Perspectives on self-management of individuals living with chronic illnesses: A qualitative study in the Asian context.

Living with a chronic illness requires individuals to perform a critical role in self-managing their illness to improve their quality of life and prevent disease-related complications. To our knowledge, no studies have explored how individuals perceive managing their illness in daily living within the Asian context. This exploratory-descriptive qualitative study aimed to explore the individuals' perspectives regarding self-managing their life with a chronic illness within the Asian context. Individual interviews were conducted with 15 adults living with chronic illness, from three teaching hospitals in Pakistan. An iterative process was followed for data collection and analysis. The analysis identified self-management as complex and situation-driven with variable roles for individuals, namely follower, selective follower, self-permitting role, and active role. Three interrelated elements were found to be influencing these roles: the components of self-management; individuals' relationship with agencies (significant people and power); and their inner drives. Individuals keep moving between these four self-management roles to avoid disharmony and reciprocate the efforts of their significant others. The interdependent community structure, which is a reality in Asian society, was reflected in our data. With this in view, a great deal of authority was given to family relationships and healthcare professionals (HCPs). This study found a lack of collaborative partnership role between individuals and HCPs. The findings and a suggested conceptual figure can facilitate redefining the individuals' and professionals' roles in the healthcare system to promote collaborative partnership and improve individuals' experience of living with a chronic illness within the Asian context. Members of the research team have extensive experience in research around chronic illness management, and self-management (support) from the Western context. The researcher did not need the patient or public contribution in this preliminary exploratory study from the Asian context.

Characteristics and patterns of individuals who have self-harmed: a retrospective descriptive study from Karachi, Pakistan.

BACKGROUND: Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die. METHOD: This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14.  RESULTS: A total of 350 cases were analysed. More than half of the reported cases were in the age group 20-39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value < 0.05) associated with intent to die. Notably, 81% of the cases do not have a history of SH. Drug overdose (61.6%) and insecticides (36.6%) were the two most common methods used. Depression was identified in nearly half of the cases. The most common reason for attempting SH was inter-personal relationship issues (54.3%). CONCLUSION: This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.

Developing mental health competency in undergraduate nursing students amid pandemic: A hybrid model approach.

COVID-19 has raised a concern about the quality and continuity of education. The uncertain situation has required universities to undertake several innovative measures to continue their educational programs without compromising the quality of education. The aim of this paper is to introduce the hybrid approach for undergraduate nursing students for teaching mental health nursing course, utilizing Gagne's instructional design theory, in a private nursing institution in Pakistan. The nine steps of instructions in Gagne's theoretical framework were utilized for teaching the mental health nursing course. The approach enhanced students' therapeutic communication skills, boosted their confidence level, and assisted them in overcoming their fears in caring patients with psychiatric illnesses. Students appreciated the innovative strategies, such as problem-based learning, case studies, interactions with standardized patients, and learning through movies. The innovative and creative clinical teaching approaches can be used to develop nursing students' competencies, core clinical skills, and to bridge the theory-practice gap.

Factors influencing nurses' provision of self-management support for patients with chronic illnesses: A systematic mixed studies review.

