co-supervision far outweigh the challenges and should be regularly considered by seasoned academics to enhance student learning. In addition, we suggest that co-supervision is intellectually stimulating for academics.

Experiences and perceptions of patients living with hepatitis C in Karachi, Pakistan.

PURPOSE: Hepatitis C (HCV) is a chronic disease that affects an individual's physical, financial, social, and emotional well-being throughout the illness. Although extensive literature is available on experiences of patients with hepatitis C in developed countries, very little exists in developing countries, particularly in Pakistan. This article describes experiences of patients living with HCV in Karachi, Pakistan. METHOD: Using descriptive exploratory DESIGN: The three categories-perceptions and misperceptions, challenges and sufferings, support and shortcomings-were subsumed under the theme "deadly, dangerous, and devastating." CONCLUSION AND IMPLICATIONS FOR PRACTICE: Patients with HCV experience profound challenges that are influenced by their level of education, financial capacity, cultural norms, family support, and the sensitivity of health care professionals. Several cultural practices existing in Pakistan identify the need for public awareness. The findings on health care professionals have implications for nursing and allied health continuing education.

Faculty members as students in the same institution: implications for the learning environment.

Because of the increasing demand for nurses entering professional practice to have a baccalaureate degree, the pressure to have faculty members prepared at the graduate level is also mounting. Due to personal, economic, or organizational factors, faculty members may undertake graduate studies at the institutions where they teach. No research has been found regarding the implications of nursing faculty members becoming students in the same institution. Thus, this qualitative descriptive study was performed to understand the implications. Data were collected through semistructured interviews from 12 participants. Interviews were recorded and transcribed verbatim for content analysis. The findings revealed that faculty members who became graduate students in their own institution had advantages that facilitated their learning. However, they received mixed messages about their identity as both a student and a faculty member. Implications for this dual identity on the learning environment are discussed.

Development of students' critical thinking: the educators' ability to use questioning skills in the baccalaureate programmes in nursing in Pakistan.

OBJECTIVE: To enhance the Critical Thinking skills of educators associated with the nursing baccalaureate programmes in Pakistan. By focusing on the type and level of questions asked by the educators. METHODS: Ninety-one faculty members from 14 out of 17 schools participated in the study. Data on the faculty's questioning skills was obtained through classroom observations and field notes. The duration of the observations was 45-60 minutes. Using Bloom's Taxonomy for cognitive thinking, questions were categorised into high and low categories. RESULTS: Most of the questions (68.9 %) asked by the participants were of lower levels, while some (5.37 %) were ambiguous. In many instances, the participants did not allow a sufficient wait-time for students to think and respond. CONCLUSION: The findings suggest that educators must learn to use the questioning strategy effectively. They should ask higher level questions if they wish to inculcate Critical Thinking in students.

Experience of caregivers with the survivors of hepatitis C.

OBJECTIVES: To assess and describe the experiences of those caring for hepatitis C patients in Karachi, Pakistan. METHODS: Using a qualitative approach, the study adopted a descriptive exploratory design for which 8 caregirers were selected through snowball sampling technique from different parts of Karachi. Data was collected between May and July 2010 through semi-structured interviews from the caregivers. The interviews were recorded on tape and were transcribed verbatim. The data was manually analysed for extracting themes and categories. RESULTS: The analyses of data led to one theme--'deadly, dangerous, and devastating. Two associated categories could also be noted: 'perceptions and misperceptions of the caregivers about hepatitis C' and 'challenges and adversities of the disease'. CONCLUSION: The diagnosis of hepatitis C had a profound impact on patients' and the caregivers' wellbeing. Although to some extent, caregivers were found to have fulfilled their role, but it was evident that better disease knowledge, funds and social support could have further helped them to address issues related to the disease.

Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study.

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects. OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances. DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions of traditional gender roles and how these preserve women's subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. CONCLUSIONS: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women's empowerment.