Dirk M. van der Wal

Mystical Experience in the Context of Health Care

Eighteen participants in a rural Appalachian community were interviewed to learn about their mystical experiences in the context of health care. Semistructured interviews addressed factors initiating mystical experience and essential qualities of mystical experience. Nursing process and the nurses response were examined. Data were analyzed using the immersion/crystallization method and concept mapping. Mystical experience was conceptualized as a process incorporating initiation, occurrence, maturation, and integration of mystical experience. Essential qualities included sensory–motor perception, interaction with the supernatural, interaction with family members, conviction of reality, cognition, dynamic tension and emotional intensity. Nursing interventions included listening and support. Subjective nursing responses included tension, intimacy and empathy, sense of awe, autonomic responses, and appreciation of the mystical in everyday life. Various stressors are associated with mystical experience. Patients having mystical experiences may benefit from nursing support.

Health-related quality of life of antiretroviral treatment defaulters in Botswana.

Background Antiretroviral therapy (ART) improves patients’ health-related quality of life (HRQoL). Defaulting from ART has detrimental consequences, including the development of viral resistance, treatment failure and increased risks of disease progression. Little is known about the quality of life of ART defaulters and reasons for discontinuing their ART. Objectives This study sought to measure the HRQoL of ART patients in Botswana who were on ART for up to 5 years but had discontinued treatment for at least 3 months, and to identify factors associated with ART defaulting. Method We conducted a cross-sectional study with 104 eligible respondents in four ART clinics in south eastern Botswana. We assessed respondents’ HRQoL using the World Health Organization Quality of Life Questionnaire for HIV short form. Clinical information was obtained from respondents’ medical records. Data were analysed using SAS version 9.2. Results Reasons for discontinuing ART were inaccessible clinics (22.4%), feeling better (21.4%), running out of pills (11.2%), depression (8.2%), lack of care and/or support (8.2%), failure to understand instructions (7.7%), medications’ side effects (6.1%) and alcohol abuse (3.1%). In multivariate analyses, respondents aged 36–45 years had a 0.03 lower independence HRQoL score compared to those aged 35 and younger (β = -0.03; 95% confidence interval: -1.72, -1.66). Despite defaulting from their ART, respondents’ calculated HRQoL scores were moderate. Conclusion This study highlights the need to enhance ART adherence in order to improve the HRQoL of people living with HIV and/or AIDS.

Using appreciative inquiry to transform student nurses' image of nursing.

Introduction Literature provides adequate evidence of a poor perception of nursing within the profession, resulting in high rates of attrition of student nurses and newly qualified nurses. The nursing profession, in particular nurse educators, has an ethical and professional responsibility to find innovative strategies to promote the positive image of nursing amongst student nurses. Purpose The purpose of the study was to explore the potential of appreciative inquiry (AI) as an intervention teaching strategy to transform student nurses’ image of nursing. Design A quantitative, quasi-experimental, explorative-descriptive design comprising the pretest, appreciative inquiry as intervention, and the post-test was used. Methods Convenience sampling was used to select third and fourth year college and university student nurses in the Gauteng province of South Africa for the pre- and the post-test respectively. Data were collected by means of a questionnaire and analysed by SPSS version 20.0. Findings The pretest results revealed a mix of positive and negative perceptions of the image of nursing amongst student nurses. The negative perceptions of the image of nursing that needed intervention included the working conditions of nurses, and the perception of nursing as a profession that was not respected and appreciated. The post-test results showed a significant and positive change in the student nurses’ perception of the image of nursing as a respected and appreciated profession. Although AI resulted in a negative to positive change in some aspects of student nurses’ image of nursing, the negative perceptions of the working conditions of nurses remained and became more negative. The positive image of gender in nursing was enhanced following the implementation of AI. Conclusion Appreciative inquiry demonstrated potential as a teaching strategy to produce a positive nursing image change and positive orientation towards nursing amongst student nurses.

Child Vulnerability in the Iraqw and Datoga Ethnic Groups of a Village in Northern Tanzania

Purpose: The purpose of this study was to analyze the concept of child vulnerability as perceived by Iraqw and Datoga peoples in northern Tanzania. Design: A mixed methods design was used, which included semistructured interviews (n = 32) and a questionnaire (n = 80) administered to members of the two ethnic groups. Findings: Five main themes emerged: (a) lack of resources, (b) intentional mistreatment, (c) deprivations (d) losses suffered, and (e) dealing with deprivation. Conclusions: The literature describes child vulnerability in terms of deprivation in an individual younger than 18 years. The following four issues were also identified as being of special local significance: (a) discrimination against handicapped, illegitimate, and foster children; (b) the child is viewed as a resource rather than an individual with rights, (c) unrelated fostering is unusual, and (d) few strategies are known to study participants. Implications for practice: Community development and children’s rights need attention, particularly for disabled and illegitimate children. The most vulnerable children can be identified using existing mechanisms, assistance may be channeled through the mother, and unrelated fostering and volunteer involvement can be encouraged.

Nurses Perceptions about Reasons for Womenâs Non-utilisation of CervicalCancer Screening Services in Malawi

Malawi offers free cervical cancer screening services in some government health institutions, but most cervical cancer cases are diagnosed during the late inoperable stages. This study attempted to identify, from nurse/midwives’ perspectives, reasons why most Malawian women fail to use cervical cancer screening services. A cross-sectional, exploratory, descriptive design was used and semi-structured interviews were conducted to collect data from the nurses. Purposively selected 14 nurse/midwives were interviewed. Malawian women’s non-utilisation of cervical cancer screening services was reportedly influenced by a shortage of nurse/midwives, inadequate health education, limited resources, unfavourable screening schedules, and geographic distances from these services. These identified factors need to be addressed to enable more women to use the available free cervical cancer screening services in Malawi, so that cervical cancer can get diagnosed during the early stages while effective treatment is available. Unless this happens, most cases of cervical cancer in Malawi will continue to be diagnosed during the terminal inoperable stages of cervical cancer.