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Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.
To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.
A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.
Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.
Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.
No patient or public contribution.
This paper responds to the recently published article on nurses' turnover intentions and their lived experiences of disempowerment, moral distress and organisational neglect. While the study illuminates important workplace realities, it overlooks the perspectives of nurses who have left not only their institutions but also their countries of origin. From the vantage point of Filipino nurses in the diaspora, the decision to migrate mirrors the dynamic, cumulative processes described in the article. Migration is seldom the result of one critical incident; rather, it arises from entrenched systemic issues—understaffing, lack of respect and persistent undervaluing of nursing contributions—that transcend borders. Diaspora nurses bring with them narratives of resilience, yet their departure reflects health system fragility in their home countries and exposes new challenges in host nations. This commentary highlights the urgent need for global cooperation, stronger leadership and policy innovations that recognise migration as part of the retention equation, not apart from it.
This article challenges the tendency to frame diminished confidence and ethical uncertainty among nurses as individual shortcomings. While the need for up-to-date knowledge and moral clarity is undeniable, this piece argues that systemic factors—such as inadequate institutional support, unsafe staffing, and lack of access to continuing education—play a significant role in undermining nurses' ability to act ethically and confidently. Drawing from global case examples, including the Ebola crisis and the COVID-19 pandemic, this article highlights how moral distress often stems not from ignorance or weakness, but from structural barriers and ethical overload.
Hysterectomy, a common surgical procedure, is frequently associated with moderate-to-severe postoperative pain and a high incidence of postoperative nausea and vomiting (PONV). Dexamethasone, a corticosteroid, may help alleviate these symptoms; however, existing evidence is largely drawn from mixed surgical populations and does not specifically address its efficacy and safety in hysterectomy patients. This meta-analysis provides a focused and updated synthesis of randomised controlled trials (RCTs) in this population, incorporating time-stratified pain outcomes and subgroup analyses by dose, surgical approach, timing and route of administration to evaluate the role of dexamethasone in postoperative recovery.
Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
PubMed, Scopus, Google Scholar and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched through 1 November 2024.
We included RCTs comparing dexamethasone with placebo for postoperative outcomes in hysterectomy patients.
Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Meta-analysis was conducted using random effects models. Findings were summarised in GRADE evidence profiles and synthesised qualitatively.
15 RCTs (1362 patients) were included. Dexamethasone significantly reduced PONV (risk ratio (RR): 0.53, 95% CI 0.47 to 0.61, p2: 0% high certainty) and pain scores at 24 hours (mean difference (MD): –0.20, 95% CI –0.35 to –0.05, p=0.009, I²=0%, moderate certainty), 8–12 hours (MD: –0.60, 95% CI –0.88 to –0.31, p2: 27%, moderate certainty and 4 hours (MD: –0.43, 95% CI –1.07 to 0.21, p=0.19, 93%, moderate certainty). It also decreased the use of rescue antiemetics (RR: 0.57, 95% CI 0.43 to 0.75, I2: 39%, high certainty) and postoperative opioid consumption (standardised MD: –0.48, 95% CI –0.90 to –0.05, p=0.03, I2: 74%, low certainty). The effects of rescue analgesics and hospital stay duration were nonsignificant. Subgroup analyses showed consistent antiemetic efficacy of dexamethasone across doses, timings, routes and procedures. For pain, greater analgesic effects were seen with higher doses and perineural administration, particularly at 8–12 hours. The risk of bias was low in most studies, but evidence of publication bias was observed for the pain score outcome.
Dexamethasone is an effective adjunct in hysterectomy, significantly reducing PONV and postoperative pain at 8–12 and 24 hours, particularly with 4–10 mg doses. Benefits are consistent across routes, timings and surgical approaches, with greater early analgesia after perineural use. It reduces opioid consumption but has a limited effect on rescue analgesia, supporting its role as a complementary analgesic. While generally considered safe, current safety data are limited, highlighting the need for further research. These results support its use in multimodal recovery protocols and identify priorities for future studies in high-risk and diverse surgical populations.
CRD42024608067.
