The use of PHC clinic-based women's groups for financial empowerment in a rural area

The article is based on a four-year project during which Primary Health Care (PHC) nurses worked with women's groups in their areas. The aim of the study was to explore the involvement of PHC nurses in economic empowerment, both in terms of health promotion and in terms of the PHC approach. In particular the objectives were to establish whether nurses could lead economic empowerment groups, whether such groups could establish adequate external links and become financially viable. Eleven groups were used as case studies, and a cross-case analysis was done in terms of the three objectives. It was found that between the women and the nurses, adequate leadership existed for the groups to function well. Very limited external linkages were established, notwithstanding efforts in this regard. Nine out of 11 groups contributed to financial welfare of their members after 18 months, but a range of problems with regard to financial viability are identified.     

The knowledge and attitudes of traditional birth attendants towards HIV/AIDS and their beliefs related to perinatal care: a study conducted in KwaZulu Natal

Traditional birth attendants (TBAs) are still mainly being utilized in the rural areas even in the presence of the formal health care facilities. Studies reveal that the utilization of TBAs is beneficial in some other contexts with some support and supervision from the western health sector. In order to develop further training for TBAs the researchers deemed it necessary to assess their knowledge, attitudes and beliefs related to HIV/AIDS, prenatal care, delivery and postnatal care. This was a survey of an identified group of TBAs who had already received some training and were currently practicing in the catchment areas. Five Primary health care (PHC) clinics from Abaqulusi sub-district in Zululand Health District, Kwa-Zulu Natal Province, were selected as sites for the focus groups. A total of 57 TBAs participated in focus groups and completed a questionnaire. The HIV/AIDS knowledge questionnaire consisted of 16 questions about transmission, symptoms, course of the disease and its risk factors. An assessment tool was used to assess attitudes, beliefs and practice in relation to pregnancy, delivery and postnatal care. The results of this study demonstrated that the TBAs have a good knowledge of what they are doing.     

A public health nursing initiative to promote antenatal health

At least one in 10 pregnant women experiences depression. Other health risks during pregnancy include family violence, substance abuse, inadequate nutrition, financial challenges, environmental hazards and lack of social support. Public health nurses are in a unique position to enhance perinatal health by assessing for antenatal psychosocial risk factors. During 2005-06 in a suburban/rural community near Edmonton, Alberta, public health nurses initiated a one-year demonstration project with the goal of increasing the number of health and community services accessed by pregnant women as a result of an interactive appointment with a public health nurse. Eight family physicians in WestView Primary Care Network and three midwives from WestView's Shared Care Maternity Program referred local pregnant clients to the public health nursing unit at WestView Health Centre in Stony Plain. Each woman was assessed by a public health nurse for a variety of psychosocial risk factors. Results of the assessment determined the type of additional health services to which the pregnant women were referred. Care providers were unanimous in their support for public health nurses' continuing to provide antenatal assessments to an expanded population of suburban/rural communities in the Capital Health region.     

The KwaZulu-Natal Health Promotion Model

PURPOSE: To describe a health promotion model aimed at assisting primary health care nurses to incorporate health promotion into their practice. ORGANIZING STRUCTURE: The model is based on empowering people through a systematic, planned, needs-driven curriculum with comprehensive content, using interactive teaching in small groups, and linking the groups with external resources. The process involves identifying and engaging partners, planning the project, implementing it, and then disengaging. METHODS: The implementation of this model in a province of South Africa, KwaZulu-Natal, in a collaborative project involving two universities and the state health services, changed the practice of the primary health care nurses involved. They worked with women's groups over 3 years and changed both their own perspectives and the lives of the women. CONCLUSIONS: Unless nurses have an implementation model available to them, they frequently focus only on illness needs of people and do not participate in health promotion.     

