Challenges in providing ethically competent health care to incarcerated older adults with mental illness: a qualitative study exploring mental health professionals’ perspectives in Canada

Background The population of incarcerated older adults is the fastest growing demographic in prisons. Older persons in custody have poorer health as compared with those in the community. The unmet and complex health care needs of incarcerated older adults with mental illness raise justice, safety, dignity and fairness in care as ethical concerns. As there exists research gap to better understand these concerns, the current study aimed at exploring the perspectives of mental health professionals on challenges in delivering ethically competent care to mentally ill incarcerated older adults in Canada. Methods Thirty-four semi-structured interviews were conducted between August 2017 and November 2018 with prison mental health professionals in Canada who were selected using purposive and convenience sampling techniques. The audio recorded interviews were transcribed verbatim and analysed inductively to generate themes. Results The results were distilled into three main categories and seven subcategories that related to ethical issues in the provision of health care for mentally ill incarcerated older adults. The main categories included imprisoned older persons with special care needs, lack of resources, and the peer-support program. Conclusions Results of this study showed that existing practices of care of mentally ill incarcerated older adults are characterised by challenges that increase their vulnerability to worse health conditions. It is imperative for local authorities, policy makers and representatives to prepare for and respond to the challenges that compromise ethically competent health care for, and healthy ageing of, mentally ill incarcerated older adults.

Perspective of Women about Her Body after Hysterectomy

Hysterectomy is the most common major gynecological operation in worldwide and Arabic countries. However, the psychological, physical and sexual consequences of hysterectomy are conflicting and the findings are mixed. While, some studies report that patients have experience greater improvement in their mental health, sexual desire and overall satisfaction. Others show that patients report various negative outcomes, with detrimental effects on sexual functioning being the main concern. My previous study demonstrated that hysterectomy had significantly negative effects on patients’ body image, self-esteem, and identified common meanings and themes associated with hysterectomy stressors, which includes difficulties or limitations in physical and psychological aspects perceived by patients after hysterectomy. In this chapter, author will expand that discuss in details the different factors that influence the perspective of women about body after hysterectomy. Mainly, author will focus on religious, cultural, and psycho-social aspects. All of these factors are interacting with health status of women and effect the situation and productivity of women in her family and culture. Different strategy need to be adopted in order to overcome this problem using evidence and analysis of our Arabic culture and structure. Recommendation of study to health care profession as physician, nurses, midwives and other health care provider to be aware of these potential problematic issues in order to provide a competent health care for women based of her needs.

Increasing Gender Awareness to Reduce Harm in Health Care

In this guest editorial, the author first discusses how gender is a historical and biopsychosocial construct. This means that there are many aspects of gender besides identity, such as gender expressions, roles and experiences. They address how this issue highlights some of these aspects but that these are not exhaustive, given the topic. They highlight how being able to consider our own gender identities, roles, expressions and experiences is an essential starting point if we are to be competent health-care providers. Finally, they suggest that stories might be one way to learn about aspects of gender we may not be as familiar with, as they allow us to connect emotionally, not just cognitively, with these aspects.

Implementation of problem-oriented learning sessions in para-clinical years of medical college

Background: In order to develop competent health care professionals and to help medical students to acquire clinical reasoning, critical thinking and problem-solving skills, it was decided to initiate problem-oriented learning (POL) sessions as a part of implementation of integrated learning in the second year of undergraduate education of medical students in a medical college. Methods: A group of 150 students in the second year of their undergraduate education was divided into 10 sets of 15 members each. For each weekly POL session, one lead department was identified and from that department, one faculty member was assigned for each of the 10 groups for clarity and guidance. Four to five departments in all were involved in these POL sessions based on the topic and were instructed to frame their objectives and share these with the lead department at least one week prior to each session to develop appropriate problems for discussion. Results: Initial results failed to meet the desired objectives. The entire exercise was restructured and attention was given to the areas where weaknesses were identified. Faculty members were provided with additional information about POL and the number of sessions was reduced to two per month. Faculty members were instructed to be discussion facilitators rather than to become involved in didactic teaching. Subsequently, a significant improvement was observed both in terms of outcomes and student participation. Conclusion: It is relatively easy to start a new mode of teaching-learning; however, outcomes improve when efforts are planned systematically and implementation is revisited after challenges and gaps are identified.