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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/

Background and PurposeNo suitable scale was identified in literature that comprehensively measure self-efficacy of Pakistani breast cancer patients. The study aimed to develop a self-efficacy scale in Urdu language and determine its dimensions.MethodsThe scale was developed with input from experts and literature. It was administered, in crosssectional phase of two pilot studies, on breast cancer patients receiving chemotherapy. Post hoc internal consistency reliability was computed and principal component analysis (PCA) was performed.ResultsSES-U comprised 17 questions. PCA revealed a total of five factors explaining cumulative variance of 68.7%. These factors were self-confidence, faith, coping, optimism, and decision making. Post hoc internal consistency (Cronbach's alpha) value was high (∞ = 0.87).ConclusionsThe self-efficacy scale has acceptable validity and reliability and has potential to obtain information related to self-efficacy of cancer patients receiving chemotherapy.

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 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 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.

Background: Heart failure (HF) is the leading cause of hospitalisation among older people. It is one of the most debilitating chronic illnesses that severely affect patients' quality of life (QoL) by reducing their physiological as well as psychological capacities. The experiences of patients with HF from Western countries are well-highlighted in the literature, while there is a gap regarding the lived experiences of patients with HF in developing countries. Therefore, the current study aimed to explore the experiences of patients living with heart failure in developing countries such as Pakistan. Methods: Using the phenomenological approach, in-depth interviews were conducted with eight patients living with HF, encompassing variation in their age, gender, income, educational status and level of self-care. The content of the interview was analysed using steps from Morse and Niehaus. Results: The analysis of patients' narratives revealed four major themes: being restrained by the illness; fear of uncertainty; challenging adaptation to health-deviated needs; and role of the healthcare system in self-care. Conclusion: HF imposes limitations upon all dimensions of life owing to its worsening nature. However, in a developing country, the problem is further intensified by the constraints of the healthcare system. Therefore, ways to support patients with HF in developing countries need to be developed to improve their QOL.

Background: Self-care in heart failure (HF) is essential to improve Quality of Life (QoL) and reduce hospital readmissions. It is a well-researched phenomenon in western countries but still unexplored in developing countries like Pakistan. Aim: The aim of this study was to explore the level of self-care behaviour (SCB) and its associated factors among patients with HF in Karachi Pakistan. Methods: In a cross-sectional survey, SCB was measured from 230 patients with HF, using the European Heart Failure Self-Care Behavior scale (EHFSCBs_9). Its associated factors were assessed via a self-developed checklist prepared by the researcher (lead author). Results: The overall mean of SCB was 29.73+/-7.03. As a result of multi-variable regression analysis, out of the six variables, only three variables were significantly associated with SCB, explaining the 23.4% variance. These variables were education; income; and chronicity of HF diagnosis. Conclusion: The findings of the study suggest that public health initiatives in the form of supportive-educative interventions are a dire need to enhance self-care among patients with HF.

Purpose This study was undertaken to determine the effects of individualized education with support intervention on breast cancer patients’ anxiety and depression while undergoing radiation therapy (RT). Moreover, the intervention was assessed for its feasibility in the context of Pakistan. Methods A quasi-experimental design was used to conduct this study in RT department of a public hospital in Karachi. A total of 61 breast cancer patients receiving radiation as adjuvant therapy participated in the study. The experimental group (n = 31) received individualized education with support in the form of face-to-face sessions and information booklet prior to the commencement of RT. In addition, the nurse remained available for the consultation during the RT sessions and on telephone throughout the RT period. However, the control group received only information booklet. Patients' anxiety and depression were measured in both of the groups before the commencement of RT, and at the completion of RT by using the Aga Khan University Anxiety and Depression Scale (AKUADS). Results A significant reduction was found in the overall mean anxiety and depression scores of the experimental group (p = 0.000) from pre-test to post-test. The overall mean anxiety and depression scores of the control group showed no significant difference (p = 0.187). The effect size of the intervention was large (Cohen's d = 2.5). Conclusion The intervention was effective in reducing anxiety and depression among breast cancer patients receiving RT. Replication of the study on a larger scale in multiple settings on other cancer patients is recommended.

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.