Australian First Nations children bear 8.5 times greater burden of early and recurrent ear and nasopharyngeal infections compared with non-Indigenous children. These disparities are compounded by structural inequities in access to healthcare. To better understand these patterns, we analysed the state-wide epidemiology of childhood myringotomy procedures in South Australia and conducted spatial analysis for its main metropolitan region—Adelaide—to examine the associations with socioeconomic status and distance to healthcare facilities.
A cross-sectional, population-wide study.
All persons who had myringotomy procedures performed between 2007 and 2022.
Annual, age and sex-specific incidence was calculated at the local scale (Statistical Area level 2, SA2). We used admitted patient care data from SA Health, providing comprehensive coverage of otitis media procedures across the population, including First Nations. We applied negative binomial regression to assess associations with socioeconomic status and distance to healthcare facilities, accounting for count-based data and overdispersion.
Myringotomy incidence among First Nations children ranged from 2.2 to 6.1 per 1000 child-years across SA2 regions, compared with 2.4 to 3.7 among non-indigenous children. For the whole population, overall annual incidence ranged from 2.7 to 4.2 for males and 2.0 to 2.9 for females, with higher incidence observed in several suburban areas of Adelaide. Myringotomy procedures were associated with socioeconomic status, with increased socioeconomic advantage associated with a 17% reduction in cases (relative risk 0.83, 95% CI 0.76 to 0.92) among First Nations children. Distance to healthcare facilities was associated with myringotomy for non-indigenous children but not for First Nations children.
This study found a higher incidence of myringotomy procedures among First Nations children, particularly in later childhood. Socioeconomic disadvantage was a driver, while geographic proximity to healthcare had limited influence. Future initiatives may benefit by prioritising culturally informed, community-led strategies focused on early intervention, prevention and equitable service delivery.
The aim of this study was to evaluate protocol adherence and its impact on inpatient mortality in patients with diabetic ketoacidosis (DKA) at a tertiary hospital in Karachi. The major hypothesis was that adherence to the DKA protocol reduces inpatient mortality.
This was a retrospective cohort study.
The study was conducted at the Aga Khan University Hospital (AKUH), Karachi, a tertiary care hospital in Pakistan.
The study included patients diagnosed with DKA and admitted to AKUH from 2017 to 2021. Eligibility criteria included patients aged 18 and older, excluding those with incomplete records or referred to other hospitals.
The primary outcome was inpatient mortality. The analysis included Cox proportional hazards regression. Secondary outcome measures included predictors of mortality such as hypertension, intubation, tachycardia and elevated creatinine levels.
Non-compliance with the DKA protocol (
Adherence to the DKA protocol is crucial for reducing inpatient mortality and improving outcomes, especially in low- and middle-income countries. Ensuring at least 70% compliance is vital. Recommendations include continuous training for healthcare providers, adequate staffing and resource optimisation. Future research should focus on interventions to boost compliance and explore other factors affecting protocol adherence to further enhance patient care.
Objetivo: caracterizar las producciones científicas sobre atención integral de salud, promovidas a través de políticas públicas para perso-nas que conviven con el Virus de Inmunodeficiencia Humana. Metodología: Revisión integrativa de literatura, a través de la búsqueda en las bases de datos PUBMED, LILACS y la biblioteca virtual SCIELO, utilizando los descriptores “Políticas Públicas de salud”, “Síndrome de inmunodeficiencia adquirida”, “Atención integral de salud” y el operador booleano “Y”, resultando en una muestra, después de leídos, de 12 artículos. Los resultados de este estudio nos permitieron identificar y clasificar el estado de las políticas públicas para la atención de esta población, en tres categorías: A: políticas y / o directrices insuficientes; B: Necesidad de mejoras e inversiones en políticas existentes; C: éxito de los programas, siendo imprescindible una articulación internacional de gobiernos y organismos no gubernamentales para la elaboración de políticas más ajustadas a las realidades y objetivando la atención integral de salud de esta población.
Rev Enferm;41(1): 22-27, ene. 2018. tab. [Artículo]
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