A Scoping Review of the Health of Conflict-Induced Internally Displaced Women in Africa.

Armed conflict and internal displacement of persons create new health challenges for women in Africa. To outline the research literature on this population, we conducted a review of studies exploring the health of internally displaced persons (IDP) women in Africa. In collaboration with a health research librarian and a review team, a search strategy was designed that identified 31 primary research studies with relevant evidence. Studies on the health of displaced women have been conducted in South- Central Africa, including Democratic Republic of Congo (DRC); and in Eastern, East central Africa, and Western Africa, including Eritrea, Uganda, and Sudan, Côte d'Ivoire, and Nigeria. We identified violence, mental health, sexual and reproductive health, and malaria and as key health areas to explore, and observed that socioeconomic power shifts play a crucial role in predisposing women to challenges in all four categories. Access to reproductive health services was influenced by knowledge, geographical proximity to health services, spousal consent, and affordability of care. As well, numerous factors affect the mental health of internally displaced women in Africa: excessive care-giving responsibilities, lack of financial and family support to help them cope, sustained experiences of violence, psychological distress, family dysfunction, and men's chronic alcoholism. National and regional governments must recommit to institutional restructuring and improved funding allocation to culturally appropriate health interventions for displaced women.

Obstetric fistula policy in Nigeria: a critical discourse analysis.

BACKGROUND: In 2012, Nigeria's Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011-2015. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing. METHODS: A critical discourse analysis of the policy was performed. We examined four policies in addition to the strategic framework: the Nigerian constitution; the Marriage Act; the Matrimonial Causes Act; and the National Reproductive Health Policy. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice. RESULTS: The analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. The overall orientation of the policy is downstream, with minimal focus on prevention. The policy language suggests victim blaming. Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations' "2030 Agenda for Sustainable Development." CONCLUSION: This analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women's access to quality maternal healthcare services. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women's interest groups.

Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge.

Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children's Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented.

Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: an integrative review of the literature.

BACKGROUND: High income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care. METHODS: Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torraco's definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination. RESULTS: Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized. CONCLUSIONS: While many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.

Ethical issues surrounding studies with vulnerable populations: a case study of South African street children.

UNLABELLED: Researchers who investigate social and economic determinants of health often interact with vulnerable and marginalized populations. Great care must be taken to conduct research studies involving vulnerable persons in a manner consistent with accepted ethical principles in order to protect participants from exploitation, to build capacity, and to promote wellbeing. Children form a particularly vulnerable group, especially those who do not enjoy the protection of parents or guardians. METHODS: A research project which studied South African Sunnyside's street children was used as a case study to illustrate ethical issues surrounding research with vulnerable populations. DISCUSSION: The participants in the case study lacked the age of majority and were without any legal guardian. The researchers experienced considerable difficulty in obtaining ethical approval to conduct the study. The street children, at first, were not allowed to give informed consent for the study because of their minor age. Ethical principles of autonomy, disclosure, competence and understanding, consent and voluntariness, beneficence and non-maleficence, and justice are described and applied to this case study involving street children in a South African neighbourhood. It is suggested that by working within an ethical framework, the safety of research participants will be assured and the quality of the research will be enhanced.

Listening to the voices of hospitalized high-risk antepartum patient.

OBJECTIVE: To explore the needs of high-risk antepartum patients while hospitalized and to generate recommendations from the patients' perspective. DESIGN: Qualitative descriptive. PARTICIPANTS/SETTING: Thirteen female patients in a high-risk antepartum unit of a large tertiary hospital, Edmonton, Alberta. DATA ANALYSIS: A qualitative data analysis process was followed. RESULTS: The major themes and subthemes that emerged from interviews with participants included stressors associated with loss of control and feelings of being a burden. The need for privacy and sensitivity to family members was expressed. Participants' recommendations included being treated as a family unit, setting up accommodation for visiting family members, and wanting more organized activities to relieve boredom. CONCLUSIONS: An understanding of the needs of high-risk antepartum patients while hospitalized from their perspective will help the primary caregiver such as the registered nurse improve the quality of the women's care, provide guidance about the management of stressors, and plan interventions to reduce stress and to involve their families.

The perception of South African adolescents regarding primary health care services.

Most of the South African public health facilities fail to provide adolescent-friendly health services. A quantitative, descriptive research study was conducted at Stinkwater, a rural area in Hammanskraal, South Africa. The objective of the study was to describe the adolescent's preferences regarding primary health care services. A survey was conducted among 119 adolescents. It was found that adolescents wished to be involved in the planning of the activities of the adolescent health service, and that friendliness and respect for adolescents were seen as desirable characteristics of an adolescent-friendly health care service. Adolescents preferred services to be available throughout the week and to be located at the school, youth center, community center, hospital, or clinic. Health education was indicated as a priority and the health care team should include different members of a multidisciplinary team. Adolescents preferred that their health services be separated from adult services and that a male nurse be employed in the adolescent service in order to create a less feminine image. It was also recommended that all adolescents be educated about the types of services available. Understanding health care service preferences of adolescents is needed in order to deliver optimal health care to this group.

Perinatal education: women's needs: descriptive study

The needs of women concerning perinatal education were investigated using a descriptive qualitative design. Purposive sampling was used; the women were chosen based on their knowledge of their perinatal education needs. Focus groups were conducted. A semi-structured interview guide was used. The data were analyzed according to Tesch's method which interprets the data in the basic sense of reflecting on the data until a better understanding of what is meant is achieved. Analysis of the data started as soon as the first data was collected and continued through the data collection phase. Guba's model was used to ensure the study's trustworthiness. Three categories emerged from the data: Women's needs concerning the perinatal educator's professional and personal traits, the educational activities and interventions, and the content of the perinatal education. Every contact with women in the perinatal period should be used as an opportunity for further education. Perinatal education must be versatile and tailored to reflect the background of the women recipients. Involvement of the partner, father of the baby or significant other in the perinatal education process is essential. Create an environment that makes the women and her significant other more comfortable to ask questions. Recognize that some women are more vulnerable for low health literacy. Single pregnant teenagers are a special group and they should be accepted that way.