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Introduction: The significance of written feedback in students’ learning is well established in the literature; however, it is contingent on several factors, particularly the quality of written feedback. Many teachers are not formally trained to give feedback that could affect the student learning. Objective: This study was designed to investigate whether teachers modify their written feedback in response to a formal training workshop on written feedback. Methodology: Using a quasi-experimental design with pre and post within subject design, 94 teachers participated in this study. As a pre-test, participants were made to provide written feedback on a sample script at the beginning of the workshop. This was followed by a two-day interventional workshop that included discussions and hands on exercises on multiple aspects of written feedback. At the end of the workshop, the participants were again asked to provide feedback on the same script. Results: Comparisons between the pre- and post-intervention data revealed several differences. The quantity of feedback increased subsequent to the intervention. A rise in feedback on form and writing style was observed after the workshop, as opposed to a slight drop in feedback on content, leading to a more balanced focus. Although some of the desired differences, such as avoiding vague comments and criticism, were statistically insignificant, most of the other, differences in the pre-test and post-test were statistically significant. Conclusion: This study affirms that a formal training workshop could improve the quality of teachers’ written feedback.

COVID-19 has raised a concern about the quality and continuity of education. The uncertain situation has required universities to undertake several innovative measures to continue their educational programs without compromising the quality of education. The aim of this paper is to introduce the hybrid approach for undergraduate nursing students for teaching mental health nursing course, utilizing Gagne's instructional design theory, in a private nursing institution in Pakistan. The nine steps of instructions in Gagne's theoretical framework were utilized for teaching the mental health nursing course. The approach enhanced students' therapeutic communication skills, boosted their confidence level, and assisted them in overcoming their fears in caring patients with psychiatric illnesses. Students appreciated the innovative strategies, such as problem-based learning, case studies, interactions with standardized patients, and learning through movies. The innovative and creative clinical teaching approaches can be used to develop nursing students' competencies, core clinical skills, and to bridge the theory-practice gap.

Background: Self-Harm (SH) is a major global public health problem which is under-researched in Pakistan. A prior act of self-harm is one of the strongest predictors of future suicide.Method: This retrospective descriptive study describes the characteristics of SH cases (n=350) that presented to a tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. Results: It was found that self-harm acts were twice as more common in females than in males. More than half of the reported cases were in the age group 20-39 years. Drug overdose and use of insecticides were the two most common methods used in both genders. Depression was identified in nearly half of the reported SH cases. Intention to die was found to be 3 times greater among patients with psychiatric illness as compared to those with no history of psychiatric illness. Conclusion: This study suggests that limiting access to lethal means, regulating over-the-counter sale of medications, and safe storage of pesticides can possibly serve as effective measures to minimize self-harm incidences. Moreover, integration of suicide assessment and prevention programmes for the general population is also suggested.

Background Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die. Method This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. Results A total of 350 cases were analysed. More than half of the reported cases were in the age group 20–39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value Conclusion This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.

Background Written feedback assists students in refining their future academic work. However, students prefer having feed-forward instead of feedback by their instructors that are the comments provided to them on drafts prior to the actual assignment submission. The current literature describes two common ways to convey feed-forward: the foremost one is on outlines while the second is on drafts. However, no existing literature had been found yet for sufficient guidance on the ideal approach of feed-forward to facilitate students' subsequent learning. Design A Quasi-experimental study design was employed to determine the effectiveness of feed-forward on outline versus drafts. Setting Study was conducted in a private nursing institution in Karachi, Pakistan. Participants 118 third-year undergraduate nursing students participated in the study. Methods Using consecutive sampling, 118 students were enrolled and equally divided in to two groups, each comprising of 59 students in the control and intervention arm. Control group received feed-forward through standard practice i.e. on their assignment outline while the intervention group received feed-forward on the draft of their scholarly paper. Results The performance of intervention arm had an upper hand over that of control wing as portrayed by their increased overall assignment and academic writing scores (of students on IELTs bands). The set outcomes also reflected better results in terms of the (reduced) frequency of visits to their instructors for clarification of written feedback. All in all, this research deduced that feed-forward on drafts is far more beneficial in contrast to that on an outline as it reinforces students' learning. Conclusion The study findings affirmed that feed-forward is a useful strategy to enhance students' subsequent learning.

