Exploring the experiences of the older adults who are brought to live in shelter homes in Karachi, Pakistan: a qualitative study.

BACKGROUND: The traditional joint family system in a culturally diverse Pakistani society shows great respect and care for older population by the families and their generations. However, in the recent years the phenomenon of population ageing in Pakistan is rapidly increasing due to demographic shift influencing life expectancy, along with changes in socio-cultural values. This transition has resulted in institutionalization of the elderly as an emerging shelter alternative. The aim of this study was to explore the experiences of the elderly people and to identify the reason which compelled them to reside in these shelter homes. METHOD: A qualitative methodology, with a descriptive exploratory design, was adopted for the study. A purposive sample of 14 elderly males and females were selected, from two different shelter homes in Karachi, Pakistan. Semi-structured interviews were audio recorded and transcribed. Content analysis was done to extract the themes and comprehend the data. RESULTS: Content analysis revealed five major themes: the circumstances of leaving home, experiences, and challenges to wellbeing before entering the care facility, coping with challenges, and decision to live in a shelter home. The analysis discovered that the elderly were experiencing lack of physical, psychological, emotional, and financial support from their family and children. It also indicated that migration of children for better career and employment opportunities, entrance of women into the workforce, and insensitive behaviour of children, left the senior citizens neglected and helpless. The findings also uncovered the challenges of unemployment and family disputes that the elderly had to face made them dependent, distressed, helpless, and lonely resulting in both their apparently willing and forceful decision to reside in shelter homes. CONCLUSION: The findings point to need for further investigation of the identified areas in this study through qualitative and quantitative researches. There is a dire need for increasing public awareness through the social, electronic, and print media, and providing capacity building training to HCPs for the care of the elderly. The lobbying group can act as a catalyst in persuading the government officials for the execution of a policy on retirement, day care and subsidized provision of health services for the betterment of the elderly.

Perception on service quality in old age homes: A qualitative study in Karachi, Pakistan.

OBJECTIVE: The growing number of older people due to demographic transition is paving the way for nongovernmental organizations and the private sector for mushrooming of old age homes (OAHs). These homes function either free or fee for services and the services provided at these OAHs determines the quality of life of older people. The aim of the study was to explore the stakeholders' perception on the quality of services offered to people living in OAHs. METHODS: A descriptive qualitative study design was used to explore stakeholders' perception of elderly living experiences in old age homes. Three OAH were selected through purposive sampling for the study. Data collected from February-March 2015 through the structured interview guide. Participants' for FGDs were recruited through universal sampling, while purposive sampling was used for KIIs selection. Researcher ensured all ethical considerations for the entire study period. RESULTS: Two major themes were drawn including the reasons and experiences of older people living in OAH, secondly the need for caregivers' academic competencies. Majority of KIIs and FGDs reported common responses under the two themes. Also the elderly experiences varied from living comfortably to being depressed. KIIs and caregivers' FGD participants' strongly urged the need for caregivers' training and institutional accreditation. CONCLUSIONS: The results of the study on the older people's experiences and challenges of living in OAHs, strongly propose community support system and credentialing of the caregivers for age appropriate care. Moreover the capacity building of academia for offering specialized training in gerontology and geriatrics is also highlighted.

Community health nursing clinical teaching models practiced in undergraduate nursing programme at a private university in Pakistan.

OBJECTIVE: To explore the perceptions and experiences of students and faculty about the modified community clinical model. METHODS: The descriptive qualitative study was conducted at a nationally-accredited Baccalaureate School of Nursing and Midwifery in Pakistan in November 2016, and comprised final year students enrolled in Advanced Concepts in Community Health Nursing course, and experienced community health nursing faculty members. Individual interviews were conducted with students while faculty members were requested to write out their reflections. On the basis of this data, codes and categories were identified which led to two broader themes; window of opportunities, and challenges in practice. RESULTS: Of the 17 subjects, 12 (70.6%) were students and 5(29.4%) were faculty members. All subjects were females. The window of opportunities theme had three categories: perceived comfort and safety; stakeholder's involvement and support; and open door for personal recognition and self-image. The challenges in practice theme had two categories: time consuming, and home visits. Faculty reflections highlighted the need for sustaining student-related activities within the communities. CONCLUSIONS: The findings are suggestive of a wide range of application of the modified clinical model at undergraduate nursing education level.

Active ageing in Pakistan: challenges and opportunities.

The increasing number of ageing population is a signpost for re-directing the resources to ensure quality of life for elderly thus promoting active ageing. However, the challenges to achieve the goal outweigh the opportunities due to scarcity of resources. Several factors including, brain drain, poverty, lack of knowledge of elderly to protect their rights in association with poor state laws determines the poor quality of life for elderly in Pakistan. Although, the apparent scenario is quite unpleasant yet there are several opportunities such as improved crude birth and death rates, increased awareness about gerontology as a specialty care area and constitutions of Pakistan can be significant to ensure the well being of elderly and overcome the challenges to achieve active ageing in Pakistan. It is important to make best use of opportunities at hand by redirecting the resources to improve the quality of life to promote active ageing in Pakistan.

Women's health: an achievable goal for public health nursing in Pakistan.

Monsoons of 2010; left devastated effects in Pakistan; it wiped away thousands of houses and damaged health infrastructure. The national and international communities rescued Internally Displaced People (IDP). Alongside the other health professionals' Public health nurses (PHN) were instrumental in assisting IDPs. This is a case study of a 30-year-old postnatal woman; who sustained an injury on her right breast and developed an abscess in IDP camp. The client was assisted by the team of public health nurses by timely referral to undergo incision and drainage for appropriate management. Moreover, post procedure follow-up assisted the woman in wound management and neonate care, especially the breast feeding. The family was also involved in client's care to ensure their empowerment in managing the case. Thus, the efforts of PHN and their health assessment saved the life of one family by saving the life of a woman in that IDP camp.

Child labour: a public health issue.

Child labour is a global practice and has many negative outcomes. According to International Labour Organization, child labour is the important source of child exploitation and child abuse in the world today. The Human Rights Commission of Pakistan has estimated the number of Pakistani working children to be around 11-12 millions, out of which, at least, half the children are under the age of ten years. It portrays the society's attitude towards child care. It is therefore, essential to break this vicious cycle and hence, enable the society to produce healthy citizens. This article analyzes the determinants of child labour in the Pakistani context and its implications for child's life, in specific, and for the nation, in general, utilizing the model developed by Clemen-stone & McGuire (1991). Since this practice has complex web of causation, a multidisciplinary approach is required to combat this issue through proposed recommendations.