Purpose This study aimed to determine the effect of individualized patient education along with emotional support on the quality of life (QoL) of breast cancer patients undergoing chemotherapy. It also aimed to determine the intervention's feasibility in the Pakistani context. Methods A quasi-experimental design, with pre- and post-test, in two groups, via time block, was used. The study was conducted at a public hospital in Karachi with a sample of 50 patients; 25 patients each in the intervention and control group. The intervention was delivered over a period of six weeks. It comprised verbal and written patient education, availability of a nurse during patients' chemotherapy administration and over the telephone, and a telephone follow-up of the patients by the nurse. patients' QoL was assessed at baseline and at the sixth week of receiving chemotherapy. Results Tests indicated a significant improvement in the overall QoL, breast cancer subscale scores, and the physical and emotional well-being of the intervention group, as compared to the control group. The intervention effect size was moderate (0.655) for the QoL. Conclusion The intervention was found to be effective in improving patients' QoL. However, a larger study, in a multi-center setting, is recommended to ascertain the findings of this pilot study.

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.

The purpose of this paper is to examine the advantages and challenges of co-supervision of doctoral students, as found in the literature and from our experiences. We define co-supervision and then discuss the process in detail. Examples are based on experiences of co-supervision from faculty perspectives as well as from the point of view of a former doctoral student. We propose that the advantages of co-supervision far outweigh the challenges and should be regularly considered by seasoned academics to enhance student learning. In addition, we suggest that co-supervision is intellectually stimulating for academics.

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.

Purpose: To describe international trends on the developing role of the nurse practitioner-advanced practice nurse (NP-APN), including nomenclature, levels and types of NP-APN education, practice settings, scope of practice, regulatory policies, and political environment. Design: A cross-sectional, descriptive Web-based survey sent in February and March 2008 to a total of 174 key informants and active members of the International Nurse Practitioner-Advanced Practice Nursing Network of the International Council of Nurses. Methods: An international Web-based survey preceded by a pilot survey. Findings: Ninety-one nurses from 32 countries responded. Thirteen titles were identified on nomenclature for the NP-APN in different countries. NP-APN education was available in 71% of the 31 countries responding to this item, with 50% identifying the master's degree as the most prevalent credential. Twenty-three countries had formal recognition of the NP-APN role. Of these, 48% had licensure maintenance or renewal requirements for the NP-APN, with most requiring continuing education or clinical practice. The greatest support for the NP-APN role came from domestic nursing organizations (92%), individual nurses (70%), and the government (68%), while opposition came primarily from domestic physician organizations (83%) and individual physicians (67%). Conclusions: Interest in the NP-APN role has been gaining ground worldwide. This study presents a snapshot of education, practice, and regulation for NP-APNs as they develop their unique role in delivering health care in various countries. Areas that may require more support are highlighted. Clinical Relevance: The NP-APN role in healthcare systems is expanding and will benefit from international networking and support.

In the past decade an increasing emphasis has been placed on the importance of critical thinking in nursing. Nurse educators are faced with the challenge of finding ways to promote and evaluate critical thinking in nursing students, and various teaching strategies have been identified to achieve this goal. Concept maps are considered a powerful metacognitive tool that can facilitate the acquisition of knowledge through meaningful learning. Hence concept mapping can be used to promote and evaluate critical thinking. Based on the published nursing literature, the scope of concept mapping is discussed in this paper as a teaching and evaluation strategy for critical thinking in nursing education.

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.

Because of the increasing demand for nurses entering professional practice to have a baccalaureate degree, the pressure to have faculty members prepared at the graduate level is also mounting. Due to personal, economic, or organizational factors, faculty members may undertake graduate studies at the institutions where they teach. No research has been found regarding the implications of nursing faculty members becoming students in the same institution. Thus, this qualitative descriptive study was performed to understand the implications. Data were collected through semistructured interviews from 12 participants. Interviews were recorded and transcribed verbatim for content analysis. The findings revealed that faculty members who became graduate students in their own institution had advantages that facilitated their learning. However, they received mixed messages about their identity as both a student and a faculty member. Implications for this dual identity on the learning environment are discussed.

