Rozprawy doktorskie na temat „Unsafe practice”

This study was conducted in the context of the regulation of professional nursing and midwifery practice in the Australian health care system. In this environment, professional regulatory authorities established by State and Territory legislation in all jurisdictions, regulate and control the work of health professionals. In Queensland, registered nurses, enrolled nurses and midwives are regulated by the Queensland Nursing Council, the statutory body created by the Nursing Act 1992 (Qld). Part of the regulatory role of this and other authorities is to discipline professionals whose conduct or behaviour falls short of appropriate and acceptable standards of practice. All regulated health professionals, including nurses and midwives, are potentially subject to professional disciplinary action if a complaint is lodged in relation to their conduct. This being an important issue in the management and delivery of health care, and an increased trend among health care consumers, the dearth of existing research into the disciplinary process is a major concern. This exploratory study examined the disciplinary role of the Queensland Nursing Council in adhering to its legislative mandate to ensure safe and competent nursing practice. The study focused on the extent to which structural (legislation and policy), professional, and process factors impacted on the outcomes of disciplinary Tribunals and Committees in cases of incompetent or unsafe practice and sexual misconduct. The study was situated within the interpretive paradigm using a case study approach. Specifically, it investigated cases of sexual misconduct by nurses and unsafe or incompetent practice by midwives. The study was guided by Donabedian's conceptual framework of structure-process-outcome. This framework was seen to be most suited to the aims of the study and provided a template for in-depth analysis of the data emerging from the two cases. The findings of this study provided insight into the factors underpinning the decisions of the disciplinary bodies in making determinations and formulating outcomes. There was found to be a lack of consistency and predictability in both the legislative frameworks and the interpretation of terms and concepts used to identify conduct warranting a disciplinary response from regulatory authorities. Although the processes of disciplinary proceedings are prescribed by both legislation and policy, their practical application was characterised by considerable challenges, which resulted in varying outcomes. The thesis reports this information so that it can be used as an initial basis to build a body of knowledge from practical experience with disciplinary proceedings that will inform future processes. Subsequent case studies in other contexts and systems will increase the level of knowledge available to nurses, other health care providers, health care institutions and regulatory authorities. The initial base of evidence suggests implications for practice, education and further research which are outlined in the final chapter of the thesis.

