Cancer Care in Pakistan: A Descriptive Case Study.

In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for universal access to health.

Effectiveness of High-Fidelity Simulation in Nursing Education for End-of-Life Care: A Quasi-experimental Design.

BACKGROUND: Providing end of life (EOL) care is a component of palliative care but dealing with dying patients and their family members is stressful for the healthcare providers. To prepare them for providing EOL care, the high-fidelity simulation could be used as a pedagogy in which real-life scenarios are used on the computerized manikins mimicking the real patients. AIMS: The aim of this study was to measure the effectiveness of high-fidelity simulation to teach EOL care in the palliative nursing course in the undergraduate nursing education program at the School of Nursing and Midwifery at Aga Khan University which is private university in Karachi, Pakistan. METHODS: This study was approved by the ethics review committee of Aga Khan University. It was hypothesized that exposure to high-fidelity simulation will lead to an increased positive attitude in participants towards the care of dying. A quasi-experimental design was used. In line with the design, there was no control group. The same group of students (n = 42) were assessed through Frommelt Attitudes Toward Care of the Dying (FATCOD) Part B assessment tool. Permission for using this tool was obtained from Dr. Katherine Frommelt, the author of this tool. Research participants filled this tool before and after the intervention, i.e., providing EOL care to a patient in a high-fidelity simulation lab. RESULTS: Out of 30-FATCOD items, significant attitude change was detected on 11-items of which 8 were positively worded statements and 3 were negatively worded statements. As per the hypothesis, it was expected for the positively worded statements that the mean score for the posttest would be significantly greater than the pretest mean score (pretest score < posttest score). The hypothesis was proved for items 1, 4, 10, 18, 22, 25, 27, and 30 as their t-value was significant at 0.05 alpha value (one-tailed). For the negatively worded statements, it was expected that the mean score for the posttest would be significantly lower than the pretest (pretest score > posttest score). The hypothesis was proved for items 5, 6, and 11 as their t-value was significant at 0.05 alpha value (one-tailed). CONCLUSION: In this research teaching, EOL care through high-fidelity simulation had improved the attitudes of students toward providing care. This pedagogy also provided the participants with a learning opportunity to deal with their own emotions. These findings provide a way forward for teaching EOL and other complex skills of clinical practice.

Perinatal women's perceptions about midwifery led model of care in secondary care hospitals in Karachi, Pakistan.

OBJECTIVE: the purpose of this study was to explore the perceptions and experiences of perinatal women who have availed of midwifery led model of care (MLC) at secondary care settings in Karachi, Pakistan. DESIGN: a qualitative descriptive exploratory approach using semi-structured interviews. PARTICIPANTS: a purposive sample of 10 women who had used MLC was enroled from each site. FINDINGS: content analysis highlighted that 'women's satisfaction with MLC' emerged as the main theme and, under this theme, the six categories that emerged were: (1) the admired capability and maturity of midwives, (2) the affordability of midwifery services, (3) a personalised relationship, (4) the empowerment of women to make decisions, (5) presence, and (6) a voiced concern regarding lack of marketing of MLC. KEY CONCLUSIONS: the study findings revealed that women had an overall feeling of satisfaction with the maternity care provided by the midwives. Mostly, women appreciated the midwives' expertise in providing maternity care. Majority of the women acknowledged the continuous presence of the midwives during childbirth and the women shared that they were empowered to make decisions related to their care. Most of the women indicated that marketing for MLC is scarce and insufficient. Majority of the women are even not aware of this model; therefore, it is imperative to create awareness and to provide MLC access to women through robust marketing. IMPLICATIONS FOR PRACTICE: the findings of this study may help to advocate and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normality by attending spontaneous vaginal childbirths.

Women's empowerment in Pakistan-definitions and enabling and disenabling factors: a secondary data analysis.

PURPOSE: The purpose of the study was to explore Pakistani women's definition of women's empowerment, including its enabling and disenabling factors. Through understanding empowerment, interventions may be developed for women to be empowered. DESIGN: Transcriptions of 35 interviews from a previous study were reanalyzed through secondary data analysis. FINDINGS/RESULTS: The themes of economic stability, social acceptability, educational achievement, and family harmony emerged for the concept of definition of empowerment. Themes for enabling factors were strength of personality and openness of mind. Disenabling factors had sociocultural influences, religious misinterpretations, and dominant ideology as themes. DISCUSSION/CONCLUSIONS: Pakistani women hold on to their customs, traditions, and religion tenaciously. The views of empowerment leading to the themes were expressed as true for their lives.

Application of Neurobiologic Risk Score in a tertiary care hospital in Pakistan.

Many health-care institutions are equipped to provide high-quality care to high-risk neonates. Purpose of this study was to assess validity of a tool using Neurobiologic Risk Score in our setting. This tool is applicable in our setting, although further studies should be initiated to determine development delay.