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Quality of life (QOL) has been studied extensively among cancer populations in high income countries where cancer care resources are available to many. Little is known concerning the QOL of cancer groups residing in Africa where resources can be scarce. The integrative review of the literature explored and critically examined studies that had addressed QOL in female cancer survivors in Africa. The extent to which QOL studies incorporated a cultural perspective was also examined. Research studies published between 2005 and 2015 were retrieved from five databases: CINAHL, MEDLINE, SCOPUS, ProQuest dissertations and Theses full text, and GlobalHealth. Primary qualitative or quantitative studies regardless of sample size or setting were included. A total of 300 studies were identified and 28 full text studies were retrieved and assessed for eligibility. Eight studies met inclusion criteria. Factors that affected the QOL were socio-demographic especially age, education, employment, income and residence; illness-related factors such as having advanced cancer and multiple symptoms; treatment-related factors associated with surgery and radiotherapy; psychosocial factors such as support and anxiety; and cultural factors including fatalism and bewitching. Practice implications entail increasing awareness among nurses and allied healthcare providers of the potential effects on QOL of a cancer diagnosis and treatment of female cancers such as pain, fatigue, sexual dysfunction, hormonal and body image changes, anxiety, depression and cultural practices. Failure to identify and deal with these may result in poor treatment adherence, low self-esteem, and ultimately poor QOL.

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OBJECTIVE: To explore the professional quality of life and associated factors among Ugandan midwives working in Mubende and Mityana rural district to recommend interventions to improve professional well-being and outcomes of midwifery care. BACKGROUND: Professional quality of life of midwives working in rural areas may be influenced by several personal and work setting factors of care professionals often impacting the quality and outcomes of patient care. METHODS: A cross-sectional study design was used to collect data from 224 midwives working in two rural districts of Uganda. FINDINGS: The majority of participants were female (80 %), with an associate degree in midwifery (92 %). The mean age and years of experience were 34 ± 6.3 and 4 ± 2.1 years, respectively. The mean scores on the professional quality of life scale showed average compassionate satisfaction (19 ± 4.88), burnout (36.9 ± 6.22) and secondary traumatic stress (22.9 ± 6.69). The midwives' compassion satisfaction was related to psychological well-being (p < 0.01) and job satisfaction (p < 0.01). Conversely, their burnout levels and secondary traumatic stress were associated with education level (p < 0.01), marital status (p < 0.01), involvement in non-midwifery health care activities (p < 0.01), and physical well-being (p < 0.01). CONCLUSION AND IMPLICATION TO PRACTICE: Midwives working in rural areas of resource-poor countries have moderate professional quality of life and tend to experience moderate to high levels of burnout, secondary traumatic stress and compassion satisfaction in their professional work. Therefore, employers need to provide deliberate work based services such as counselling, debriefing, training and social support to enhance midwives professional quality of life and quality of midwifery care and practice.

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One of the hardships faced by midwives in developing countries is dealing with maternal death. Taking care of pregnant women who end up dying makes midwives mindful of their own mortality and this experience provokes discomfort and anxiety. To determine the predictors of death anxiety among midwives who have experienced maternal death at work in order to recommend interventions to facilitate effective coping with the distress. An exploratory, descriptive design was used to collect data about death anxiety from 224 midwives working in two rural districts of Uganda. Death anxiety was measured using a subscale of the Death Distress Scale. The majority of participants were female (80 %) and with associate degree level professional education (92 %). Participant's mean age and years of professional experience were 34 (±6.3) and 4 (±2.1) years, respectively. Most participants (74.6 %) had moderate or high death anxiety. The predictors of death anxiety were: having witnessed two and more maternal death in the past 2 years [odds ratio (OR) = 3.175; p ≤ .01]; being in charge of four or more maternal deaths (OR = 5.13; p ≤ .01); lack of professional training in handling death situations (OR = 3.32; p ≤ .01); and coping with maternal death situations using methods such as: planning (OR = 4.90; p ≤ .01), active coping (OR = 3.43; p ≤ .05) and acceptance (OR = 2.99; p ≤ .05). Multiple exposure to maternal death situations is associated with an increase in death anxiety among midwives working in rural settings. Employers need to provide deliberate support to enable midwives to cope effectively with death anxiety at work.

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AIM: to explore the psychological outcomes of occupational exposure to maternal death and the coping methods used by midwives working in rural areas. BACKGROUND: maternal deaths are common in rural areas of developing countries because of the shortages of human and other resources needed for maternity services. When maternal deaths occur, midwives often experience emotional distress while striving to perform their work. This may have a negative impact on their well-being. METHODS: Descriptive design. A self-administered questionnaire in the English language, comprising the Death Distress Scale and Brief COPE Scale, was used to collect data from 238 midwives working in two rural districts of Uganda. FINDINGS: the majority of participants were female (81%) and had a diploma in midwifery (36%). Mean age and years of professional experience were 34 [standard deviation (SD) 6.3] years and three (SD 1.3) years, respectively. The majority of participants (94%) had witnessed a maternal death. The results from the Death Distress Scale showed that the majority of midwives who had witnessed a maternal death had moderate to high death anxiety (93%), mild to moderate death obsession (71%) and mild death depression (53%). Most midwives coped with their distress using methods such as active coping, venting, positive reframing, self-distraction and planning. CONCLUSION: midwifery educational programmes and work settings need to understand the importance of maternal death from the midwives' perspective and their ability to cope with this detrimental experience. IMPLICATIONS FOR PRACTICE: there is a need for midwifery practice settings to provide respite care, education on coping with death experiences and counselling after traumatic experiences in order to maintain the well-being of midwives. As occupational exposure to maternal death can have a negative effect on the well-being of midwives, this can affect their professional quality of life and clinical practice.

