Sustaining hope: A narrative inquiry study exploring midwives' hope-focused practices in HIV care in Ghana.

HIV remains a statistically significant issue for women of childbearing age in Ghana. Nurses and midwives form the backbone of care providers for the prevention of mother-to-child transmission programmes. However, nurses and midwives receive little support to provide the emotional aspects of HIV/AIDS care. AIM: Our aim was to build an understanding of how midwives currently embrace their experience of hope and hoping to support mothers living with HIV. DESIGN: This is narrative inquiry study. METHODS: We engaged in two to three conversations with five midwives in rural settings in Ghana to understand their experiences of hope and hoping in their interactions with mothers living with HIV. Using the narrative inquiry common places of temporality, the social and personal, and space/place, we wrote narrative accounts for each participant and then searched for resonances across the narrative accounts. RESULTS: We highlight three emerging narrative threads that resonated across narrative accounts. The three emerging narrative threads were (1) sustaining hope by drawing on life experiences across time and place; (2) hope is sustained through a focus on relational engagement with mothers; (3) midwives embrace the possibility to learn more about hope-focused practices. CONCLUSION: The midwives began, although tentatively, to shine light on the things and events that diminished their abilities to maintain a hopeful perspective. At the same time, they became more comfortable and familiar with the notion of making hope visible and accessible in their experiences. IMPACT: Since the midwives welcomed additional support to cope with the challenges they were experiencing, we imagine one day being able to make sense of how nurses and midwives engage with a narrative pedagogy of hope. Including hope-focused practices in nursing and midwifery preservice and in-service opportunities is important. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or public involvement in this study.

Narrative Inquiry into the Professional Identity-Making of Ghanaian Midwives.

Professional identity-making is a complex life-making endeavor that is shaped by both the personal and professional knowledge landscapes in which people live and work. Using narrative inquiry, four midwives who had worked in diverse contexts in Ghana were purposively selected. We highlight how midwives' experiences across time, place, and in diverse contexts shape their professional identity-making. Three main life experiences that shape professional identity-making were discovered: 1. Childhood experiences, 2. Education experiences, and 3. Professional work experiences. Midwifery education should prepare students to attend to this complex and ongoing identity development, in order to enhance midwifery practice.

Family-Based Index testing for HIV; a qualitative study of acceptance, barriers/challenges and facilitators among clients in Cape Coast, Ghana.

Family-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counselling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholder engagement is key in identifying and addressing barriers to implementation. This study explored acceptance, barriers/challenges and facilitators of FBIT. Seventeen in-depth qualitative interviews were conducted among clients who had been offered FBIT at the Cape Coast Teaching Hospital using a semi-structured interview guide. Data were analysed using Braun and Clarke's [(2006)] thematic analysis framework and found that (1) participants accepted the strategy and were willing to use it; (2) lack of awareness of the strategy among the general public, fear of disclosure/stigmatization, issues with confidentiality and privacy are barriers/challenges associated with the FBIT approach, and (3) increasing public education on HIV in general and FBIT in particular, ensuring confidentiality and privacy regarding testing are facilitators for increasing uptake of FBIT. It is concluded that despite acceptance of FBIT as a good strategy among index clients, general HIV education to reduce stigma and addressing confidentiality can optimize uptake.

Experience of Registered Nurses of Postoperative Pain Assessment Using Objective Measures among Children at Effia Nkwanta Regional Hospital in Ghana.

Introduction: People undergoing surgical operations experience some level of pain. Assessing pain intensity is one of the duties of the nurse and it involves subjective measures (self-report), and objective measures (behavioural and physiological). It has been observed by the researcher that nurses in clinical practice do not assess pain before management more so among children. Also, there is limited research in the area of pain assessment in children who cannot communicate. This study aimed to describe the experiences of registered nurses in assessing postoperative pain among children (0-3 years) using objective measures. Methods: Descriptive phenomenology was the chosen design. Maximum variation sampling was used to recruit nine registered nurses with experience in nursing children after surgery at Effia Nkwanta Regional Hospital (ENRH) in Ghana. The researchers conducted audio-recorded in-depth interviews, transcribed verbatim and qualitatively analyzed following Colaizzi's approach to descriptive phenomenology analysis. Results: The study revealed that the nurses have more experience with using behavioural measures with limited experience with the use of physiological measures. The behavioural measures mostly reported from their experience were changes in facial expression and unusual crying of the child. In general, the nurses do not formally use consistent approaches to assess pain among children. Conclusion: Given these results, opportunities should be made available for nurses to enhance their skills and utilize evidence-based approaches to formally assess pain among post-operative children.