This study was conducted in the context of the regulation of professional nursing and midwifery practice in the Australian health care system. In this environment, professional regulatory authorities established by State and Territory legislation in all jurisdictions, regulate and control the work of health professionals. In Queensland, registered nurses, enrolled nurses and midwives are regulated by the Queensland Nursing Council, the statutory body created by the Nursing Act 1992 (Qld). Part of the regulatory role of this and other authorities is to discipline professionals whose conduct or behaviour falls short of appropriate and acceptable standards of practice. All regulated health professionals, including nurses and midwives, are potentially subject to professional disciplinary action if a complaint is lodged in relation to their conduct. This being an important issue in the management and delivery of health care, and an increased trend among health care consumers, the dearth of existing research into the disciplinary process is a major concern. This exploratory study examined the disciplinary role of the Queensland Nursing Council in adhering to its legislative mandate to ensure safe and competent nursing practice. The study focused on the extent to which structural (legislation and policy), professional, and process factors impacted on the outcomes of disciplinary Tribunals and Committees in cases of incompetent or unsafe practice and sexual misconduct. The study was situated within the interpretive paradigm using a case study approach. Specifically, it investigated cases of sexual misconduct by nurses and unsafe or incompetent practice by midwives. The study was guided by Donabedian's conceptual framework of structure-process-outcome. This framework was seen to be most suited to the aims of the study and provided a template for in-depth analysis of the data emerging from the two cases. The findings of this study provided insight into the factors underpinning the decisions of the disciplinary bodies in making determinations and formulating outcomes. There was found to be a lack of consistency and predictability in both the legislative frameworks and the interpretation of terms and concepts used to identify conduct warranting a disciplinary response from regulatory authorities. Although the processes of disciplinary proceedings are prescribed by both legislation and policy, their practical application was characterised by considerable challenges, which resulted in varying outcomes. The thesis reports this information so that it can be used as an initial basis to build a body of knowledge from practical experience with disciplinary proceedings that will inform future processes. Subsequent case studies in other contexts and systems will increase the level of knowledge available to nurses, other health care providers, health care institutions and regulatory authorities. The initial base of evidence suggests implications for practice, education and further research which are outlined in the final chapter of the thesis.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing
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In this mini-dissertation the aim was to explore and describe the safety of infant feeding practices. It is argued that safe infant feeding practices can have a positive and long term effect on the health status and growth development of all infants. World wide, countries but more specific developing countries, are faced with the growing dilemma of high mortality and morbidity rates among infants. The need to find a way to eliminate and prevent the causing factors of life-threatening infectious diseases like diarrhoea and HIV/AIDS is now more important than ever before. A sound nutritional foundation together with safe infant feeding methods play a predominant role in ensuring the very survival of the infant. A cross-sectional, descriptive research design was used in this study. Non-probability sampling was used to identify the sample who complied with the set selection criteria. The research took place in a semi-urban community as the community serves a large group of mothers and infants as well as being accessible to the researcher. The semi-urban community was also identified as an area with health care needs that could be addressed in the research project. A questionnaire was adapted from an existing WHO assessment tool. A pilot study was conducted after which the questionnaire was finalised and the questionnaires were completed with the aid of three fieldworkers. Data collection took place until the sample size (n=155) was achieved according to the calculation of the statistician. The data analysis was done by means of descriptive statistics such as frequency, percentage, mean and standard deviation by using the STATISTICA data analysis software system programme. The results of the research study indicated that the majority of participants practice mixed feeding methods which do not comply with safe infant feeding standards. Infant feeding methods are not changed during illness or disease experienced by either the mother or infant, which again may greatly compromise their health status. The uptake of HIV testing and disclosure were relatively high. Recommendations are made for nursing education, nursing research and nursing practice with special focus on establishing safe infant feeding practices.
Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2008.

Young people have high rates of risk-taking, including alcohol use/abuse and high risk sex. The main purpose of this study was to gain insight into the drinking patterns and sexual behaviour of young UWC students. The aim was to investigate the relationship between alcohol use and unsafe sex practices (such as unplanned sex, multiple partners, and non/inconsistent condom use) and to identify any shifts in sexual practices in response to the HIV/AIDS crisis.

This thesis is the first full-length study of the fiction-of Kathy Acker, a radical and transgressive American female writer (1947-1997). The study maps the development of Acker's fiction by focusing on the political dimension of her aesthetic strategies. It explores the politics of plagiarism and appropriation; the subversive representation of gender and sexual politics; and the anarchistic impulse of Acker's work. The main theoretical and political approaches employed are: feminist theory, poststructuralism, abjection and anarchism. The study begins with an introduction to Acker's life, since there is a significant if problematic autobiographical impulse in her writing, and her socio-cultural context. It proceeds to a detailed critical exploration of work published between 1968 and 1986, drawing attention to Acker's affinities with a poststructuralist project. Acker's strategies of juxtaposition, paradox, and contradiction, alongside her fragmented, non-linear, digressive narratives, are read as a form of social critique. Her use and abuse of the white, male, Euro-centric canon is examined in light of the construction of female sexuality, and Acker's focus on phallocentric language as a source of subjugation is also considered. The study then argues for and interrogates Acker's move towards a more affirmative narrative strategy before looking in detail at her fiction of the 1990s - fiction which, until now, has received slight attention. Through close readings of her later novels, the study illustrates how Julia Kristeva's concept of the abject is fruitful for an examination of Acker's work, and examines cross-cultural intertextuality (from the horror film to the avant-garde). It also relates the trope of piracy that is present in Acker's later works to the political ideology of anarchism. The conclusion to the thesis argues that Acker's strength lies in her uncompromising belief in the avant-garde, and details her sustained attempt to make critically incisive political art.