An assessment of the implementation of the provincial cervical screening programme in selected Primary Health Care Clinics in the Ilembe Region, KwaZulu-Natal

Cervical cancer is almost completely preventable, yet it is the second most prevalent cancer amongst women in South Africa. KwaZulu-Natal (KZN) in particular has a high mortality rate of cervical cancer and 1: 40 women die from cancer of the cervix. Therefore, in 1997 a cervical screening policy and programme was implemented in the province. The purpose of the study was to evaluate the implementation of selected aspects of the Provincial cervical screening programme in selected Primary Health Care (PHC) clinics in Ilembe Region, KZN. Results indicated that there was a lack of resources needed for implementing the programme in rural clinics compared to urban clinics. However, all clinics in the study had an adequate supply of the drugs needed for the treatment of abnormal smears. On reviewing the records, the researcher noted that most of the results indicated that smears had adequate cells needed for analysis. However, the results indicated that there was a problem with follow-up of clients with abnormal smears. Feedback to the clinics from the referral hospital regarding the outcome of the visit was inadequate. The results indicated that the mechanisms of record keeping were inadequate. Therefore, the above results indicate that problems exist at the selected PHC clinics that may result in ineffective implementation of the cervical screening programme.     

Management of chronic illness: voices of rural women

BACKGROUND: The prevalence and cost of chronic illness globally and in the United States of America continue to escalate and the day-to-day management of these conditions presents a major challenge. The burden of chronic illness disproportionately affects vulnerable populations such as women and those living in rural areas. AIM: To add to the knowledge base of illness management by chronically ill rural women through examining their individual perceptions of the illness experience. METHOD: The Women to Women project provided a nursing research-based computer intervention model for conducting support groups, providing health education, and fostering self-care, via personal computers and evaluated its effect on the women's psychosocial health. FINDINGS: Fatigue and pain were the major physical symptoms that impacted the women's quality of life, with depression and stress being the primary emotions they experienced. The characteristics of humour, hope, and courage were key in their successful adaptation to living with chronic illness. CONCLUSIONS: The women's voices relate how they manage their illness responses and adaptation mechanisms. The data provide nurses with information to heighten their sensitivity to clients' day-to-day needs and experiences. It will assist them in their designing and planning of interventions that will enable clients to adapt and to have the best quality of life possible within the limitations of their chronic illnesses. The data are also important to nurses involved in rural research and theory development concerning self-management and adaptation to chronic illnesses.     

A new role for nurses as Primary Care Cancer Lead Clinicians in Primary Care Trusts in England

AIM: The aim of this study was to evaluate the Primary Care Cancer Lead Clinician initiative in England. One of the objectives was to examine the impact of the Primary Care Cancer Lead Clinicians' clinical background on how they perform their role. This study compares nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. BACKGROUND: The Primary Care Cancer Lead Clinician initiative developed from the National Health Service Cancer Plan. Primary Care Cancer Lead Clinicians are expected to work strategically to raise the standards of cancer care within primary care. METHODS: A postal questionnaire survey was sent to Primary Care Cancer Lead Clinicians and one manager in each Primary Care Trust in England. Telephonic interviews were also undertaken with a range of stakeholders in six case study areas. RESULTS: There were striking similarities between nurses and General Practitioners in the Primary Care Cancer Lead Clinician role. Differences related to the wider roles of the two groups. Nurses placed greater emphasis on fitting in whereas General Practitioners were more likely to expect to take charge and look for administrative support. CONCLUSIONS: There is evidence to show that whether the Primary Care Cancer Lead Clinician was a nurse or a General Practitioner was less important than having local credibility and the support of their Primary Care Trust.     

An evaluation of an online intervention to provide social support and health education

Managing chronic illness in the isolation of rural environments is challenging for women who lack access to personal sources of social support and health information. The Women to Women project was designed to provide chronically ill rural women access to support and health information via electronic means. This article reports on the acquisition of computer skills, the perceptions of importance of various aspects of the intervention, and an assessment of women's overall satisfaction with participation in the research project. Findings indicate that the women's self-ratings of computer skills improved significantly over the 22-week intervention and that highly interactive features of the project were rated as most important by the participants. Overall, women found the program beneficial in assisting them to better manage their chronic illness.     

