Aisha Holloway

The Impact of HIV-related Stigma on the Lives of HIV-positive Women:: An Integrated Literature Review

AIMS AND OBJECTIVESnTo critically explore how Human Immunodeficiency Virus-related stigma impacts on the lives of Human Immunodeficiency Virus-positive women through an integrative review of the literature.nnnBACKGROUNDnThroughout history Human Immunodeficiency Virus infection has been associated with sex trade, injecting drug use and other deviant behaviours within society. These historical associations can lead to the generation of negative perceptions of Human Immunodeficiency Virus-positive women. As such, women who contract Human Immunodeficiency Virus infection can be susceptible to societal stigma.nnnDESIGNnAn integrative literature review.nnnMETHODSnTo identify the publications on the impact of Human Immunodeficiency Virus-related stigma among women, a search was performed using the following databases: CINAHL, Medline, PsycINFO, EMBASE, and Applied Social Sciences Index and Abstract covering the period from 2000-2014. The following key words were included in the search: women, Human Immunodeficiency Virus, and stigma.nnnRESULTSnTwenty-six articles were retrieved and reviewed. From the results, four key themes merged in relation to the impact of Human Immunodeficiency Virus-related stigma on Human Immunodeficiency Virus-positive womens lives: the individual, relationships, work and the community.nnnCONCLUSIONSnDespite great advances in the management and treatment of those who are Human Immunodeficiency Virus positive, it appears the lives of many women living with Human Immunodeficiency Virus remain greatly affected by their Human Immunodeficiency Virus infection with gender-specific stigma and stereotypes. Having a holistic understanding of this impact offers the potential for those responsible for the funding and draws the attention of researchers and policy makers on promoting medical services specifically for Human Immunodeficiency Virus-positive women, minimising social stigmatisation towards this client group, and optimising their health outcomes.nnnRELEVANCE TO CLINICAL PRACTICEnIn an attempt to amplify Human Immunodeficiency Virus-positive womens ability to resist social injustice, obtain support and optimise their health outcomes, nurses should expand their roles and work with professionals from different sectors to ensure the provision of comprehensive care to women with Human Immunodeficiency Virus infection.

Alcohol education and training in pre-registration nursing: A national survey to determine curriculum content in the United Kingdom (UK)

BACKGROUNDnAlcohol-related harm impacts significantly on the health of the population. Nurses are often among the first health professionals that many patients with alcohol-related problems come into contact with and have been identified as playing a key role but may be ill-prepared to respond. Future nurses need to have the skills, knowledge and clinical confidence to respond to patients suffering from alcohol-related harm. A pre-registration curriculum that ensures a nursing workforce fit for practice in responding to alcohol-related harm is necessary.nnnOBJECTIVESnTo determine the level of alcohol education and training content in the pre-registration curriculum for nursing in the United Kingdom (UK). To establish whether there are variations in the pre-registration curriculum content across the UK.nnnDESIGNnA descriptive study.nnnSETTINGnAll 68 UK Higher Education Institutions offering a total of 111 pre-registration courses for nurses were invited to participate in the study.nnnPARTICIPANTSnTwenty nine completed questionnaires were returned, a response rate of 26%. The largest number of identified responders were from England (n=15), with 3 from Scotland and 1 each from Wales and Northern Ireland. Nine Universities chose not to identify themselves.nnnMETHODSnAn online semi-structured questionnaire survey was used to collect the study data.nnnRESULTSnTeaching of alcohol and alcohol related harm was mainly delivered during the second year of a pre-registration nursing programme provided mainly to adult and mental health students. Overall, the majority of alcohol related content that is provided within the responding pre-registration nursing courses relates to biophysiology, aetiology, and pharmacological and non-pharmacological interventions.nnnCONCLUSIONnThis study highlights the need for a greater and more relevant focus of alcohol education to pre-registration nursing students of all fields of practice incorporating an integrated approach across all years of study.