This thesis analyzes the relationship between Swedish video game companies and the institutions for Archive, Libraries and Museums (ALM). The aim is to further the discussion regarding preservation of digital games. The thesis is based on semi-structured interviews with four video game companies and three institutions; an archive, a library and a museum. The theoretical foundation resides within practice theory, with the assumption that a practice is a combination of what people do and what they say. By analyzing what video game companies say they do the authors ascertain which methods of preservation is currently. The analysis is a cross-examination of the seven interviews with the result indicating that while video game companies are interested in the preservation of digital games they do not participate actively in the discussion on the best method of doing so. Communica- tion between video game companies and ALM institutions has room for improvement, as it is virtually non- existent. Furthermore, the findings indicate different motivations for preserving games and it is unclear which perspective the preservation should have; a technical perspective, cultural perspective or for the company’s bene- fit. In conclusion the current situation is that ALM institutions preserve games with a cultural and/or a technical perspective while game companies preserve their games for the company’s benefit.

Magister Public Health - MPH
Introduction: In-house contamination of drinking water stored in wide-mouthed buckets (even with lids) has been widely reported in epidemiologic investigations as vehicles for diarrhoea disease transmission. The long handled mukombe cup (LHM cup), recently developed by the National Institute of Health Research (NIHR), a department of the Ministry of Health and Child Care (MoHCC) in Zimbabwe, is a promising low cost dipping devise for extraction of water from wide-mouthed containers. Aim: The study aim was to assess the effectiveness and household acceptability of the long handled mukombe cup in reducing bacteriological contamination of drinking water stored in wide-mouthed vessels in the home in a peri urban settlement in Harare, Zimbabwe. Methodology: A randomised controlled trial of a long handled mukombe cup was conducted in Hatcliffe, Harare. After collecting baseline data on demographics, household water quality, and other sanitation and water handling practices, households were given basic health education before the two selected communities were randomly assigned to one of the two groups of 119 households each. The intervention group received the LHM cup while the control group received no intervention. Households were followed up after two months and assessed effectiveness and user acceptability of the intervention. Data Analysis: Data analysis was conducted using STATA 11. Descriptive statistics were calculated and reported as percentages, proportions, frequencies and measures of central tendency. Bivariate statistics were carried out to test independent associations between use of the LHM cup and E. coli. All analyses were conducted in an intention-to-intervene analysis. Results: A total of 230 households were analysed during follow-up. Samples of stored drinking water from intervention households were significantly lower in E. coli levels than those of control households (geometric mean E. coli of 0.8/100 ml vs 13.0/100 ml, p <0.0001). Overall, 78.4% (987/111) of samples from the intervention households met World Health Organization (WHO) guideline value of 0 cfu/100ml sample, while 52.1% of the 119 samples from control households met such a benchmark (p < 0.0001). In addition, 94.6% of intervention household samples were in compliance with this intervention or presented low risk, 27.7% of samples from control group households presented intermediate or high risk. There was a statistically significant association between LHM cup use and reduced E. coli bacterial contamination in stored drinking water (p < 0.05). There was no statistically significant difference in turbidity in both intervention and control groups, both for turbidity <5 and >5 (p = 0.071). Acceptability of the LHM cup was very high (100%). Conclusion: To our knowledge, this is the first study on the evaluation and acceptability of the LHM cup in the Sub-Saharan Africa. Positive results were recorded that showed that the LHM cup was effective in minimising E. coli contamination in the intervention group as compared to the control group. It is postulated that this is because the LHM cup reduces hand contact with stored water during scooping, thus maintaining improved water quality in communities in Zimbabwe that collect and store drinking water in wide-mouthed containers with lids where extraction is by scooping. However, more research is required to document the LHM cup's continued and effective use, durability and overall sustainability in the absence of any serious sampling or monitoring.

