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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.

Unintended pregnancies due to low prevalence of contraceptive use in Pakistan leads to a huge burden of induced abortions. These abortions are a major cause of concern, as a majority of these abortions are performed in an unhygienic environment by untrained providers, leading to maternal morbidities and mortalities. Some of the contributing factors of unsafe abortions are lack of availability of quality services, financial barriers, stigma associated with abortion and lack of awareness about abortion law. Therefore, there is an urgent need to invest on family planning and post-abortion care services through health system strengthening approach. The proposed comprehensive strategy for actions at the individual, facility, community and policy levels can address the issue of unsafe abortion in the country.

Objective:The purpose of this study was to explore the perceptions of women about childbirth experiences at the birthing centers (BCs) in Karachi, Pakistan.Design:A qualitative descriptive exploratory approach was employed using semistructured interviews.Participants:A purposive sample of eight women who had used BCs was enrolled from each site.Findings:Five themes emerged from content analysis including: (a) satisfaction with BC, (b) provision of homely environment, (c) promotion of normalcy, (d) facilitation of family support, and (e) protection of privacy.Key Conclusions:Overall, the findings of the study revealed that women who used BCs were satisfied with the services and the environment provided to them by the midwives during the antenatal, intranatal, and postnatal periods. Most of the women appreciated the privacy offered at the BCs. They considered BCs as a safe, accessible, and affordable option for childbirth and encouraged others in the community to opt for it.Implications for Practice:The findings of this study may help to advocate for births at BCs and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normalcy by attending spontaneous vaginal delivery.

Aims: To explore the perceptions of community midwives about their work experiences after deployment in the rural settings of Chitral, Khyber Pakhtunkhwa, Pakistan. Methods: A qualitative descriptive approach was used, conducting in-depth semi-structured interviews with 13 community midwives. Findings: The three major themes that emerged from the analysis of the data were: (1) rural community midwives' perceptions of their role and competencies, (2) factors facilitating and hindering the rural community midwives' ability to function, and (3) continuation of community midwives' services in the future. Conclusions: The study findings highlighted the factors that empower and obstruct community midwives in providing services in rural areas. The majority of the community midwives felt empowered because of their increased earning capacity and enhanced competencies in performing their roles. However, some of them shared challenges in terms of socio-cultural and financial constraints. These findings have important implications for midwives working in rural areas.

Objective The study aimed to determine the maternal and newborn outcomes of Community Midwives’ (CMWs’) services in Pakistan as recorded in the provincial Management Information System (MIS) of the government's Maternal Newborn and Child Health (MNCH) program of Sindh province. Methodology A descriptive retrospective design was used to examine the monthly reports of CMWs, stored in the MNCH-MIS, for the period of January 2013 to December 2015. A total of 200 CMWs were randomly selected from 23 districts of the Sindh province. The outcomes of the CMWs’ services were analyzed, using descriptive statistics. Results The analysis of data of 23 districts revealed that a total of 103,836 antenatal care were attended by 200 CMWs who were selected for the study. For intranatal care, 23,296 cases were registered, of which 78.3% (n = 18, 233) returned to these CMWs at the time of delivery. During the period, 17,849 were live births. The still birth rate was calculated to be 13.4/1000, the abortion rate was 7.3 per 1000 pregnant women, newborn mortality rate was 12.4/1000 live births, and the maternal mortality ratio was 142.5/100,000 live births. Moreover, the low birth weight newborns were 9% of the total live births. Conclusion This study indicates that although the outcomes for CMWs are better than for some other cadres in Pakistan, they are still inadequate compared to midwives trained to the international standards. The outcomes presented in this study are in line with the challenges of CMWs survival reported in the earlier studies. This strongly indicate need for improvement in CMWs pre-service and in-service education to meet the international quality standards set by ICM.

Objective: To explore community midwives' (CMs') experiences with respect to deployment policies and processes developed and used in Pakistan. Methods: A qualitative, descriptive, exploratory design was used; 11 CMs' perspectives were gained through two focus groups. Results: The findings are summarised under a key theme, ‘Surviving as community midwives', and four related categories: (1) lack of identity and recognition; (2) state of helplessness; (3) depletion of competence and confidence; (4) unavailability of resources and financial support. Conclusion: The study findings highlight the need for revising the deployment policies, especially those related to the preparation of CMs for working independently in communities; introducing the CMs and their roles within the communities; establishing independent work stations (birthing centres); and streamlining the remuneration processes. The findings recommend greater preparation of district and regional-level government officials by policy makers for the implementation of the new CMs' deployment plan.