Women's patterns of provider use across the lifespan and satisfaction with primary care coordination and comprehensiveness

BACKGROUND: Women have different patterns of provider use across the lifespan, but few studies have investigated women's evaluations of their primary care providers at different ages. OBJECTIVE: We sought to investigate the relationship between patterns of regular provider use and women's satisfaction with primary care across the lifespan. RESEARCH DESIGN: A sample of 1197 women ages 18 to 87 making primary health care visits was surveyed. Satisfaction with primary care in the past year was measured with a subscale the Care Coordination and Comprehensiveness subscale of the Primary Care Satisfaction Survey for Women (PCSSW). Bivariate comparisons and age stratified multivariate ordinal logistic regression models were estimated. RESULTS: Women in their early reproductive years (ages 18 to 34) are more satisfied with care coordination and comprehensiveness when their regular provider is a reproductive health specialist, primarily obstetrician gynecologist (ob/gyn) physicians. The odds of higher satisfaction are reduced with a generalist regular provider (OR = 0.38, P < 0.01), a generalist regular provider plus an ob/gyn (OR = 0.47, P < 0.05), or no regular provider (OR = 0.52, P < 0.05). The pattern of regular provider use is not significantly associated with satisfaction for women in other age categories. CONCLUSIONS: Most adult women see generalists for their primary health care, either alone or in combination with ob/gyns. Among younger women satisfaction is higher when an ob/gyn is the regular provider. Further research must consider women's perspectives on their provider use patterns and the appropriate role of ob/gyns in women's primary care across the lifespan.     

Connecting Chronically Ill,Uninsured Patients Who Use the Emergency Department as a Medical Home: A Process Improvement Project

IntroductionThe use of the emergency department by uninsured patients with chronic health problems may adversely affect those patients’ health outcomes. Successful interventions have involved the use of patient navigators to connect the uninsured adult population with medical coverage and a medical home. The aim of this project was to use principles of patient navigation in a nurse-led process improvement intervention to connect uninsured patients to medical homes.MethodED nurses were trained to refer uninsured patients with chronic health problems to care coordinators when they were discharged from emergency departments. The care coordinator was provided by the Health Care District, a community-funded medical department. Patients were therefore connected to community-funded medical homes.ResultsED nurses improved their knowledge about the overuse of the emergency department and successfully referred uninsured patients who were discharged. The referred patients successfully made contact with members of the Health Care District by phone or by attending their appointments.ConclusionThe role of patient navigators is essential in the emergency department. They assist patients to navigate through the various health care resources available in their communities, which can help to reduce ED overuse.     

A feasibility study of part time day and evening classes in the Nursing Science Department of the University of Zululand

The study determines the practising professional nurses including those in the nursing colleges who would enroll if part time studies were introduced at the University of Zululand in 1991. Questionnaires were sent to various institutions in KwaZulu-Natal. Four hundred and fourty eight (448) nurses responded positively to the questionnaire which was an indication that if such studies were introduced many nurses would enroll. The study reveals the enthusiasm and action taken by a nurse who is working and attending classes part time.     

Gender-related concerns of rural women with severe and persistent mental illnesses

This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI.     

Women''s Health and the Practice of Public Health Nurses in Northern British Columbia

This study explored women's health and the practice of public health nurses in northern British Columbia using a phenomenological methodology. Ten public health nurses in northern British Columbia were interviewed to determine their perspectives on their practice in the area of women's health. Findings reveal three central themes: women's health, public health nursing practice, and rural context. Several subthemes elaborate on the central themes. Women's health is described in terms of women's health needs, how women stay healthy in northern communities, and conditions that affect women's health. Public health nursing practice is described in terms of activities, strengths, conditions, and ways to strengthen practice. Definitions of rural context are provided and some of the benefits and challenges of living and working in northern communities are presented. Health promotion and illness and injury prevention needs of women are clearly evident in the findings. Public health nurses are well placed in the North to help women meet their health care needs. However, further attention to women's health needs and the expansion of public health nursing services would facilitate improved health for women who live in isolated northern settings. In addition, further research is needed to explicate women's health and public health nursing practice in isolated northern settings in Canada.     