BACKGROUND: Self-management support is considered an important task for nurses working in chronic care provision. The complex nature of self-management support makes it necessary to clarify the factors affecting the behaviour of nurses in supporting patients living with chronic illnesses. OBJECTIVE: The aim of this review is to synthesize the factors influencing the provision of self-management support as perceived by nurses in the care for patients living with a chronic illness. DESIGN: A systematic mixed studies review. DATA SOURCE: Studies published in English from 1999 to April 2020 were extracted from five databases: CINAHL, PubMed, Cochrane library, EMBASE, and Web of Science. REVIEW METHOD: The selection process was guided by PICo (Population, phenomenon of Interest, and Context). Studies that highlighted factors associated with the provision of self-management support among nurses, within the context of the top four non-communicable chronic diseases, were included. The risk of bias was carefully assessed. Using data-based convergent synthesis, the identified factors were synthesized and tabulated. The clusters of factors organized under each theme were approved by all researchers in discussion meetings. RESULTS: In total, sixteen studies met the inclusion criteria; out of these, seven were qualitative, seven quantitative, and two mixed methods studies. The review identified nurses' perspectives regarding factors influencing self-management support at the patient, nurse, care relationship, education and training, organization and healthcare system, and intra- and inter-professional levels. The review provided evidence that these factors are interdependent in nature. CONCLUSION: This review proposed considering a framework of interdependent factors influencing self-management support. It highlighted the need to come up with a comprehensive definition of self-management support that takes into account the emotional aspect as well as patient-as-partner approach. The proposed framework can be useful in tailoring multi-faceted interventions to strengthen nurses' supportive role in self-management of chronic care. Future studies should focus on exploring contextually relevant factors impacting nurses' supportive role in self-management.

Implementation of Simulation: A Contemporary Strategy to Enhance Clinical Skills of Undergraduate Students in Mental Health Nursing.

Simulation is an innovative teaching strategy that supports student centered learning. It improves therapeutic communication skills with clients. Additionally, it enhances critical thinking, problem solving, and confidence among students, in a non-threatening and safe environment, without posing a risk to actual patients. This paper describes the process of application of simulation for undergraduate nursing students enrolled in a mental health nursing course. The project aimed to determine the significance of simulation to improve the communication skills and confidence level, and to decrease the anxiety of undergraduate nursing students, prior to attending mental health clinical. The Experiential Learning (ELT), by Kolb in 1984, was chosen as a framework for the simulation strategy. The simulation experience was a stepwise process that comprised a briefing session with students to explain them the process and purpose of the simulation activity, followed by a two-day simulation experience. The experience comprised students' interaction with Simulated Patients (SP), who had been prepared to manifest symptoms of depression, mania, and schizophrenia. The later part of the experience was a debriefing session, in which students were provided an opportunity for self-reflection and for thinking a way forward, to enhance their clinical competency, using their video recording. The students' evaluation regarding the simulation experience was positive and they suggested that it be integrated in the mental health nursing course.

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.

Influence of supportive care on chemotherapy patients' self-care behaviour and satisfaction: A pilot study conducted in Karachi, Pakistan.

BACKGROUND AND AIM: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program. METHODS: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals located in Karachi, Pakistan. In this study, supportive care interventions were offered via the patient help group program over a 5-week period, and in the 6th week, data were collected. The total sample size of this pilot study was n = 17. Female cancer patients receiving weekly chemotherapy regimen and diagnosed with breast or gynecological cancers were a part of the study. Outcome variables, self-care behavior and satisfaction, were assessed via a self-developed questionnaire. Content validity index of the questionnaire was calculated on the basis of expert review and was found to be 96% for relevancy and 94% for clarity. Frequencies were calculated to evaluate outcome variables. Outcome variable satisfaction was also assessed via few open-ended questions. RESULTS: Participants reported moderate-to-high self-care behaviors and satisfaction after exposure to supportive care interventions delivered via the patient help group program. CONCLUSION: Counseling and mind diversion activities are effective in producing a positive change in chemotherapy patients' self-care behaviors and satisfaction. Therefore, oncology nurses must utilize them in chemotherapy patient care. Future studies should evaluate the effectiveness of these interventions with larger sample size and comparative analysis.

Learning environment and emotional well-being: A qualitative study of undergraduate nursing students.

