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Objective: The main objective of the study was to determine the effects of Surah Al-Rehman on post CABG patients’ pain level, oxygen saturation, and vital signs. Methodology: A quasi-experimental pre and post-test design was used with a sample size of 60 patients in two tertiary care Hospitals, from July 2018 to September 2018. A non-probability convenient sampling method was used to recruit the participants. Post CABG adult Muslim patients were the study participants. Surah Al-Rehman’s recitation in the voice of the Qari Abdul Basit was the intervention for the current study. At a significance level of p-value ≤ 0.05, a repeated measure ANOVA was applied to determine the effects of Surah Al-Rehman on the outcome variables, which were patient’s pain level, oxygen saturation level, and vital signs including heart rate [HR], respiratory rate [RR], systolic and diastolic blood pressure. Results: Overall, Surah Al Rehman had shown statistically significant effects on the participants’ pain level (p

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.

Background: Critical thinking is an imperative outcome of nursing education. However, several factors contribute to the development of critical being including critical thinking dispositions (CTDs). Objective: This study aimed to assess the critical thinking dispositions and factors affecting critical thinking dispositions of BScN students and their educators in twin city Rawalpindi and Islamabad, Pakistan. Methodology: A cross- sectional analytical design was used in this study. A consecutive sample of 215 BScN students and 63 educators participated in the study. Data were collected via Pakistan-Critical Thinking Dispositions Scale (P-CTDS) comprising 54 items under the seven constructs; responses were measured on 5-points Likert scale. Data were analyzed with SPSS version 22. Results: The findings showed that 52% of the educators were at the developed level of CTDs and nearly 48% at the developing level; whereas 76% students were inclined towards CTD and only 23% were found at the developed level of CTDs. Although with considerable difference in the scores of the 7 constructs, both, students and educators obtained highest scores on inquisitiveness and contextual perspective. Similarly, students and educators obtained low score on open-mindedness. The difference between students and their teachers was statistically significant for the total scores of CTDs as well as for the scores of six of seven constructs. Conclusion: Although educators exhibited stronger CTDs than their students, both have room for improvement, specifically their open mindedness. If educators are willing to challenge their personal assumptions, students will also emulate them.

Khairulnissa Ajani,1 Ambreen Gowani,1 Raisa Gul,1,2 Pammla Petrucka3 1School of Nursing, Aga Khan University, Karachi, Pakistan; 2School of Nursing, Shifa Tameer-e-Millat University, Islamabad, Pakistan; 3College of Nursing, University of Saskatchewan, Saskatoon, CanadaCorrespondence: Khairulnissa AjaniAga Khan University School of Nursing, P.O. Box 3500, Stadium Road, Karachi, PakistanEmail khairulnissa.ajani@aku.eduBackground: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol.Results: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population.Conclusion: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications.Keywords: hypertension, self-care management, cross-sectional study, Pakistan

