Dilemmas in international research and the value of practical wisdom.

When conducting research in an international setting, in a country different than that of the researcher, unpredictable circumstances can arise. A study conducted by a novice North American researcher with a vulnerable population in northern Ghana highlights these happenings with an emphasis placed on the ethical challenges encountered. An illustration from the research is used to highlight an ethical dilemma while in the field, and how utilizing a moral decision-making framework can assist in making choices about a participant's right to autonomy, privacy, and confidentiality during the research process. Moral frameworks, however, can never be enough to solve a dilemma since guidelines only describe what to aim for and not how to interpret or use them. Researchers must therefore strive to move beyond these frameworks to employ practical wisdom or phronesis so to combine the right thing to do with the skill required to figure out what the right choice is. The skill of practical wisdom must be acquired because without it international researchers indecisively fumble around with good intentions, often leaving a situation in worse shape than they found it.

Relationships Among Mode of Birth, Onset of Labor, and Bishop Score.

OBJECTIVE: To investigate mode of birth in relation to onset of labor and Bishop score. DESIGN: Retrospective observational cohort design. SETTING: A 434-bed Magnet e-designated community hospital. PARTICIPANTS: Nulliparous women, 18 years of age or older, who gave birth at 37 to 41 weeks gestation to live, singleton fetuses in the vertex presentation (N = 701). METHODS: We conducted a retrospective chart review and used chi-square analysis to measure the associations among mode of birth, onset of labor, and Bishop score. We used logistic regression to test the probability of cesarean birth for women undergoing elective induction of labor. RESULTS: Most participants (n = 531, 75.7%) gave birth vaginally. Significant findings included the following relationships: spontaneous onset of labor and vaginal birth (χ2 = 22.2, Ø = 0.18, p < .001) and Bishop score of greater than or equal to 8 and vaginal birth (χ2 = 4.9, Ø = .14, p = .028). Induction of labor was a significant predictor in cesarean birth when controlling for age and body mass index (OR = 2.1, 95% confidence interval [1.5, 3.1], p < .01). CONCLUSION: Reducing elective induction of labor in women with low-risk pregnancies may help lower the risk of cesarean birth. Clinically, Bishop score and mode of birth have a weak association, particularly when induction includes cervical ripening.

Pregnant and postnatal women's experiences of interacting with health care providers about their tobacco smoking: a qualitative systematic review.

OBJECTIVE: The objective of this review was twofold: i) to comprehensively identify the best available evidence about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) concerning health care providers' interactions with them about their smoking, when such interactions occurred during contact for prenatal or postnatal health care in any health care setting; and ii) to synthesize the research findings for recommendations to strengthen health care providers' interventions regarding smoking during pregnancy and smoking during the postnatal period. INTRODUCTION: Maternal tobacco smoking during pregnancy and maternal tobacco smoking postnatally pose serious health risks for the woman, fetus, and offspring, whereas maternal smoking cessation has beneficial health effects. Given the importance of health care providers' interactions with pregnant and postnatal women for smoking cessation care, it is essential to understand women's experiences of such interactions. INCLUSION CRITERIA: Studies considered for this review had qualitative research findings about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) in relation to health care providers' interactions with them about their smoking. METHODS: The review was conducted using the JBI approach to qualitative systematic reviews. Published studies were sought through 6 academic databases (eg, CINAHL, MEDLINE). Unpublished studies were searched in 6 gray literature sources (eg, ProQuest Dissertations and Theses, Google Scholar). Reference lists of retrieved records were also searched. The searches occurred in October and November 2020; no country, language, or date limits were applied. Study selection involved title and abstract screening, full-text examination, and critical appraisal of all studies that met the inclusion criteria for the review. Study characteristics and research findings were extracted from the included studies. Study selection and extraction of findings were conducted by 2 reviewers independently; differences between reviewers were resolved through consensus. The research findings were categorized, and the categories were aggregated into a set of synthesized findings. The synthesized findings were assigned confidence scores. The categories and finalized synthesized findings were agreed upon by all reviewers. RESULTS: The 57 included studies varied in qualitative research designs and in methodological quality (from mostly low to high). There were approximately 1092 eligible participants, and 250 credible and unequivocal research findings. The research findings yielded 14 categories and 6 synthesized findings with low to very low confidence scores. Some women who smoked tobacco during pregnancy and some women who smoked tobacco postnatally lacked supportive interactions by health care providers regarding their smoking; other women experienced supportive interactions by health care providers. Women were adversely impacted when health care providers' interactions lacked supportiveness, and were beneficially impacted when interactions were supportive. Women varied in openness to health care providers' interactions regarding their smoking, from not being receptive to being accepting, and some women wanted meaningful health care provider interactions. CONCLUSIONS: Although confidence in the synthesized findings is low to very low, the evidence indicates that supportive health care provider interactions may facilitate positive smoking behavior change in pregnancy and postnatally. It is recommended that health care providers implement accepted clinical practice guidelines with women who smoke prenatally or postnatally, using an approach that is person-centered, emotionally supportive, engaging (eg, understanding), and non-authoritarian. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020178866.