Thesis (MPhil)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: The objective of this study was to measure the level of HIV and Aids knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape. The study served to recommend guidelines for effective and enhanced targeted intervention response for MSM student community. A total of 36 MSM students aged between 19 and 36 (of which most were South African, black and Xhosa speaking) were recruited to take part in the study. Selection was done via snowball sampling. Respondents completed questionnaires upon consenting to participate in the study. The study found moderately high levels of basic HIV knowledge among the sampled MSM population. There were, however, lower levels of knowledge reported regarding the associated risk and effective prevention strategies of anal sex when compared to similar information about vaginal sex and oral sex. Findings also show that participants had very positive attitudes towards HIV testing, condom use and a non-discriminating environment. Respondents lacked confidence in both management and student leadership with regards to their responsibility in mitigating homophobia/discrimination against MSM student population. Furthermore, a high number of respondents reported having sex with men and women as well as multiple sexual partnerships. Self-reported alcohol and drug use were found to be very low, with the majority of participants indicating non-use. Participants stated little challenges accessing health care services. However, respondents felt MSM specific information about health care related rights and needs were lacking. Recommendations from this study include current HIV and Aids policy reform, mainstreaming MSM-friendly health care services, introducing combination HIV prevention programmes such as Mpowerment and addressing the human rights needs of MSM.
AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die vlakke van MIV en Vigs kennis, houdings en veilige seksuele praktyke onder manlike studente wat seks het met mans (MSM) by 'n hoër onderwys instansie in die Wes-Kaap te meet. Die studie het gepoog om riglyne daar te stel vir die bewerkstelling van effektiewe en verbeterde geteikende intervensies vir die MSM studente gemeenskap. Daar was 36 MSM studente tussen die ouderdomme van 19 en 36 (meestal Suid-Afrikaans, swart en Xhosa-sprekend) gewerf vir die studie. Seleksie is gedoen deur middel van die sneeubal steekproef-metode. Deelnemers het 'n vraelys voltooi nadat hulle ingewillig het om deel te neem aan die studie. Deelnemers het matig tot hoë vlakke van basiese MIV en Vigs kennis getoon. Daar was egter laer vlakke van kennis oor gepaardgaande risiko’s en effektiewe voorkoming strategieë ten opsigte van anale seks in vergelyking met dieselfde informasie oor vaginale en orale seks. Die studie het verder bevind dat deelnemers baie positiewe houdings gehad het teenoor MIV-toetsing, die gebruik van kondome en 'n nie-diskriminerende omgewing. Verder het hulle min vertroue getoon in beide die bestuur en studente leierskap se vermoë om sake wat verband hou met homofobie en/of diskriminasie teen die MSM studente bevolking, effektief te hanteer. Daar is gevind dat baie respondente seks het met mans en vroue en ook verskeie seksuele maats het. Self-gerapporteerde alkohol- en dwelmgebruik was relatief laag onder respondente met die meerderheid wat aangedui het hulle glad nie alkohol of dwelms gebruik nie. Deelnemers het ook rapporteer dat gesondheidsdienste vir hulle maklik toeganklik is. Respondente het ook gevoel dat MSM spesifieke informasie oor gesondheidsverwante regte en behoeftes tans ontbreek. Aanbevelings wat voortspruit uit hierdie studie sluit in die hersien van die huidige MIV en Vigs beleid, die skepping van MSM-vriendelike dienste, die implementering van MIV-voorkomingsprogramme soos Mpowerment en die bevordering van menseregte wat verband hou met MSM.