Critical thinking (CT) is a generic attribute that is greatly valued across academic disciplines in higher education, and around the globe. It is also defined as one of the graduate attributes of higher education for the sample private university where this research was conducted, as it is perceived that CT helps the graduate to become ‘engaged citizens’ in the twenty-first century. Despite the well-documented importance of CT, its assessment remains a challenge. This study addresses this challenge through the systematic development and field-testing of a rubric for assessing critical thinking in a multidisciplinary context in higher education. A multidisciplinary group of faculty (i.e. education, nursing, medicine) from the sample university partnered with a policy research group in Canada to translate this plan into action. The development of the assessment tool followed a multi-step process including: (i) identification of the main elements of CT; (ii) choice of a rubric format; (iii) adaptation of the currently available relevant rubrics; and, (iv) field testing and establishment of the reliability of the rubric. The process resulted in the development of a holistic template, the Assessment of Critical Thinking (ACT) rubric. Two versions of the rubric have been field tested on a sample (n=59) of students drawn from different entities of the sample university. The data collected was subjected to psychometric analysis which yielded satisfactory results. This was a modest attempt to develop an assessment tool to guide multidisciplinary faculty members in teaching and assessing CT by assisting them to make decisions about the level of their students’ CT skills through a combination of numerical scores and qualitative description. It may also empower them to make self-initiated, conscious efforts to improve their classroom practice with reference to CT. The ACT rubric provides an anchoring point to start working on the daunting yet doable task of developing and fine-tuning both the assessment measures of CT and interventions to promote CT based on the assessment findings. Future research may not only provide robust evidence of the reliability and validity of the ACT rubric for a larger and varied sample but also help in making informed decisions to enhance teaching and learning of CT across entities of the sample university. How to cite this article: BHUTTA, Sadia Muzaffar; CHAUHAN, Sahreen; ALI, Syeda Kausar; GUL, Raisa; CASSUM, Shanaz; KHAMIS, Tashmin. Developing a rubric to assess critical thinking in a multidisciplinary context in higher education. Scholarship of Teaching and Learning in the South. v. 3, n. 1, p. 6-25, Apr. 2019. Available at: https://sotl-south-journal.net/?journal=sotls&page=article&op=view&path%5B%5D=69&path%5B%5D=34 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Objective: This study aimed to explore and identify the nurses’ and physicians’ views about Advance Directives and identified their perspectives on its importance, in the context of Pakistan. Methodology: Using a purposive sample, six physicians and seven nurses from two tertiary care hospitals in Karachi participated in the study. Data was collected using semi structured interviews that were transcribed verbatim. The interviews were coded and categorized manually. Analysis of the data drew four categories: roles of physicians and nurses in the End of life care, challenges they faced while taking end of life care decisions; their perspectives about Advance Directives, and the scope of acceptability of Advance Directives in the context of a Pakistani society. Results: This study revealed that patients’ families and physicians usually take decisions for patients’ End of Life care. Although majority of participants acknowledged the usefulness of Advance Directives, they explicated several issues that may be encountered in implementing it. The issues included non-disclosure of diagnosis to the patient in Pakistani culture, the tedious legalization process involved, and the potential problem of forged documents. Conclusion: Participants recommended establishment of Palliative Care services before execution of Advance Directives. This study indicated viability of Advance Directives; however, a wider exploration would be required in terms of study population. Reforms to support this concept would be required in systems, structure, legal policy, and training of Health care professionals. Besides these transformations, promotion of public education about the advantages of Advance Directives could enhance their acceptability among the general population.

Background In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC). Objectives This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan. Methods A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the public and private sectors. Face-to-face, in-depth interviews were conducted using a semi-structured interview guide. Data were collected until theoretical saturation was achieved and conventional content analysis was carried out. Results Although there was general support among all the stakeholders for integration of mental health services within PHC, there were also a number of reservations. First was the perceived lack of support within the system in terms of resource allocation and acceptance from the community. Second was the lack of human resources in the field of mental health. In addition, resistance at the PHC level is likely as staff are already burdened with other preventive care services. Conclusions The study suggests that strong political commitment, adequate human and financial resources, and strong advocacy are needed for the integration of mental health into PHC in Pakistan.

Objective: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals' well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients' survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. Methods: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. Results: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. Conclusions: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients.

Objective: The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society. Methods: A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories. Results: Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope. Conclusions: The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women's physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers' support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints.

Several studies have been conducted to analyze the quality of written feedback given by teachers on students’ written assignments. However, it has been observed that there is no clear existing method or tool to facilitate the analysis of teachers’ written feedback. This paper aims to document a step by step methodological approach to analyze teachers’ comments and appraise the quality of feedback on students’ written assignments. A self-initiated tool was developed from the comment analysis process which revealed the use of various formats and modes employed to provide written feedback to the students. In addition, this tool helped to determine the focus and tone of the feedback. Using a step by step approach, the tool also helped to identify clarity in the given feedback. This paper is an addition to the existing literature in the qualitative research method for in-depth analysis of teachers’ comments. This effort will not only appraise the quality of Method Article Ghazal et al.; BJESBS, 10(4): 1-10, 2015; Article no.BJESBS.17713 2 given feedback but also help in further development of a comprehensive qualitative tool to assess its quality.