Background Self-management support is considered an important task for nurses working in chronic care provision. The complex nature of self-management support makes it necessary to clarify the factors affecting the behaviour of nurses in supporting patients living with chronic illnesses. Objective The aim of this review is to synthesize the factors influencing the provision of self-management support as perceived by nurses in the care for patients living with a chronic illness. Design A systematic mixed studies review. Data source Studies published in English from 1999 to April 2020 were extracted from five databases: CINAHL, PubMed, Cochrane library, EMBASE, and Web of Science. Review method The selection process was guided by PICo (Population, phenomenon of Interest, and Context). Studies that highlighted factors associated with the provision of self-management support among nurses, within the context of the top four non-communicable chronic diseases, were included. The risk of bias was carefully assessed. Using data-based convergent synthesis, the identified factors were synthesized and tabulated. The clusters of factors organized under each theme were approved by all researchers in discussion meetings. Results In total, sixteen studies met the inclusion criteria; out of these, seven were qualitative, seven quantitative, and two mixed methods studies. The review identified nurses’ perspectives regarding factors influencing self-management support at the patient, nurse, care relationship, education and training, organization and healthcare system, and intra- and inter-professional levels. The review provided evidence that these factors are interdependent in nature. Conclusion This review proposed considering a framework of interdependent factors influencing self-management support. It highlighted the need to come up with a comprehensive definition of self-management support that takes into account the emotional aspect as well as patient-as-partner approach. The proposed framework can be useful in tailoring multi-faceted interventions to strengthen nurses’ supportive role in self-management of chronic care. Future studies should focus on exploring contextually relevant factors impacting nurses’ supportive role in self-management.

Simulation is an innovative teaching strategy that supports student centered learning. It improves therapeutic communication skills with clients. Additionally, it enhances critical thinking, problem solving, and confidence among students, in a non-threatening and safe environment, without posing a risk to actual patients. This paper describes the process of application of simulation for undergraduate nursing students enrolled in a mental health nursing course. The project aimed to determine the significance of simulation to improve the communication skills and confidence level, and to decrease the anxiety of undergraduate nursing students, prior to attending mental health clinical. The Experiential Learning (ELT), by Kolb in 1984, was chosen as a framework for the simulation strategy. The simulation experience was a stepwise process that comprised a briefing session with students to explain them the process and purpose of the simulation activity, followed by a two-day simulation experience. The experience comprised students' interaction with Simulated Patients (SP), who had been prepared to manifest symptoms of depression, mania, and schizophrenia. The later part of the experience was a debriefing session, in which students were provided an opportunity for self-reflection and for thinking a way forward, to enhance their clinical competency, using their video recording. The students' evaluation regarding the simulation experience was positive and they suggested that it be integrated in the mental health nursing course.

Cancer is a growing health problem worldwide. Common treatments include surgery, chemotherapy and radiation therapy. Systemic anti-cancer medications often result in an array of physical and psychological side effects. Supportive care assists patients with cancer in managing multidimensional symptoms that result from treatment or the illness itself. This review discusses supportive care and examines patient counselling and mind-diversion activities, which are safe and cost-effective strategies. Improving cancer patients' health and wellbeing should be encouraged in oncology nursing practice and by teaching students the knowledge and skills needed to provide supportive care.

Nursing is considered both science and art. Artful nursing has been essential for holistic nursing practice since the time of Nightingale, but it is getting neglected and has been lately limited to nursing literature (Gramling, 2004). This qualitative study seeks to gain an understanding of the perceptions of active nurses in Pakistan about nursing art and yields four major themes: artful nursing is embedded in humane responsiveness, artful nursing has healing power, artful nursing is a satisfying experience, and artful nursing is invisible in nursing practice. Study participants valued nursing art, and their perceptions illuminate Watson's Theory of Human Caring (1988).