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Therapeutic touch (TT) is a valid nursing intervention but some patients feel uncomfortable with it because of personal beliefs. This commentary presents observations and experiences of the use of TT during care of Muslim patients in the Sultanate of Oman. There is need to teach nursing students deliberate steps when considering its use in Muslim patients because they increase acceptability and implementation in a culturally sensitive manner.

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OBJECTIVE: across Africa the prevalence of postpartum depression is a major health problem affecting mothers, their infants and families. The purpose of this study was to explore the factors associated with postpartum depressive symptoms (PDS) among women living in a rural Ugandan district. DESIGN: descriptive correlation design. SETTING: Young-Child's Clinic of a public hospital, providing postpartum care services to approximately 450 women and their babies per month in a rural district of Uganda. PARTICIPANTS: 202 postpartum women who have lived in the rural district both during pregnancy and postpartum period following birth of the current infant of age ≤12 weeks. MEASUREMENTS: PDS were measured using the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS: participants' mean age and number of children were 24±4.33 years and 2.85±1.26 children, respectively. Majority of participants were married (61%), delivered the current infant by normal vaginal delivery (91%) at a health facility (86%) and experienced no complications (80%). The mean EPDS score for the sample was 9.5±0.18 and 43% of the participants were found to have PDS (scores ≥10). Statistically significant relationships were found between PDS and factors such as number of female sexual partners the husband has (r=0. 28, p≤0.01); current problems in marriage (r=0.22, p≤0.01), participant's parity (r=-0.24, p≤0.05), infant's ability to breast feed (r=0.28, p≤0.05) and husband support during the postpartum period (r=0. 20, p≤0.05). CONCLUSION: male partners of postpartum women are a major source of factors associated with PDS in rural areas. IMPLICATION FOR PRACTICE: midwifery practitioners in rural settings should emphasise psychosocial assessment and male involvement in postpartum care to increase opportunities of identifying mothers at risk of PDS and implementation of interventions targeting men.

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BACKGROUND: The quality of nursing care in developing countries is poor, and attempts to improve it through continuing education programs are under way. Nurses' orientation toward lifelong learning has not been explored, despite its potential effect on the success of such programs. METHODS: The Jefferson Scale of Physician Lifelong Learning (JSPLL) was used to measure orientation toward lifelong learning among 200 nurses at Uganda's national hospital. RESULTS: Most participants had fair orientation (52%) toward lifelong learning (JSPLL mean score = 36.8 [SD = 7.2]) and rated their skills in self-directed learning as good or excellent (44%). Reported barriers to lifelong learning included patient workload, lack of mentors, lack of library resources, and lack of computer skills. Nurses' orientation toward lifelong learning was significantly associated with professional experience (p ≤ .05), age (p ≤ .05), and education level (p ≤ .01). CONCLUSION: In Uganda, nurses' orientation toward lifelong learning remains low, and this has implications for successful implementation of continuing education programs for nurses.

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Informal caregivers worldwide are faced with the dilemma of maintaining their health and meeting the caregiving demands of their loved ones. This study explores the health outcomes of caregiving, caregivers' health-promoting practices and the challenges to providing care among caregivers to children orphaned by AIDS in southwest Uganda. A descriptive design and interview questionnaires were used to collect data from 204 caregivers. The average age of the caregivers was 41.36 (±10.9) years and most of them (53%) were grandmothers to the orphans. The majority (65%) of the caregivers were caring for at least three orphans, had been in the caregiver role for more than five years (61%), and stated that their health had been negatively impacted by caregiving (61%). According to self-reports, the most common new health problems since taking up the caregiving role were chronic ill health (97%), social isolation (95%) and mental stress (92%). The health-promoting practices most often engaged in were eating a balanced diet (67%), seeking spiritual support (58%), and performing self-care activities (44%). The challenges to caregiving most often reported were poverty (88%) and a lack of time to seek personal medical care (59%). The predictors of self-reported poor health among the caregivers were stress (odds ratio [OR] = 3.43; p ≤ 0.01), caring for three or more orphans (OR = 2.19; p ≤ 0.01), female gender (OR = 1.77; p ≤ 0.01), and having spent more than five years as a caregiver to an orphan (OR = 1.35; p ≤ 0.01). The findings suggest that caregivers commonly experience poor health and their health-promoting practices are inadequate. There is a need for organised and formal health-promotion programmes for caregivers of children orphaned by AIDS, especially in rural areas of developing countries. Interventions for health promotion can be achieved through integrated programmes that provide health education, social services, respite from caregiving and counselling.