Interventions impacting the accessibility of sexual reproductive health services for head porters in sub-Saharan Africa- A scoping review protocol.

Head porters working in markets in sub-Saharan Africa (SSA) are one of the world's most vulnerable and socioeconomically disadvantaged groups. They consist predominantly of uneducated women and girls seeking to escape poverty, early marriage, and other issues of domestic violence. Most female head porters are in their reproductive years and often lack access to sexual reproductive health services (SRHS) despite being at high risk for sexually transmitted infections (STIs), unplanned pregnancies, and gender-based violence. The low priority for women and girls' SRH in many SSA countries highlights the need to explore the factors influencing the accessibility of services for failure to do so restrains human development. An initial search of the literature was conducted and revealed no current scoping or systematic reviews on the accessibility to SRHS for female head porters in SSA. We outline a scoping review protocol, using the Joanna Briggs Institute methodology, to determine the interventions that influence the accessibility of SRHS for female head porters in SSA. The protocol is registered with Open Science Framework (https://osf.io/hjfkd). Findings will not only be valuable for female head porters but for all vulnerable female groups in SSA who experience high SRH risks and social disparities.

Mentorship programs for nurse educators accompanying nursing students on international placements to low-middle-income countries: a scoping review protocol.

OBJECTIVE: This scoping review will synthesize literature on mentorship programs for nurse educators who accompany nursing students on international placements to low-middle-income countries. INTRODUCTION: University nursing programs have been increasingly incorporating global health education into their curricula. Nurse educators play a significant role in the provision of international clinical experiences for nursing students by supporting and developing confidence and clinical competence. The contribution of nurse educators can affect a student's decision to remain in the profession, suggesting that providing quality professional development for nurse educators is a worthwhile investment. The challenges that come with this role require the development of a mentorship program for nurse educators who accompany nursing students on international placements to low-middle-income countries. INCLUSION CRITERIA: This scoping review will include studies that consider mentorship programs for nurse educators who accompany nursing students on clinical placements in low-middle-income countries. This scoping review will consider experimental and quasi-experimental studies, qualitative studies, text and opinion papers, dissertations, theses, conference reports, and gray literature. Studies published within the previous 40 years will be included as a systematic approach to global education started in the early 1980s. METHODS: Databases to be searched include MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Sociological Abstracts (ProQuest), and Global Health (Ovid). Following screening, all identified citations will be collated. Titles and abstracts will be screened by two independent reviewers. Potentially relevant studies will be retrieved in full and assessed for inclusion. Data will be extracted by two independent reviewers and presented in diagrammatic or tabular format and accompanied by a narrative summary.

Strategies and interventions that foster clinical leadership among registered nurses: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and describe strategies and interventions aimed at fostering registered nurses' clinical leadership in any clinical setting, identify the theories and/or frameworks that guide registered nurses' clinical leadership development, and describe the types of research conducted on this topic. INTRODUCTION: Registered nurse clinical leaders may be defined as staff nurses in clinical settings who influence and coordinate patients, families, and health care team members for the purpose of integrating care for positive patient outcomes. They have been described as expert clinicians, effective decision-makers, and relationship-focused professionals who build trust among patients, families, and health care colleagues to ensure the best possible patient care. Clinical nursing is the cornerstone of the nursing profession. Registered nurses' clinical leadership is considered critical to the health of patients and to the advancement of nursing practice. Hence, it is important to understand strategies and interventions for fostering this leadership. INCLUSION CRITERIA: This scoping review will include any quantitative, qualitative, or mixed methods studies that have registered nurse participants practicing in any clinical setting globally and that examined strategies and interventions to foster registered nurses' clinical leadership. Besides primary research studies, we will also include reviews. METHODS: This scoping review will be conducted using JBI methodology. Academic databases and sources of gray literature will be searched for published and unpublished studies. Screening and full-text review of accessed records will be conducted to determine alignment with the inclusion criteria. For records that meet the inclusion criteria, data will be extracted, mapped, and presented in a table. A narrative summary will describe how the tabulated results addressed the review questions. SCOPING REVIEW REGISTRATION: Open Science Framework Registration: https://osf.io/hjfkd.

