Raisa Gul

An International Survey on Advanced Practice Nursing Education, Practice, and Regulation

PURPOSE To describe international trends on the developing role of the nurse practitioner-advanced practice nurse (NP-APN), including nomenclature, levels and types of NP-APN education, practice settings, scope of practice, regulatory policies, and political environment. DESIGN A cross-sectional, descriptive Web-based survey sent in February and March 2008 to a total of 174 key informants and active members of the International Nurse Practitioner-Advanced Practice Nursing Network of the International Council of Nurses. METHODS An international Web-based survey preceded by a pilot survey. FINDINGS Ninety-one nurses from 32 countries responded. Thirteen titles were identified on nomenclature for the NP-APN in different countries. NP-APN education was available in 71% of the 31 countries responding to this item, with 50% identifying the masters degree as the most prevalent credential. Twenty-three countries had formal recognition of the NP-APN role. Of these, 48% had licensure maintenance or renewal requirements for the NP-APN, with most requiring continuing education or clinical practice. The greatest support for the NP-APN role came from domestic nursing organizations (92%), individual nurses (70%), and the government (68%), while opposition came primarily from domestic physician organizations (83%) and individual physicians (67%). CONCLUSIONS Interest in the NP-APN role has been gaining ground worldwide. This study presents a snapshot of education, practice, and regulation for NP-APNs as they develop their unique role in delivering health care in various countries. Areas that may require more support are highlighted. CLINICAL RELEVANCE The NP-APN role in healthcare systems is expanding and will benefit from international networking and support.

Concept mapping: A strategy for teaching and evaluation in nursing education

In the past decade an increasing emphasis has been placed on the importance of critical thinking in nursing. Nurse educators are faced with the challenge of finding ways to promote and evaluate critical thinking in nursing students, and various teaching strategies have been identified to achieve this goal. Concept maps are considered a powerful metacognitive tool that can facilitate the acquisition of knowledge through meaningful learning. Hence concept mapping can be used to promote and evaluate critical thinking. Based on the published nursing literature, the scope of concept mapping is discussed in this paper as a teaching and evaluation strategy for critical thinking in nursing education.

Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study

Background Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on womens and mens life prospects. Objective The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence mens and womens life circumstances. Design Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve womens subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting womens empowerment.

Enhancing Educators' Skills for Promoting Critical Thinking in Their Classroom Discourses: A Randomized Control Trial

The literature reveals that educators find it challenging to foster critical thinking (CT) in their students if they have not learned how to use CT in their educational system or training. This paper reports findings from a national research project that was undertaken to enhance the educators’ ability to promote CT in their teaching practices. Using a randomized control trial design with a preand post-test, 91 educators from 14 of the 17 schools of nursing in Pakistan consented to enroll in the study and 72 completed the study. The intervention included 40 hours of learning experience during two workshops that focused on CT. Data were collected, preand post-intervention, via observations and audiotaping of the participants teaching sessions for 60-90 minutes. The data obtained was assessed for the educators’ level of questioning, teaching strategies, and facilitation skills. Data were analyzed using descriptive and inferential statistics. Compared with the preintervention data, findings from the post-intervention data in the experimental group revealed positive changes in their pedagogical skills, including a significant increase in the number of higher order questions that are considered important for developing students’ CT skills. This study affirms that educators must have structured training to use and foster CT in their teaching practices.

Experiences and perceptions of patients living with hepatitis C in Karachi, Pakistan.

Purpose: Hepatitis C (HCV) is a chronic disease that affects an individual’s physical, financial, social, and emotional well-being throughout the illness. Although extensive literature is available on experiences of patients with hepatitis C in developed countries, very little exists in developing countries, particularly in Pakistan. This article describes experiences of patients living with HCV in Karachi, Pakistan. Method: Using descriptive exploratory design, data were collected through semistructured interviews from 10 patients with HCV. The interviews were tape recorded and transcribed verbatim. Findings: The three categories—perceptions and misperceptions, challenges and sufferings, support and shortcomings—were subsumed under the theme “deadly, dangerous, and devastating.” Conclusion and implications for practice: Patients with HCV experience profound challenges that are influenced by their level of education, financial capacity, cultural norms, family support, and the sensitivity of health care professionals. Several cultural practices existing in Pakistan identify the need for public awareness. The findings on health care professionals have implications for nursing and allied health continuing education.

Strengths and Challenges of the First Prelicensure Baccalaureate of Science in Nursing Program in Pakistan

With the increasing complexities of health care and the associated strong advocacy for baccalaureate of science in nursing (BScN) program as entry to practice in the developing countries, gradually, nurse leaders are moving in that direction. Although extensive information is available in the literature about the outcomes of prelicensure BScN programs in developed countries, little is known about the outcomes of such programs in developing countries. In this article, we report strengths and challenges of the first prelicensure BScN program in Pakistan. Using a focused ethnographic approach, data for this study were collected mainly through semistructured interviews of the graduates from the first five cohorts of the BScN program and their supervisors at Aga Khan University, Pakistan. Interviews were tape-recorded, transcribed verbatim, and content analyzed for explicit and implicit patterns of themes, meanings, and understanding about the program. Findings of this study affirmed the worth of BScN program for preparing competent nurses that can contribute to the development of nursing in Pakistan. However, various contextual issues and challenges in the nurses work environment have affected the utilization and retention of these graduates and hence the perceived outcome of the program.

Integration of mental health into primary healthcare: perceptions of stakeholders in Pakistan

Background In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). Objectives This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan.

Experiences of the Breast Cancer Patients Undergoing Radiotherapy at a Public Hospital Peshawar Pakistan

Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan. Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually. Results: Four main categories emerged from data analysis, which were: feelings and perceptions of the patients, their challenges, coping strategies, and teaching and informational needs. Conclusions: Women undergoing RT in this culture experience more intense psychological effects, as compared to the physical effects. Keeping in mind, the magnitude of the emotional stress experienced by the participants, recommendations for policy reforms, and training for female RT staff are suggested based on findings of this research.

Facilitators and Deterrents of Critical Thinking in Classrooms: a Multidisciplinary Perspective in Higher Education in Karachi, Pakistan

The paper presents the perceptions of educators from nursing, medicine and education discipline about the facilitators and deterrents of critical thinking (CT) in higher education in Karachi, Pakistan. Using a qualitative descriptive exploratory design, 12 university educators from three disciplines were recruited as study participants using purposive sampling. Data was collected through semi structured interviews and manually analyzed for themes and categories. Findings related to the theme of facilitators and deterrents of CT are presented in this paper. Study participants identified a variety of key factors related to teacher competence, nature of students, learning environment, and organizational ethos and resources that influence the implementation and promotion of CT in higher education.

Co-supervision of doctoral students: enhancing the learning experience

Abstract The purpose of this paper is to examine the advantages and challenges of co-supervision of doctoral students, as found in the literature and from our experiences. We define co-supervision and then discuss the process in detail. Examples are based on experiences of co-supervision from faculty perspectives as well as from the point of view of a former doctoral student. We propose that the advantages of co-supervision far outweigh the challenges and should be regularly considered by seasoned academics to enhance student learning. In addition, we suggest that co-supervision is intellectually stimulating for academics.