Exploration of delivering brief interventions in a prison setting: A qualitative study in one English region

Abstract Aims: There is evidence that alcohol is strongly correlated with offending. This qualitative study explored the views of staff on the efficacy of alcohol brief interventions within a prison setting. The perceptions of prisoners in relation to non-dependent drinking were also examined. Methods: Nine prisons in one English region took part in this research. Five focus groups with 25 prisoners were undertaken with prisoners alongside focus group discussions with 30 professionals. Discussions were recorded using shorthand notation and the main themes were thematically mapped using visual mapping techniques. Findings: The use of the Alcohol Use Disorder Identification Test (AUDIT) was perceived as problematic. Prisoner drinking norms differed widely from community consumption patterns. There were also operational issues that reduced the salience of a brief intervention for prisoners. Conclusions: The delivery of screening and brief interventions within a prison setting is highly nuanced and fraught with inconsistencies. Despite these challenges, there are opportunities to develop coherent and tailored brief interventions for a custodial environment that should focus on developing three key areas around: (a) interventions for the point of release; (b) enhanced content around family impact and offending; and (c) forward-looking goal-setting as motivational tools to facilitate change.

Screening and brief intervention delivery in the workplace to reduce alcohol-related harm: A pilot randomized controlled trial

AIMnTo explore the feasibility and cost effectiveness of screening and delivery of a brief intervention for hazardous drinking employees.nnnMETHODSnA pilot randomised controlled trial of a brief intervention delivered by an Occupational Health nurse versus no delivery of brief intervention (control group) conducted in a Local Authority Council (LCA) in the United Kingdom. Changes in quality of life and economic indicators were measured by the EQ-5D.nnnRESULTSn627 employees were screened of whom 163 (26.01%) fulfilled the inclusion criteria with a total of 57 (35%) agreeing to participate. No significant differences were found between the groups for baseline demographics or levels/patterns of alcohol consumption. A statistically significant effect was found in the mean AUDIT scores over time (F=8.96, p=0.004) but not for group (F=0.017, p=0.896), and no significant interaction was found (F=0.148, p=0.702). The cost of each intervention was calculated at £12.48, the difference in service costs was calculated at £344.50 per person; that is there was a net saving of health and other care costs in the intervention group compared to the control group. The QALYs fell in both intervention and control groups, the difference -0.002-(-0.010) yields a net advantage of the intervention of 0.008 QALYs.nnnCONCLUSIONnThe main results from this pilot study suggest that alcohol brief interventions delivered in the workplace may offer the potential to reduce alcohol-related harm and save public sector resources. A fully powered multi-centre trial is warranted to contribute to the current evidence base and explore further the potential of alcohol brief interventions in the workplace. In a full trial the recruitment method may need to be re-considered.

A study examining the appropriateness of a self‐rated alcohol‐related clinical confidence tool as a method of measurement among registered hospital nurses using Rasch analysis

AIMSnThis paper is a report of a study, which seeks to determine if self-reported estimates of RNs self-rated confidence in responding to alcohol use in patients is a psychometrically sound measure.nnnBACKGROUNDnAlcohol-related harm is a global public health problem. Nurses are the largest group of health professionals worldwide, with evidence showing that despite being well placed to respond, they are not engaging in this important role.nnnDESIGNnInstrument development.nnnMETHODnThe study was a survey set in a large teaching hospital in England, UK. The Clinical Confidence Questionnaire was made available to a convenience sample of 200 RNs in 2007, with a response rate of 22%. Rasch analysis was used to develop a scale for future learning based on the conjoint estimates of registered hospital nurses abilities to meet needs of patients requiring nursing care of different complexities related to alcohol use in patients.nnnRESULTSnOutcomes verify that registered hospital nurses self-rated clinical confidence measures for their own nursing abilities in responding to alcohol use in patients can be reliably estimated and a hierarchical scale of learning can be generated to inform curricula content and learning processes.nnnCONCLUSIONnCurrent health policy in the UK identifies nurses as having a role in responding to alcohol-related harm. More focus should, therefore, be placed on ensuring that they are prepared to fully engage with patients in assessing and responding to alcohol use through specific education, training and skill development. The self-rated clinical confidence tool offers evidence as an acceptable method of measurement in this area.