BACKGROUND: Students can experience multiple stressors during their academic life which have an impact on their emotional health and academic progress. PURPOSE: This study sought to explore students' understanding of and factors affecting their emotional well-being in an undergraduate nursing programme at a private nursing institution in Karachi, Pakistan. METHOD: In this qualitative study, data were collected through individual semi-structured interviews using a self-designed guide from 16 participants in total, drawn from various years of the selected undergraduate programme. FINDINGS: Participants noted that the quality of the 'learning environment' was a key influence on their emotional well-being. They highlighted faculty role and teaching approaches, academic expectations and availability of learning resources as important factors that affected their emotional well-being as well as their academic performance. Institutional support was also deemed important. Factors associated with a 'hidden curriculum' were found to be a threat to students' emerging sense of professionalism. CONCLUSION: Suggestions are given as to how the learning environment in the nursing programme under study can be improved to take into account students' emotional well-being. Emphasis needs to be laid on developing supportive faculty role to provide conducive learning environment and professional development of students. Efforts to develop stress-free academic environment with supportive institutional policies need to be considered.

Compliance to antipsychotic medication: a challenge for client, family and health care providers.

Compliance with anti-psychotic medications plays a significant role in managing clients with schizophrenia. It not only helps in controlling the symptoms, but also decreases the risk of relapses and ultimately improves quality of life (QoL) for the clients. However, compliance with anti-psychotic medication remains a challenge for the client, family and healthcare providers. Identification of these associated factors is vital to make appropriate plan to enhance medication compliance. In this paper, various factors are highlighted that are associated with medication compliance in clients with schizophrenia.

Community mental health services: a way forward to rehabilitate chronic mentally ill client.

Schizophrenia and other mental illnesses produce devastating effects on a clients' personal and psychosocial wellbeing. Besides the sufferer, it has irrevocable impacts on the lives of their loved ones. With advancement in the treatment modalities, researches have proven that hospital based care and psychotropic drugs are not the sole solution in managing the client symptoms. Deinstitutionalization is the paradigm shift from hospital based to community based care model that allows client/s to spend rest of their lives in the community setting. A well-structured community care based programme that focuses on psychosocial interventions has significant contribution in treatment and rehabilitation of client/s. This article is aimed to provide the evidence of the effective use of community mental health care for management and prevention of relapse of a client with chronic schizophrenia. The substantial evidence of rehabilitation is represented through this case study of a chronic schizophrenic client who received these psychosocial interventions in his own community setting.

Women trafficking: causes, concerns, care!

Pakistan is both a country of origin and destination as far as women trafficking is concerned. Poverty, gender discrimination, lack of education, and ignorance about legal rights are some of the underlying causes. Available data suggest several areas of concern, like, for instance: direct health effects, maladaptive coping leading to the use of illicit drugs, and inaccessibility to healthcare facilities. Therefore, numerous interventions would be required at three levels: the prevention of trafficking, the protection of victims and the prosecution of the traffickers.

Factors associated with stress among adolescents in the city of Nawabshah, Pakistan.

OBJECTIVE: To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan. METHODS: The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population. RESULTS: Of the total, 529 (66%) children belonged to state-run schools while 271 (34%) were studying at private facilities. The mean age was 13.7+/-1.3 years. The level of stress was positively associated with the number of siblings, parental conflicts, the age of the mother and the number of rooms in the household. There was decreased level of stress among female adolescents (n=474; 59.3%) who had prior information about pubertal body changes than the boys (n=326; 40.8%). CONCLUSION: The study showed that stress among adolescents can be reduced by modifying socio-economic and demographic factors.

Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: a cross sectional study.

BACKGROUND: There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. METHODS: We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ2 test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression. RESULTS: The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use. CONCLUSION: We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.

Sexual harassment at work place: are you safe?

In today's world women are increasingly participating in the realm of work force, yet they are facing many obstacles in their way. Sexual harassment is one of those obstacles. Sexual harassment at work place is prevalent in every society. It could happen to anyone but women are the targeted victims. Sexual harassment is considered as a traumatic event and the victim may end up in having physical and mental sufferings that hinders a person to work effectively. At an organisational level this may result in decrease work effectiveness, decreased work productivity, high absenteeism, high turnover, and low staff morale. Hence there is a need that, organisations and government should look seriously into this matter. Proper education and training programs should be developed to deal with these issues. The goal must be both to deal with sexual harassment incidents effectively and to prevent the occurrence of future incidents.