Background in 2012 the Aga Khan University in Karachi, Pakistan opened the country's first bachelor's degree program in midwifery for women who held diplomas in nursing and midwifery. The principal aims were to prepare midwives who would be competent to provide full-scope practice. For quality assurance, the programme was continuously monitored and assessed. As part of this ongoing evaluation process we sought in-depth feedback from the first graduates about their student experiences. Objective this study aimed to explore the experiences of the first graduates of a Bachelor of Science in Midwifery (BScM) program to deepen our understanding of their views of the program's strengths and difficulties and to obtain their suggestions for change. Design and Methods: This qualitative descriptive exploratory study used universal sampling to collect data from all 21 of the first graduates of the BScM Program. Data collection involved focus group discussions using a semi structured interview guide and content analysis. The study was approved by Institutional Ethics Review Committee. Findings three main themes emerged from the data: (1) Competence acquisition, (2) Attitude transformation, and (3) Strengths and limitations of the program. Conclusions the study findings highlighted that the degree program in midwifery had a positive impact on graduates' perceptions of their knowledge, skills, attitudes and ability to implement evidence-based midwifery practice. The graduates regarded the university's environment, teaching-learning strategies, preceptorship model, self-directed learning and exposure to diverse clinical settings as major facilitators in achieving competence.

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.

premji s.s., lalani n., ajani k., lakhani a., moez s. & dias j.m. (2011) Faculty practice in a private teaching institution in a developing country: embracing the possibilities. Journal of Advanced Nursing67(4), 876–883. Abstract Aim. This paper discusses a case study on implementing faculty practice in a private teaching institution in a developing country where direct ‘hands-on’ care is undervalued by nurses. Background. In Pakistan, faculty practice is not well known and related to indirect care. In the institution studied, faculty practice has been a major consideration to strengthen relationships between clinical and academic sectors. Data sources. MEDLINE and CINHAL were searched (1979 to July 2009). A consultative process was used by the faculty practice committee members and involved open discussions with academic and clinical service faculty in the institution studied. Discussion. There is no empirical evidence to identify effective models for implementing faculty practice. A formalized faculty practice plan was identified as an important organization factor to promote faculty practice. Implications for nursing. Identifying a definition of faculty practice and scholarship was an important step to ensure conceptual clarity. Consistent with the literature, workload, remuneration and performance appraisal were identified as perceived threats. The hierarchy in nursing is a unique organizational factor that will need to be addressed. Given the lack of research on the effectiveness of faculty practice and its models, evaluation is imperative. Conclusion. Dissonance is an overall theme of the literature and stems from the perceived threats/risks of faculty practice. Faculty practice may fulfil institutional, personal and professional needs of individual faculty members. Faculty practice offers an opportunity to change attitudes, beliefs and values related to direct care in the institution studied and influence other institutions in Pakistan.

Midwives in Pakistan and the South Asian region who complete a diploma program face many challenges for career growth and development. The absence of higher education in professional midwifery in the region has contributed to general non-acceptance and invisibility of midwifery. In response to the interest, Aga Khan University (AKU) developed bachelors program in midwifery based on the Global Standards for Midwifery Education developed by the International Confederation of Midwives (ICM) with the vision to equip midwives to provide full-scope practice, develop confidence to practice midwifery independently, become clinical leaders and contribute to the future of midwifery. The final curriculum had a balance of theory and clinical practice in order to develop a high level of clinical competence that would meet the ICM standards and guidelines. The two year bachelors program is currently in progress. The first cohort of 21 midwives graduated in 2014 and a second cohort was enrolled in 2015. There is a planning for a future graduate program in midwifery to prepare individuals for leadership roles in practice, teaching, maternal–child health provision and policy making through a master’s degree in midwifery.