Determinants of accessibility to primary sexual reproductive health care among vulnerable women in Canada: a scoping review protocol.

OBJECTIVE: The objective of the review is to describe, synthesize and document the determinants that impact a vulnerable woman's access to primary sexual reproductive health care in Canada. INTRODUCTION: Canada is committed to advancing sexual reproductive health care initiatives. Although both men and women require sexual reproductive health care, the implications for women are far more significant. While Canadian women do generally experience "good health," issues with sexual reproductive health do exist, particularly for vulnerable women for whom questions about accessibility arise. Therefore, there is a need to understand the true extent of a woman's access to sexual reproductive health in Canada. Findings will be used to inform future implementation research and provide recommendations to key stakeholders. INCLUSION CRITERIA: Studies on primary access to sexual reproductive health care for vulnerable women (those living in poverty, with risky sexual behaviors, and/or are Indigenous, immigrants or refugees) aged nine to 49 who reside in Canada will be considered. Studies published in French or English from 2008 will be included. Women with a physical and/or mental disability and/or who are part of the lesbian, gay, bisexual, transgender and queer community will be excluded if they do not have one or more of the defining characteristics listed above. METHODS: Databases to be searched include PubMed, Embase, CINAHL, PsycINFO, Sociological Abstracts and Women's Studies International. Gray literature searches will also be conducted. Following screening, all identified citations will be collated. Titles and abstracts will be screened by independent reviewers. Potentially relevant studies will be retrieved in full and assessed. Data will be extracted by independent reviewers and presented in diagrammatic or tabular form and accompanied by a narrative summary.

Self-Directed Female Migration in Ghana: Health and Wellness of Elderly Family Caregivers Left Behind. An Ethnographic Study.

Driven by the global economic crisis, families are developing strategies for survival, including self-directed female migration. Female migration has negative and positive impacts on families in rural areas. The purpose of the project was to explore the health and wellness experiences of elderly family caregivers who have female family members who have migrated to improve the status of their families. In this focused ethnographic study, we interviewed elderly family members who had a female family member who migrated outside their community for employment. Participants were enrolled from northern Ghanaian communities known to be economically disadvantaged in comparison to their southern counterparts. All interviews were audio-recorded, transcribed verbatim, and translated into English. Data were analyzed based on thematic content. Majors themes that emerged were reasons for children leaving their families; physical, emotional, and spiritual health; and social and economic struggles. Challenges of family care work undertaken by the elderly in families with emigrated female kin strongly also emerged as a theme. New contextual knowledge was developed about the impact of self-directed female migration on the health and wellness of elderly family caregivers. The information is valuable for the development of culturally appropriate social support and health practices for female migrants and their families.

Exploring the needs and challenges of women reintegrating after obstetric fistula repair in northern Ghana.

OBJECTIVE: to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair. DESIGN: a critical ethnographic approach. SETTING: a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana. PARTICIPANTS: ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included. FINDINGS: the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair. CONCLUSION: developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration. IMPLICATIONS FOR PRACTICE: Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy.

Reintegration of Women Post Obstetric Fistula Repair: Experience of Family Caregivers.

In northern Ghana, families traditionally function as the main provider of care. The role of family, however, is becoming increasingly challenged with the social shifts in Ghanaian culture moving from extended kinship to nuclear households. This has implications for the care of women post obstetric fistula (OF) repair and their family members who assist them to integrate back into their lives prior to developing the condition. This research is part of a larger critical ethnographic study which explores a culture of reintegration. For this article, we draw attention to the findings related to the experience of family caregivers who care for women post OF repair in northern Ghana. It is suggested that although family caregivers are pleased to have their family member return home, there are many unanticipated physical, emotional, and economic challenges. Findings lead to recommendations for enhancing the reintegration process and the need for adequate caregiving support.