The “Outcome Reporting in Brief Intervention Trials: Alcohol” [ORBITAL] framework: Protocol to determine a core outcome set for efficacy and effectiveness trials of alcohol screening and brief intervention

BackgroundThe evidence base to assess the efficacy and effectiveness of alcohol brief interventions (ABI) is weakened by variation in the outcomes measured and by inconsistent reporting. The ‘Outcome Reporting in Brief Intervention Trials: Alcohol’ (ORBITAL) project aims to develop a core outcome set (COS) and reporting guidance for its use in future trials of ABI in a range of settings.Methods/designAn international Special Interest Group was convened through INEBRIA (International Network on Brief Interventions for Alcohol and Other Drugs) to inform the development of a COS for trials of ABI. ORBITAL will incorporate a systematic review to map outcomes used in efficacy and effectiveness trials of ABI and their measurement properties, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. This will support a multi-round Delphi study to prioritise outcomes. Delphi panellists will be drawn from a range of settings and stakeholder groups, and the Delphi study will also be used to determine if a single COS is relevant for all settings. A consensus meeting with key stakeholder representation will determine the final COS and associated guidance for its use in trials of ABI.DiscussionORBITAL will develop a COS for alcohol screening and brief intervention trials, with outcomes stratified into domains and guidance on outcome measurement instruments. The standardisation of ABI outcomes and their measurement will support the ongoing development of ABI studies and a systematic synthesis of emerging research findings. We will track the extent to which the COS delivers on this promise through an exploration of the use of the guidance in the decade following COS publication.

Alcohol Brief Interventions (ABIs) for male remand prisoners: protocol for development of a complex intervention and feasibility study (PRISM-A)

Introduction In the UK, a significant proportion of male remand prisoners have alcohol problems. Alcohol Brief Interventions (ABIs) are an effective component of a population-level approach to harmful and hazardous drinking. ABIs have been shown to reduce the aggregate level of alcohol consumed and therefore reduce harm to the individual and to others. However, in relation to remand prisoners, there is no evidence as to how effective ABIs could be. The aims of this study are therefore to explore the feasibility and acceptability of an ABI for adult male remand prisoners and to develop an ABI for this group to be piloted in a future trial. Methods and analysis The study will comprise three stages. Stage 1: a cross-sectional survey of adult male remand and convicted prisoners (n=500) at one Scottish prison and one English prison will be undertaken to assess acceptability and feasibility of delivering an ABI, as well as prevalence rates of harmful, hazardous and dependent drinking. Stage 2: in-depth interviews will be conducted with a sample of remand prisoners (n=24) who undertook the survey (n=12 in Scotland; n=12 in England). Two focus groups (one in Scotland and one in England) with six to eight key stakeholders associated with alcohol-related healthcare provision in prisons will be conducted to explore views on barriers, facilitators and levers to ABI delivery. Stage 3: through formal intervention mapping, the analysed data will inform the refinement of an acceptable ABI that is feasible to deliver to male remand prisoners. Ethics and dissemination The project has been approved by the National Research Ethics Committee (NRES), National Offender Management System, Health Board Research and Development, Scottish Prison Service and ethics committee at The University of Edinburgh. Results will be published in peer-reviewed journals and presented at local, national and international conferences.

Climbing down the steps from the ivory tower: how UK academics and criminal justice practitioners need to work together on alcohol studies

Purpose Evidence in the UK tells us that risky drinking is high amongst those in contact with the criminal justice system. The purpose of this paper is to explore the reasons why carrying out research around risky drinking in this setting is so difficult. Design/methodology/approach A commentary on the issues of carrying out research in the criminal justice setting. Findings There are issues of carrying out research in the criminal justice setting. The authors argue, that as academics we can be more proactive in working with practitioners in the design and carrying out of studies. By examining what the primary outcome of interest is to those that work in the field rather than what funding agencies tell us academics must use, academics may engage in a more co-productive way that enables everyone to achieve what they need. Moreover more work is needed to show how this approach can be achieved both in the UK and internationally. Originality/value This editorial explores some of the difficulties of carrying out alcohol research in the criminal justice system and postulates ways that this could be made easier.