Aims and objectives. This article, based on the available literature, attempts to discuss the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers. Background. The inability to recruit and retain the required participants in a research project poses serious threats to both the internal and the external validity of a research study. Despite serious implications, the issues of recruitment and retention do not receive due attention in research and publications. Literature suggests a lack of coordinated efforts to collect information on the outcomes of recruitment experiences in clinical trials and population studies. Studies often mention the number of participants who refuse to participate; however, the majority of the studies often fail to mention the specific reasons insufficient recruitment or retention of the participants. Design. A methodological paper. Method. Various participant-, context-, environment- and research-related factors are examined that affect the phenomenon of recruitment and retention of the participants in a study. Results. Delayed or inefficient recruitment also has financial and ethical implications. Although there are many pieces of information scattered throughout academic journals on recruitment and retention of participants in research, few authors have dealt with the issue holistically. It is imperative for researchers to understand the importance of recruitment and retention of research participants, the associated barriers and challenges, and various strategies to overcome these barriers. Conclusion. Appropriate recording and reporting of the problems faced while recruiting and retaining the participants in research studies can help not only in understating the challenge, but will also help in devising the strategies to overcome this problem. This article was an attempt to synthesise and review the available literature on recruitment and retention issues, which demand extensive theoretical and conceptual thinking as part of the research design. Relevance to practice. An understanding of the challenges and issues related to recruitment and retention can help researchers to think ahead about the strategies to overcome these issues and consequently save the time and energy of the participants, researchers and funding agencies.

With the increasing complexities of health care and the associated strong advocacy for baccalaureate of science in nursing (BScN) program as entry to practice in the developing countries, gradually, nurse leaders are moving in that direction. Although extensive information is available in the literature about the outcomes of prelicensure BScN programs in developed countries, little is known about the outcomes of such programs in developing countries. In this article, we report strengths and challenges of the first prelicensure BScN program in Pakistan. Using a focused ethnographic approach, data for this study were collected mainly through semistructured interviews of the graduates from the first five cohorts of the BScN program and their supervisors at Aga Khan University, Pakistan. Interviews were tape-recorded, transcribed verbatim, and content analyzed for explicit and implicit patterns of themes, meanings, and understanding about the program. Findings of this study affirmed the worth of BScN program for preparing competent nurses that can contribute to the development of nursing in Pakistan. However, various contextual issues and challenges in the nurses work environment have affected the utilization and retention of these graduates and hence the perceived outcome of the program.

Advanced practice is the conceptual focus for the first Master’s of Science in Nursing (MScN) program in Pakistan. Initiated at the Aga Khan University School of Nursing (AKUSON) in October 2001, this full time two-year program aims to prepare nurses who are leaders in nursing practice with advanced knowledge and skills for their roles in either urban, rural, tertiary-care or community settings. The significance of the progress must be emphasized in a country where most nursing education takes place at diploma level and relatively few opportunities exist for nurses seeking a baccalaureate degree. Other countries developing graduate nursing programs may benefit from the expereince in Pakistan.

The paper presents the perceptions of educators from nursing, medicine and education discipline about the facilitators and deterrents of critical thinking (CT) in higher education in Karachi, Pakistan. Using a qualitative descriptive exploratory design, 12 university educators from three disciplines were recruited as study participants using purposive sampling. Data was collected through semi structured interviews and manually analyzed for themes and categories. Findings related to the theme of facilitators and deterrents of CT are presented in this paper. Study participants identified a variety of key factors related to teacher competence, nature of students, learning environment, and organizational ethos and resources that influence the implementation and promotion of CT in higher education.

Background : Written feedback is known to enhance students' learning. However, the effectiveness of feedback is determined by the quality of feedback and the students' receptivity towards written feedback. This study aimed to explore students' experiences of written feedback in the nursing degree programmes in Karachi Pakistan. Method : A descriptive exploratory design was used in the study. The study comprised of 379 nursing students from nine nursing institutions. Students filled out the questionnaire that had open ended questions regarding the current practices of written feedback. They also provided suggestions for improving these practices in their institutions. Nearly 93% of the students responded to the open ended questions. The information was than manually analyzed for categories and subcategories. Findings : Student shared numerous experiences and suggestions regarding written feedback. Five categories were extracted from students' narratives. These included: merit of verbal and written feedback; quantity and quality of the feedback including need for personalized feed-forward; care for students' self- esteem; teachers' competence for written feedback; and consistency in feedback practices. Conclusion : The findings of this study have implications for teachers, students and institutions similar to the context of this study. Teachers need to be aware of the role and impact of written feedback on students' learning and develop competence for giving effective feedback. Polices need to be developed to enhance the effectiveness of written feedback practices.

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.