Background : Written Feedback (WFB) plays a significant role in student’s learning in terms of improvement of their academic writing skills. However, the quality of WFB may be affected by various personal and contextual factors. This study aimed to identify nurse teachers’ conceptions and practices of WFB on written assignments in nursing degree offering institutions in Karachi, Pakistan. Methods : A cross-sectional descriptive study design was used to answer the study questions. The study was conducted at 11 nursing schools in Karachi by recruiting those teachers who were teaching in nursing degree programs. The sample size of the study consists of 80 teachers. Universal sampling technique was used to select the subjects of the study. Results : The study result consists of demographic information of the participants, teachers’ conceptions and their practices of WFB. Although majority (92%) of the teachers believed that WFB is important for students’ learning, they acknowledged that they were not able to provide WFB at optimum level to their students. This gap in practice is attributed to various personal, contextual, and organizational factors; among them, the highest reported factors were teachers’ lack of training for provision of WFB (84%), distraction in the environment (78%), and constraints of time due to teacher’s workload (74%). Conclusions : The importance of WFB for students’ learning is well established in the literature. However, the preparation of teachers and an enabling environment to facilitate teachers for optimum practices of WFB needs considerable attention by educational institutions.

Background Students can experience multiple stressors during their academic life which have an impact on their emotional health and academic progress. Purpose This study sought to explore students' understanding of and factors affecting their emotional well-being in an undergraduate nursing programme at a private nursing institution in Karachi, Pakistan. Method In this qualitative study, data were collected through individual semi-structured interviews using a self-designed guide from 16 participants in total, drawn from various years of the selected undergraduate programme. Findings Participants noted that the quality of the ‘learning environment’ was a key influence on their emotional well-being. They highlighted faculty role and teaching approaches, academic expectations and availability of learning resources as important factors that affected their emotional well-being as well as their academic performance. Institutional support was also deemed important. Factors associated with a ‘hidden curriculum’ were found to be a threat to students' emerging sense of professionalism. Conclusion Suggestions are given as to how the learning environment in the nursing programme under study can be improved to take into account students' emotional well-being. Emphasis needs to be laid on developing supportive faculty role to provide conducive learning environment and professional development of students. Efforts to develop stress-free academic environment with supportive institutional policies need to be considered.

This mixed-methods research aimed to understand the practices and perceptions of teachers regarding writtenfeedback. For this purpose, a survey was administered to 150 teachers forming a non-probability sample, who wereworking in various universities in Karachi. The disciplines chosen for the study included nursing, applied linguistics,medicine and education departments in institutes of higher education situated in Karachi. Before sampling, initialscreening was done to obtain a list of institutes which provide written feedback on students’ assignments. Twohomogenous groups of teachers by discipline (nursing and education) were then selected for focus group discussions.It was found that most teachers consider written feedback an important tool for guiding and helping students improvetheir work. In fact, they consider written feedback as important as verbal feedback. Teachers also recognized theimportance of discussing the written feedback with the students but they rarely did so because of time constraints.Most teachers preferred to directly fix students’ errors instead of providing feedback to enable them to correct thoseerrors by themselves. While less than half of the participants used a checklist for grading, others used annotation.Several factors were found to have a great influence on the amount and quality of feedback. The most significantfactor was whether teachers had formal training in providing feedback. Only 17% of the participants in this study hadproper training to give written feedback. They also identified several environmental and personal factors that had animpact on their feedback practices including time, the relationship between the teacher and individual students, and,most importantly, the policies and culture of the institutes.