Cue acquisition: A feature of Malawian midwives decision making process to support normality during the first stage of labour

OBJECTIVEnto explore Malawian midwives decision making when caring for women during the first stage of labour in the hospital setting.nnnDESIGN AND METHODSnthis focused ethnographic study examined the decision making process of 9 nurse-midwives with varying years of clinical experience in the real world setting of an urban and semi urban hospital from October 2013 to May 2014.This was done using 27 participant observations and 27 post-observation in-depth interviews over a period of six months. Qualitative data analysis software, NVivo 10, was used to assist with data management for the analysis. All data was analysed using the principle of theme and category formation.nnnFINDINGSnanalysis revealed a six-stage process of decision making that include a baseline for labour, deciding to admit a woman to labour ward, ascertaining the normal physiological progress of labour, supporting the normal physiological progress of labour, embracing uncertainty: the midwives construction of unusual labour as normal, dealing with uncertainty and deciding to intervene in unusual labour. This six-stage process of decision making is conceptualised as the role of cue acquisition, illustrating the ways in which midwives utilise their assessment of labouring women to reason and make decisions on how to care for them in labour. Cue acquisition involved the midwives piecing together segments of information they obtained from the women to formulate an understanding of the womans birthing progress and inform the midwives decision making process. This understanding of cue acquisition by midwives is significant for supporting safe care in the labour setting. When there was uncertainty in a womans progress of labour, midwives used deductive reasoning, for example, by cross-checking and analysing the information obtained during the span of labour. Supporting normal labour physiological processes was identified as an underlying principle that shaped the midwives clinical judgement and decision making when they cared for women in labour.nnnKEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICEnthe significance of this study is in the new understanding and insight into the process of midwifery decision making. Whilst the approach to decision making by the midwives requires further testing and refinement in order to explore implications for practice, the findings here provide new conceptual and practical clarity of midwifery decision making. The work contributes to the identified lack of knowledge of how midwives working clinically, in the real world setting. These findings therefore, contribute to this body of knowledge with regards to our understanding of decision making of midwives.

A systematic review of the efficacy of alcohol interventions for incarcerated people

AimnThe aim of this current study was to systematically review the literature on brief alcohol interventions for incarcerated individuals to ascertain the efficacy or effectiveness in making changes to either consumption of alcohol or other social outcomes.nnnShort summarynLevels of risky drinking and dependency are high amongst incarcerated individuals. Eleven studies from nine articles were included in the systematic review. Six of the studies included brief intervention and three extended interventions. Interventions have the potential to positively impact on risky drinking. More studies are needed in this setting.nnnIntroductionnIt has been shown that around three times as many incarcerated individuals are risky drinkers and alcohol dependency is ten times higher than in the general population.nnnMethodsnSystematic review of randomised controlled trials or matched group trials of the efficacy of psychosocial alcohol interventions for incarcerated individuals: we searched seven databases, with no restrictions on language, year or location from inception through to August 2017. The Critical Appraisal Skills Programme tool was used to assess the quality of included studies. The Template for Intervention Description and Replication checklist was used to ascertain intervention descriptions.nnnResultsnNine studies from 11 papers were included in the analysis. Six of the studies included brief interventions and three extended interventions. Every study used a different measure of alcohol consumption. Three of the studies that looked at brief interventions and all of the three extended intervention studies found significant reductions in relation to alcohol outcomes.nnnConclusionsnResults show that interventions in the prison setting have the potential to positively impact on alcohol use; however, because of small numbers and the use of different outcome measures we could not conduct a meta-analysis or generalise findings. Future studies are needed to standardise approaches to ensure greater rigour and efficacy.