O presente estudo enfoca o trabalho penoso e as consequências nocivas à saúde dos trabalhadores que exercem atividades penosas, com evidência na reparação social dos danos e com fundamento nos princípios ambientais. Analisam-se o trabalho na sociedade atual, o processo de organização do trabalho, a globalização da economia, a precarização das relações de trabalho e os impactos sobre a saúde dos trabalhadores. Os princípios ambientais são estudados, bem como todo o arcabouço constitucional e legal de proteção ao direito à saúde no trabalho. Efetua-se o debate acerca do papel da sociedade civil, das entidades sindicais, dos empregadores, bem como dos poderes públicos, na fiscalização do meio ambiente de trabalho e na prevenção de doenças e acidentes do trabalho. A responsabilidade do empregador é examinada à luz da doutrina e da jurisprudência predominante nos nossos Tribunais. Realiza-se o estudo de doutrina sobre medicina do trabalho, em especial de ergonomia, psicologia do trabalho, bem como de textos de filosofia e sociologia do trabalho, economia e administração de empresas, para a caracterização da penosidade. Por fim, são debatidas formas de reparação dos danos, descartando-se a via da monetização do risco. Propõe-se a revogação de legislação em vigor, para que nova normatização efetivamente imponha aos responsáveis pelos danos causados aos trabalhadores, os empregadores que exigem tarefas ou condições de trabalho no limite do risco proibido, o dever de arcar com as despesas da reparação, de ressarcimento dos benefícios que serão gastos pelos cofres públicos.
This study approaches the unsafe or overly strenuous labor practises and its nocuous effects on workers health, especially the compensation of the social harms based on the environmental principles. An analysis of the work in the current society is undertaken, along with that of the work organization process, of the economic globalization, of the deterioration of the working conditions and the impacts on the workers health. The environmental principles are addressed, as well as the entire occupational health protection legal framework, along with the debate regarding the roles of society, trade unions, employers, as well as the role of the government on investigating the work environment and preventing labor accidents and diseases. The employers responsibility is examined, according to the prevailing doctrine and cases. There are the doctrine studies regarding occupational medicine, especially ergonomics, occupational psychology; including the study of texts relating to labor philosophy and sociology, economy and business management, in order to distinguish the laboriousness. Lastly, there is the discussion about the compensation of the damages, excluding the commodification of the risk. The proposition repeals the current act, in order for the new statute to effectively hold the employers accountable for the damages caused to the employees, through the burden of bearing the costs of the reparation, as well as the reimbursement of the expenses incurred by the Treasury.

Research Doctorate - Doctor of Philosophy (PhD)
This thesis is titled ‘Nurses’ recognition and response to unsafe practice in their peers’. Using a mixed methods approach, this study aimed to identify the behaviours and cues that nurses recognised as indicating unsafe practice and the factors which they perceived influenced the occurrence of unsafe practice by their peers. In addition, this study sought to report the actions and responses by nurses when they encountered unsafe practice by their peers. During Phase One a small number of participants were interviewed about their perceptions of working with colleagues they thought were practicing unsafely. Data were analysed using open coding and content analysis and resultant categories included types of unsafe behaviour, intentions and values, cues to identifying unsafe practice, responses to unsafe practice, actions to address unsafe practice, barriers to addressing unsafe practice, enablers for addressing unsafe practice, effects of unsafe practice on patient safety, conditions that create unsafe practice and conditions that promote safe practice. Data from this phase were used in combination with information from relevant literature to develop the survey used in Phase Two of the study. The Phase Two survey collected quantitative data from nurses in New Zealand about organisational practices and policies for the prevention of unsafe practice, identification of the potential for unsafe practice, identification of behaviours and factors associated with unsafe practice, and nurses’ responses to unsafe practice. The prevalence of witnessing unsafe practice in the previous 12 months was similar for nurses and managers, and higher than reported in other studies. All the behaviours in this survey were found to be strongly associated with unsafe practice. Unprofessional behaviour was identified as being related to unsafe practice by the majority of participants. Comparisons between nurses and managers showed that managers had a better understanding of organisational approaches to assessing practice and were more likely to formally report a colleague for unsafe practice. Issues such as poor organisational culture and leadership, inadequate training, workload, staffing and skill mix were identified by both groups as factors that influenced the occurrence of unsafe practice. The rate of reporting unsafe practice was lower than in other studies and the odds of reporting were significantly higher for managers. Participants reported a variety of different responses to witnessing unsafe practice, with the most common action being speaking to the nurse involved. A qualitative-descriptive approach was used to collect and analyse data in Phase Three. Interviews from Phase One and Phase Three were analysed together and data were coded into seven categories and thematically analysed. Final codes were grouped into recognition and responses. Cues to unsafe practices included overconfidence, hiding practice, complacent attitude and approach, scope of practice transgressions, unprofessional behaviour, failure to follow accepted practice standards, poor interpersonal and communication skills, culturally unsafe behaviour and bullying as a precursor. The influence of collegial and organisational culture on the recognition of unsafe practice was also identified. Interview participant responses included the challenge of taking action, watching and waiting (increased vigilance), the influence of a perceived lack of responses, self-monitoring as a response, the effect of collegial and organisational culture on response, and the conditions that influenced responses to unsafe practice. Themes of uncertainty, sensing unsafe practice, and disrupted professionalism emerged from the data analysis. A micro-meso-macro framework was developed to illustrate and evaluate the recognition of, responses to, and influences on unsafe practice, at the level of the individual, team/organisation and the wider health care system. In addition, a critical realist lens was used to provide insight into the structural and cultural mechanisms that influence unsafe practice. In conclusion, recognition of, and response to unsafe practice was a fraught process for nurses. In addition, although reporting requirements exist, this process was assumed to be linear. However, this study showed that recognising and reporting unsafe practice was influenced by enablers and barriers that resulted in a highly complex process. The results provided comprehensive insight into the behaviours and cues that nurses recognised as indications of unsafe practice and how they responded to unsafe practice by their peers. When unsafe practice is recognised, organisations should have a response which focuses on excellent clinical practice. Organisations require policy and guidelines which are non-punitive and support practice improvement. There is scope for future research studies to extend this work and identify early interventions to decrease instances of unsafe practice.