Living with breast cancer: the influence of rurality on women's suffering and resilience. a postmodern feminist inquiry.

This paper focuses on rural living as a dimension of women's experiences of living through breast cancer. The findings presented emanate from a feminist narrative research project that examined the experiences of rural women from south-west Queensland who were long-term survivors of breast cancer. This project aimed to listen, report and interpret rural women's stories of resilience in surviving breast cancer and moving on with their lives. The participants reported that there were both positive and negative aspects of living in a rural setting, especially when ill. Eight of the nine participants, however, felt strongly that the positive aspects of rural living outweighed the difficulties. This suggests that rurality in the context of health and illness must be considered as a multifaceted dimension, with resources to support cancer survivors building on the existing strengths in rural communities.     

An exploration of rural women's knowledge of heart disease and the association with lifestyle behaviours

Heart disease is the leading cause of morbidity and mortality in Australian women. The purpose of the study was to investigate Australian rural women's knowledge of heart disease and the association with lifestyle behaviours. A questionnaire was developed to collect data on rural women's knowledge and risk of heart disease. Despite having an overall good knowledge of heart disease, there was an identified lack of health promoting behaviours by the women to reflect their knowledge. Over half of the women participants of this study reported two or more lifestyle risk factors for heart disease. This study shows that women might know about heart disease risk factors, nevertheless they might be unaware of their susceptibility to heart disease in relation to the risk factors. Without an awareness of personal susceptibility, women might be less likely to take action to reduce the risk of heart disease.     

Nurses, nursing and women

WHO's project on women as providers of health care, in which many countries, agencies and individuals have been involved in various capacities, has given birth to a book entitled "Women as Providers of Health Care". While presenting an objective picture of the situation of women who dispense health care--formally or informally, within the family and community--around the world, the book tries to stimulate thought on the subject of women's contribution to health and how it can be enhanced. The chapter on "Nursing and the condition of women", condensed below, identifies some of the major issues hindering nursing education and practice. It is intended to lead to a better and broader understanding of the problems faced by women as health care providers.     

Folklore linked to pregnancy and birth in Nigeria

As a part of a safe motherhood project implemented in eastern Nigeria between 1992 and 1996, in-house interviews were conducted with rural women and traditional birth attendants in the seven states of eastern Nigeria. The overall project was designed to contribute toward the reduction of maternal mortality and morbidity through the involvement of community leaders and women's organizations in women's health activities in rural Nigeria. It also focused on identifying and addressing some of the underlying cultural factors in maternal mortality and morbidity in Nigeria. Findings from the interview show that women in rural eastern Nigeria still hold many folklore beliefs about pregnancy and childbirth, and some of these beliefs lead to delay in the referral of complications to hospitals.     

Career ladders: an important element in CNA retention. Certificate nursing assistant

In August 1999, a consortium of individuals joined to develop and evaluate a career ladder for certified nursing assistants in Boston. The consortium consisted of representatives from Benjamin Health Care Center, Massachusetts Extended Care Federation, and Boston Private Industry Council. Funded by a Department of Labor grant, the project was implemented to evaluate the effects on turnover and retention when opportunities for career development are provided. The population first studied was a group of men and women interested in ending their dependence on the welfare system and seeking full-time employment in long-term care. As part of the project, the curriculum was first piloted at Benjamin Health Care Center and tested in 10 long-term care centers across Massachusetts. A curriculum evaluation demonstrates positive outcomes.     

Carers' health clinic initiative in Edinburgh: pilot evaluation

Unpaid carers see the Primary Health Care Team as an important source of help, information and support. A pilot Carers' Health Clinic to address the health needs of carers was set up in South West Edinburgh. The Clinic offered carers an assessment of their own health needs and information on a range of support services available to them including referral to a stress management therapist, if appropriate. Although physical health problems identified were mainly minor, the clinic findings indicate that many carers experienced emotional costs which they perceived to have an impact on their health. The Carers' Health Clinic pilot was a successful model, targeting carers who had not previously been in touch with carer support organizations and improving the awareness of carers of their own health needs.