Background and Aim: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program. Methods: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals located in Karachi, Pakistan. In this study, supportive care interventions were offered via the patient help group program over a 5-week period, and in the 6th week, data were collected. The total sample size of this pilot study was n = 17. Female cancer patients receiving weekly chemotherapy regimen and diagnosed with breast or gynecological cancers were a part of the study. Outcome variables, self-care behavior and satisfaction, were assessed via a self-developed questionnaire. Content validity index of the questionnaire was calculated on the basis of expert review and was found to be 96% for relevancy and 94% for clarity. Frequencies were calculated to evaluate outcome variables. Outcome variable satisfaction was also assessed via few open-ended questions. Results: Participants reported moderate-to-high self-care behaviors and satisfaction after exposure to supportive care interventions delivered via the patient help group program. Conclusion: Counseling and mind diversion activities are effective in producing a positive change in chemotherapy patients' self-care behaviors and satisfaction. Therefore, oncology nurses must utilize them in chemotherapy patient care. Future studies should evaluate the effectiveness of these interventions with larger sample size and comparative analysis.

Schizophrenia and other mental illnesses produce devastating effects on a clients' personal and psychosocial wellbeing. Besides the sufferer, it has irrevocable impacts on the lives of their loved ones. With advancement in the treatment modalities, researches have proven that hospital based care and psychotropic drugs are not the sole solution in managing the client symptoms. Deinstitutionalization is the paradigm shift from hospital based to community based care model that allows client/s to spend rest of their lives in the community setting. A well-structured community care based programme that focuses on psychosocial interventions has significant contribution in treatment and rehabilitation of client/s. This article is aimed to provide the evidence of the effective use of community mental health care for management and prevention of relapse of a client with chronic schizophrenia. The substantial evidence of rehabilitation is represented through this case study of a chronic schizophrenic client who received these psychosocial interventions in his own community setting.

Excellence in academic performance at the graduate level requires good command of writing skills. Teachers’ written feedback can help students to develop their writing skills. However, several personal and contextual factors may influence feedback processes and its utilization by students. Therefore, understanding these factors is essential to improve the practice of written feedback. This study aimed to appraise the quality of written feedback in the graduate programmes and to ascertain students’ perceptions about it at a private university in Pakistan. A purposive sample of 15 participants comprised the study. The data were collected through in-depth students’ interviews and the teachers’ written comments on students’ assignments. Data were coded and categorized to assess the pattern of similarities and dissimilarities. The analysis of comments on students’ assignments indicated that the amount of feedback varied greatly. Although some feedback focused on form and style, most comments focused on the content. Moreover, the tone of comments lacked a balance of praise, criticism and suggestions. The data from students’ interviews were categorized as: variations in experiences, functions of written feedback, effectiveness of feedback and utilization of feedback. With some exceptions students’ perceptions about the quality feedback corroborated with the teachers’ comment analysis. The study highlights several factors that impact the receptivity and utilization of feedback by students. Therefore, teachers need to be aware and trained to enhance the quality of their feedback.

To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan.The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population.Of the total, 529 (66%) children belonged to state-run schools while 271 (34%) were studying at private facilities. The mean age was 13.7+/-1.3 years. The level of stress was positively associated with the number of siblings, parental conflicts, the age of the mother and the number of rooms in the household. There was decreased level of stress among female adolescents (n=474; 59.3%) who had prior information about pubertal body changes than the boys (n=326; 40.8%).The study showed that stress among adolescents can be reduced by modifying socio-economic and demographic factors.

In today's world women are increasingly participating in the realm of work force, yet they are facing many obstacles in their way. Sexual harassment is one of those obstacles. Sexual harassment at work place is prevalent in every society. It could happen to anyone but women are the targeted victims. Sexual harassment is considered as a traumatic event and the victim may end up in having physical and mental sufferings that hinders a person to work effectively. At an organisational level this may result in decrease work effectiveness, decreased work productivity, high absenteeism, high turnover, and low staff morale. Hence there is a need that, organisations and government should look seriously into this matter. Proper education and training programs should be developed to deal with these issues. The goal must be both to deal with sexual harassment incidents effectively and to prevent the occurrence of future incidents.

Background There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. Methods We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ2 test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression. Results The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use. Conclusion We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.