yes
Background The issue of opioid use and misuse is current and topical at present with reports of opioid epidemics in the USA and the increasing use of opioids in other parts of the world. The New Scientist asserted that America was in the throes of an opioid epidemic with reports of fatalities linked to physical contact with fentanyl. Discussions have progressed from an American focus to speculating on the spread of this issue to UK cities, Glasgow in particular. Safety issues have more recently come to light regarding the physical application and management of specific drug forms e.g. opioid transdermal patches (OTPs). The prescribing, application and safe disposal of OTPs within both healthcare settings and personal dwellings is critical to the effective use of these products. Healthcare professionals have a duty of care and responsibility to ensure the safe application and disposal of OTPs. Aims The aims of this study were to 1) gain insight into current practices of healthcare professionals regarding OTPs (fentanyl and buprenorphine) disposal practices and 2) identify Abstract knowledge and system awareness surrounding the disposal of these products in care home settings. Methods We decided to focus on care homes due to the estimated high prevalence of prescribing of OTPs in these care settings. The study was undertaken by the University of Bradford School of Pharmacy in 2015 and the participant sample focussed on the North of England (UK). Results The findings (based on 56 survey responses) displayed a significant variation in current disposal practices and a lack of specific working policies. We unearthed anomalies in the participants’ knowledge of the active ingredient volume held in depleted patches which, if not disposed of correctly, can lead to harm. This has highlighted the need for more thorough training and education on the safe and effective management of OTPs. Conclusions Further education and training is needed regarding safe disposal practices of OTPs, with the suggestion of pharmacist-led interventions. This will minimise confusion and reinforce safe disposal practices (denaturing products) and support the reduction of unsafe disposal practices (domestic waste or flushing).

