Providing Palliative Care in Rural Nepal: Perceptions of Mid-Level Health Workers.

INTRODUCTION: Nepal is beginning to develop palliative care services across the country. Most people live in rural areas, where the Mid-Level Health Workers (MHWs) are the major service providers. Their views on providing palliative care are most important in determining how the service is organized and developed. AIM: This study aims to ascertain the perceptions of MHWs about palliative care in their local community, to inform service development. METHODS: A qualitative descriptive design, using focus group discussions, was used to collect data from a rural district of Makwanpur, 1 of the 75 districts of Nepal. Twenty-eight MHWs participated in four focus group discussions. The data were analyzed using content analysis. RESULT: Four themes emerged from the discussion: (i) suffering of patients and families inflicted by life-threatening illness, (ii) helplessness and frustration felt when caring for such patients, (iii) sociocultural issues at the end of life, and (iv) improving care for patients with palliative care needs. CONCLUSION: MHWs practicing in rural areas reported the suffering of patients inflicted with life-limiting illness and their family due to poverty, poor access, lack of resources, social discrimination, and lack of knowledge and skills of the health workers. While there are clear frustrations with the limited resources, there is a willingness to learn among the health workers and provide care in the community.

Sailing against the tide: Taiwanese women's journey from pregnancy loss to motherhood.

PURPOSE: To understand the experiences of Asian women in Taiwan who are adjusting to motherhood following previous pregnancy loss. STUDY DESIGN AND METHODS: Phenomenology was used as the study design, and interviews were used to collect data in a medical center in Northern Taiwan with six women who had given birth to a healthy baby after previous pregnancy loss. Following ethical approval, interviews were audio-recorded, transcribed, and analyzed to develop data themes. RESULTS: The nautical metaphor was chosen because of the fact that Taiwan is an island and surround by sea. The sea has deep cultural meaning of uncertainty in life for the Taiwanese people. A metaphor of "sailing against the tide" emerged from the data to depict three stages of the women's journey: remembering the previous journey of loss; the rising sun brings new life within; and changing tide brings new birth. The essence of their journey through the pregnancy and birth was a permutation of fear, uncertainty, and a deep desire for reassurance of fetal well-being. CLINICAL IMPLICATIONS: This study reinforces the difficulties that women have after a pregnancy loss, but examines it with a unique cultural focus. Nurses and midwives can use these findings to develop caring and understanding practices designed to help women in these circumstances. Pregnancy after a loss is never the same as a previous pregnancy, and is perceived as different from a pregnancy that other "normal" pregnant women have. Women need nurses and midwives who can provide comprehensive practical, physical, culturally specific, psychosocial, and spiritual support to help them successfully chart their journey out of profound loss.