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.

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.

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.

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.

Clinical trials: the challenge of recruitment and retention of participants.

AIMS AND OBJECTIVES: This article, based on the available literature, attempts to discuss the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers. BACKGROUND: The inability to recruit and retain the required participants in a research project poses serious threats to both the internal and the external validity of a research study. Despite serious implications, the issues of recruitment and retention do not receive due attention in research and publications. Literature suggests a lack of coordinated efforts to collect information on the outcomes of recruitment experiences in clinical trials and population studies. Studies often mention the number of participants who refuse to participate; however, the majority of the studies often fail to mention the specific reasons insufficient recruitment or retention of the participants. DESIGN: A methodological paper. METHOD: Various participant-, context-, environment- and research-related factors are examined that affect the phenomenon of recruitment and retention of the participants in a study. RESULTS: Delayed or inefficient recruitment also has financial and ethical implications. Although there are many pieces of information scattered throughout academic journals on recruitment and retention of participants in research, few authors have dealt with the issue holistically. It is imperative for researchers to understand the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers. CONCLUSION: Appropriate recording and reporting of the problems faced while recruiting and retaining the participants in research studies can help not only in understating the challenge, but will also help in devising the strategies to overcome this problem. This article was an attempt to synthesise and review the available literature on recruitment and retention issues, which demand extensive theoretical and conceptual thinking as part of the research design. RELEVANCE TO PRACTICE: An understanding of the challenges and issues related to recruitment and retention can help researchers to think ahead about the strategies to overcome these issues and consequently save the time and energy of the participants, researchers and funding agencies.

Strengths and challenges of the first prelicensure baccalaureate of science in nursing program in Pakistan.

With the increasing complexities of health care and the associated strong advocacy for baccalaureate of science in nursing (BScN) program as entry to practice in the developing countries, gradually, nurse leaders are moving in that direction. Although extensive information is available in the literature about the outcomes of prelicensure BScN programs in developed countries, little is known about the outcomes of such programs in developing countries. In this article, we report strengths and challenges of the first prelicensure BScN program in Pakistan. Using a focused ethnographic approach, data for this study were collected mainly through semistructured interviews of the graduates from the first five cohorts of the BScN program and their supervisors at Aga Khan University, Pakistan. Interviews were tape-recorded, transcribed verbatim, and content analyzed for explicit and implicit patterns of themes, meanings, and understanding about the program. Findings of this study affirmed the worth of BScN program for preparing competent nurses that can contribute to the development of nursing in Pakistan. However, various contextual issues and challenges in the nurses work environment have affected the utilization and retention of these graduates and hence the perceived outcome of the program.

Concept mapping: A strategy for teaching and evaluation in nursing education.

In the past decade an increasing emphasis has been placed on the importance of critical thinking in nursing. Nurse educators are faced with the challenge of finding ways to promote and evaluate critical thinking in nursing students, and various teaching strategies have been identified to achieve this goal. Concept maps are considered a powerful metacognitive tool that can facilitate the acquisition of knowledge through meaningful learning. Hence concept mapping can be used to promote and evaluate critical thinking. Based on the published nursing literature, the scope of concept mapping is discussed in this paper as a teaching and evaluation strategy for critical thinking in nursing education.