This study explored the readiness of stakeholders in Afghanistan for sustaining delivery of the Basic Package of Health Services (BPHS) without external technical and financial assistance. A stakeholder analysis was applied using qualitative methods. Fifteen stakeholders were purposively drawn from the Afghanistan ministries of public health and finance, political representatives, development partners, nonprofit organizations and public health experts. Data were collected through in-depth interviews with the stakeholders and desk review of pertinent documents. We found that sustainability of the BPHS in Afghanistan is questionable as stakeholders are suboptimally organized to come up with effective alternatives. Uneven ownership and divisive positioning are bottlenecks to the evolution of a realistic continuation plan. Those with the most significant influence are lukewarm, while those who are most supportive have the least influence. Sustainability needs to be tackled at the start in designing the BPHS rather than in the wake of eventual donor withdrawal.

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.

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.

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.

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.

Critical thinking (CT) is a phenomenon of worldwide importance and is a desired outcome in higher and professional education. Development of CT is considered a primary responsibility of educators; however, educators find it challenging to foster learners’ CT if their own understanding of CT skills and concepts is not well developed. Limited research is available on how multidisciplinary educators perceive and practice CT. The study aimed to identify perceptions and practices of CT among educators from the disciplines of nursing, medicine, and education in higher education in Karachi, Pakistan. A descriptive exploratory qualitative design was used where 12 purposefully selected educators from three disciplines participated. Semi structured interviews were conducted and content analysis was done. Although the findings revealed four major themes, the focus of this paper is limited to the theme of faculty perceptions. Faculty’s perceptions of nature, acquisition, and application of critical thinking are multidimensional and although the educators were from various disciplines their perceptions of critical thinking were analogous. Thus combined efforts by all multidisciplinary educators in a higher education are needed to assist them to actualize their perceptions to promote CT practices in a classroom setting.

Critical thinking (CT) is considered an important attribute in practice disciplines and faculty members in nursing, medicine, and education are expected to facilitate the development of CT in their graduates so that these individuals can be critical, reflective, competent, and caring professionals and service providers (Distler, 2007; Shiau & Chen, 2008; Worell & Profetto-McGrath, 2007). When students are actively engaged in their learning, and classrooms have an enabling environment, critical thinking is promoted. Teachers must reflect upon their teaching pedagogy when students do not participate in stimulating discussions, or asks questions in class. Research suggests that lack of understanding of CT affects teachers’ CT practices in the classroom. Literature supports that teaching learning activities and opportunities that emphasize encouragement of students’ participation in classroom fosters communication, student engagement, creativity, self – directedness and critical thinking (Choy & Cheah, 2009). Thus it is vital to explore what CT practices can be performed by educators to influence students’ CT. The present study aimed to identify perceptions and practices of CT among educators from the disciplines of nursing, medicine, and education in higher education in Karachi, Pakistan. A descriptive exploratory design was used where 12 multidisciplinary educators participated in semi structured interviews and allowed classroom observations. Four major themes were identified, but this paper will explore multidisciplinary educators’ practices of CT in a classroom setting. The faculty needs to be aware of how their practices of critical thinking can create an enabling learning environment, and what factors in its physical, psychological and intellectual environment can affect critical thinking in students. Keywords: Enabling environment, Student engagement, Faculty practices, & Critical thinking

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.

Background: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women’s and men’s life prospects. Objective: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men’s and women’s life circumstances. Design: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings: Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions: This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women’s empowerment. Keywords: gender roles; gender inequality; women’s health; intimate partner violence; focus group discussions; Pakistan (Published: 2 November 2011) Citation: Global Health Action 2011, 4 : 7448 - DOI: 10.3402/gha.v4i0.7448

Critical thinking is an important outcome criterion of higher education in any discipline including nursing. If nursing programs envisaged preparing graduates who are equipped with critical thinking, then the educators who plan and deliver the programs must exhibit higher level thinking in their teaching practices. This paper presents finding of the 1st phase of a National level research study that aims to assess, develop and enhance educators’ critical thinking capacity.