Written feedback can facilitate students’ learning in several ways. However, the teachers’ practices of written feedback may be affected by various factors. This study aimed to explore the nurse teachers’ accounts of their perceptions and practices of providing written feedback. A descriptive exploratory design was employed in the study. A purposive sample of 12 teachers from nursing institutions in Karachi, Pakistan, participated in the study. Using a semi-structured guide, in-depth interviews were conducted with the participants, between January-September, 2013. The interviews were tape recorded and transcribed verbatim and were manually content analyzed. The analysis of findings led to three sections: teachers’ conceptions about written feedback, teachers’ practices of providing written feedback, and factors that affect the teachers’ practices of providing written feedback to their students. The findings indicated that although the teachers realize the importance of written feedback and its impact on students’ learning, several factors, including teachers’ competence and commitment, students’ receptivity, and contextual barriers, affected their practices. To actualize the potential power of teachers’ written feedback in students’ learning, both teachers and institutional administrators need to realize the importance of written feedback. Moreover, concerted efforts including teachers’ development and policies are required to overcome the factors that negatively influence the practices of written feedback.

To assess how families perceive the positive and negative impacts of caring for a child with mental retardation.The quantitative descriptive study was conducted from January to August 2007 and comprised 54 families attending a private day-care centre for children with special needs in Karachi, Pakistan. The Kansas Inventory of Parental Perceptions was used to assess mothers' perceptions on the impact of caring for a child with mental retardation. Positive contributions, social comparisons with others, understanding of disability and perception of control were assessed. SPSS 16 was used for statistical analysis.Mothers reported positive contribution to family life as a result of caring for a child with mental retardation (Mean: 2.95 +/- 0.37). There was an acceptance of the situation and a trend towards upward favourable comparison with other families (Mean: 3.13 +/- 0.07).Contrary to earlier studies exploring the impact of caring for a child with disabilities having largely focused on negative contributions, the study highlights some positive contributions.

To identify students' perceptions about the practices of provision and utilization of written feedback in the nursing degree programmes in Karachi.Cross-sectional descriptive study.Nine Nursing Institutions in Karachi, Pakistan were selected for the study, from February to October 2011.The sample consisted of 379 second year nursing students from nine institutions in Karachi. The data was collected through a modified Assessment Experience Questionnaire (AEQ) developed by Gibbs and Simpson. The data obtained through AEQ was analyzed in the SPPS.Students reported wide variations in the practices related to written assignments, and the provision of written feedback. Although 80% of the students, reported receiving written feedback with or without oral feedback, 20% of them, received only verbal feedback on their assignments. For 44 - 46% of the students, the quality, quantity, timing, and utilization of feedback was below the reference scores, which is indicative of negative perceptions. Only 40% reported receiving feedback on regular basis. Assignment guidelines were not always provided in a written form. In most cases, the guidelines were ambiguous as well as the feedback was not always reflective of the guidelines.The findings have implications for teachers, students, and institutions similar to the context of this study. Teachers need to be aware of the role and the impact of written feedback on students' learning and develop competence for giving effective feedback. Finally, institutional commitment and policies are needed to promote the practices of written feedback.

This paper discusses a case study on implementing faculty practice in a private teaching institution in a developing country where direct 'hands-on' care is undervalued by nurses.In Pakistan, faculty practice is not well known and related to indirect care. In the institution studied, faculty practice has been a major consideration to strengthen relationships between clinical and academic sectors.MEDLINE and CINHAL were searched (1979 to July 2009). A consultative process was used by the faculty practice committee members and involved open discussions with academic and clinical service faculty in the institution studied.There is no empirical evidence to identify effective models for implementing faculty practice. A formalized faculty practice plan was identified as an important organization factor to promote faculty practice.Identifying a definition of faculty practice and scholarship was an important step to ensure conceptual clarity. Consistent with the literature, workload, remuneration and performance appraisal were identified as perceived threats. The hierarchy in nursing is a unique organizational factor that will need to be addressed. Given the lack of research on the effectiveness of faculty practice and its models, evaluation is imperative.Dissonance is an overall theme of the literature and stems from the perceived threats/risks of faculty practice. Faculty practice may fulfil institutional, personal and professional needs of individual faculty members. Faculty practice offers an opportunity to change attitudes, beliefs and values related to direct care in the institution studied and influence other institutions in Pakistan.