Harrowing, Jean

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    Qualitative research in an international research program: maintaining momentum while building capacity in nurses
    (Sage, 2014) Mill, Judy E.; Davison, Colleen; Richter, Solina; Etowa, Josephine; Edwards, Nancy; Kahwa, Eulualia; Walusimbi, Mariam; Harrowing, Jean N.
    Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decisionmakers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.
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    The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa
    (BioMed Central, 2016) Edwards, Nancy; Kaseje, Dan; Kahwa, Eulalia; Klopper, Hester C.; Mill, Judy E.; Webber, June; Roelofs, Susan; Harrowing, Jean N.
    Background: The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low-and-middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care. Methods: A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test. Results: Response rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self—pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73–0.82), p = 0.002; workplace policies—pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance—pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising—pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002—and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation—pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). Multivariate results for Kenya and Jamaica were non-significant. Twelve hubs were established; 11 were active at follow-up. Hub members (n = 34) reported significant improvements in their capacity to address care gaps. Conclusions: Leadership hubs, comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy. Overall, hubs did not provide the necessary force to improve the uptake of evidence-informed HIV care in their districts. If hubs are to succeed, they must be integrated within district health authorities and become part of formal, legal organisations that can regularise and sustain them.
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    Compassion practice by Ugandan nurses who provide HIV care
    (OJIN, 2011-01-31) Harrowing, Jean N.
    Compassion is fundamental to ethical nursing practice; it represents a commitment to acknowledge and respond to the suffering of the patient. Many structural, economic, and sociopolitical challenges confront Ugandan nurses in their efforts to incorporate compassion into their care of persons with HIV illness. After reviewing the literature related to compassion fatigue, the author describes nursing in sub-Saharan Africa and presents a qualitative study exploring the impact of education on 24 nurses’ lives, including their capacity to avoid or mitigate the development of compassion fatigue. Data were collected through interviews, observation, and focus group discussions. Findings illustrate the barriers participants faced in providing competent care and the liberating effects of new knowledge and skills. Engaging in meaningful relationships, maintaining hopeful attitudes, and advocating for the profession were found to transform and affirm the nurses’ approach toward their work and enhance their experiences of compassion satisfaction. The author discusses the unique aspects of the experience of compassion among Ugandan nurses caring for persons with HIV illness.
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    The impact of HIV education on nurses and nurse-midwives in Uganda
    (University of Alberta, 2009) Harrowing, Jean N.
    Over the past three decades, the HIV epidemic has gained a stranglehold in sub-Saharan Africa, where 10% of the world‟s population comprises more than 60% of all people living with the disease. Recent initiatives to boost prevention and treatment interventions are beginning to yield modest but promising results, as infection rates slowly start to stabilize. However, continued improvement will require aggressive and unrelenting efforts to prepare and equip a workforce for the tremendous challenges that remain. The purpose of this critical ethnography was to explore the impact of an intensive 6-month HIV/AIDS education program on the lives of 24 Ugandan registered nurses and nurse-midwives who worked at a large referral hospital. The study began following completion of the course and involved participant observation and semi-structured interviews for 18 weeks over a 2-year period. The findings are presented in this dissertation, which consists of four published or publishable manuscripts along with introductory and concluding chapters. The first paper describes the impact of education on the personal, professional, and social lives of the participants, and provides an account of their new ways of viewing themselves as nurses, leaders, and advocates. The second paper addresses ethical issues concerning the conduct of research in international settings. The third paper identifies the phenomenon of moral distress as it manifested in the participants, and the effects of education on their ability to transform practice and attitudes. The final paper examines the congruence between the critical qualitative methodology used in the study and the concept of cultural safety in the context of international nursing research. The dissertation concludes with a discussion of the crucial role of continuing professional education for the development of a strong and responsive nursing workforce that is prepared to contribute leadership and vision to addressing the obstacles presented by HIV and AIDS. Dealing effectively with the epidemic requires numerous interventions at various levels; the potential synergies offered by a small investment in education may have far-reaching effects. Finally, implications for nursing practice are presented along with suggestions for further research.
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    "Everything depends on good nursing" Spanish influenza epidemic of 1918-19
    (ProQuest, 2006-03) Harrowing, Jean N.
    Nurses have always played a vital role in the response to outbreaks of deadly illnesses. The story of Alberta nurses' heroic efforts in the face of the Spanish influenza epidemic of 1918-19, in the absence of public health infrastructure, reminds us of the importance of preparedness. The virus, which accompanied soldiers returning from Europe after the First World War, spread quickly along transportation routes from Eastern Canada to the West. Although many nurses had not yet returned from war service, or were assisting in Halifax following the explosion of 1917, those who were available in Alberta volunteered without hesitation to care for victims of the virus. In the absence of cure, good nursing care was usually the only treatment for the illness. Recognition of the need for planned response to crises, availability of resources and excellent skills and knowledge prompted nursing leaders to lobby the government for a formal public health system and contributed to the organization of professional nursing associations In the likely event of another global influenza pandemic, nurses may draw upon the lessons of the past as they once again face the complex challenges of a modern health crisis.