The purpose of this study was three fold: 1) to determine if false consensus effects would be found for estimates of sexual behaviors, 2) to determine the directional accuracy of consensus estimates for subscribers and nonsubscribers and 3) to determine if the degree of accuracy of those estimates was influenced by self-esteem, sexual esteem, collective self-esteem, and religiosity. A questionnaire was administered to a sample of 821 university students to gather consensus estimates for twelve sexual behavior items. False consensus effects were found for all twelve behavioral items and further analysis was done to determine the directional accuracy of the estimates as well as to determine what motivational factors might influence the degree of accuracy of the consensus estimates. The specific motivational factors examined were self-esteem, sexual esteem, collective self-esteem, and religiosity. These four factors were measured using the following scales: 1) the Self-Esteem Scale (SES) (Rosenberg, 1965), 2) the Sexuality Scale (SS) (Snell & Papini, 1989; Wiederman & Allgeier, 1993), 3) the Collective Self-Esteem Scale Revised (CSES-R) (Luhtanen & Crocker, 1992) and 4) the Scale of Attitude Towards Christianity (Francis & Stubbs, 1987; Francis, 1989). Results of the study indicated that although significant false consensus effects were found for all twelve behavioral items, the directional accuracy of subscriber's estimates of consensus was not consistently or predictably different from the directional accuracy of nonsubscriber's estimates of consensus. A motivation theory for false consensus effects as measured by the self-esteem scale, sexuality scale, collective self-esteem scale, and religiosity scale used in this study was not supported.
Graduation date: 1995

Background: Much of the research on injection drug use practices has focused on adult populations and relatively little is known about safer and/or unsafe injection practices among youth who use injection drugs (YWID). Unsafe practices may be risk factors for blood borne illnesses, abscesses or other infections, and overdose. Multiple factors may create barriers to the access of clean supplies and the ability to practice safer injection. It is important to understand how YWID engage in safer and/or unsafe injection practices so that use of safer practices may be supported. Purpose: The purpose of this study was to explore the understandings and practices of safer and/or unsafe injection drug use among YIWD, as well as key social factors influencing these understandings and practices. Methods: Ten semi-structured qualitative interviews were conducted with YWID aged 18 to 29 in Halifax, Nova Scotia. Voluntary informed consent was obtained prior to conducting the interviews. All interviews were audio-taped and transcribed, then analyzed using a modified approach to grounded theory for key themes and subthemes. Results: The experiences of the YWID can be categorized into two overarching themes. The first theme relates to the power of the drugs and the control (or, at times, lack of control) YWID have over safer practices. This theme explores how access to clean supplies and understandings of safer use can influence the control YWID have over safer practices. The second theme describes experiences YWID have with “getting clean,” or gaining power over drugs, including experiences with methadone maintenance treatment. Discussion: YWID can and do practice safer use, however multiple factors, such as the perception of cleanliness in injection practices and the availability of clean needles in the community, impact how YWID understand and practice safer injection drug use. Barriers that impede YWID’s ability to practice safer use need to be addressed.

The purpose of this qualitative research study was to understand the facilitators and/or barriers to safer drug use and sexual practices among a sample of young female injection drug users (IDUs) who live in small towns/rural communities in Cape Breton, Nova Scotia. This study examined how economic status, relationships, social roles, small town/rural living, and stigma function as facilitators and/or barriers to safer practices. Eight female IDUs aged 20-31, living in small towns/rural communities in Cape Breton, engaged in face-to-face, semi-structured interviews. The women described what day-to-day life is like for female IDUs living in small towns/rural communities. They spoke about managing drug addiction, their understanding of safer and unsafe injection drug use and risky and safer sexual practices, as well as their experiences with services/supports. The information obtained from this study will help to inform harm reduction policy and program initiatives.

This study investigated coercive and high risk sexual practices in South African adolescent dating relationships. Quantitative and qualitative information was collected from secondary school learners in a community near Johannesburg. Of 928 learners surveyed, 23.5% of females and 53.7% of males ever had sex. Of these, 57.8% of females and 44.2% of males reported sexual victimisation, and 46.8% of females and 50% of males reported perpetrating sexual coercion in a relationship. Significantly more males engaged in risky sex than females. Among females, sexual coercion was significantly linked to risky sexual behaviour. Among males, alcohol and perpetration of sexual coercion were significantly associated with risky sexual behaviour. Focus group data reveal how dominant constructions of gender normalise male coercion and contribute to risky sexual practices. Recommendations for sexual health initiatives include introducing alternative discourses of female sexual desire and male sexual responsibility as a means for building healthier adolescent dating relationships.
Psychology
M.A. (Psychology)