Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.

Like researchers, clinicians (i.e. nurses, physicians and other healthcare providers) face complex ethical issues in the delivery of patient care in Tanzania. However, there are few resources to aid those faced with making difficult ethical decisions in clinical practice. Healthcare practitioners must individually handle clinical ethics problems that arise within their respective clinics, hospitals or other settings, making decisions based on their own beliefs about what is morally right or wrong, when no ethics committee or ethics support system exists. This can lead to frustration, dissatisfaction and high turnover of the clinicians who are critical to the country's infrastructure and overall quality of healthcare. Healthcare ethics committees (HECs) are common within US hospital-based institutions, and assist clinicians, patients, families and others with difficult ethical problems that arise in patient care delivery. An analysis of data from 300 HEC chairpersons in the USA, for example, showed that the most successful functions reported by HEC members were patient, family, community and provider education and conflict mediation. [1] Additionally, the most frequent clinical issue that HEC chairpersons reported, and also the one best handled, was that of making end-of-life decisions (including 'do not resuscitate' , advance directives and withdrawing and withholding treatment), which remains a ubiquitous issue in many healthcare institutions. In their survey of 600 US general hospitals, Fox et al. [2] also identified reported goals of ethics consultations as intervening to protect patients' rights, addressing conflicts, discussing ethical issues with staff and providing moral support as needed, among other issues. Moreover, in a randomised trial of 551 patient cases in the USA in 2001, the majority (87%) of healthcare professionals, patients and families claimed that ethics consultations in the intensive care unit (ICU) were beneficial in alleviating conflict, and perceived as facilitative. [3] The majority of patients and surrogates also indicated that they would seek an ethics consultation again, and recommend it to others. This same study investigated the effects of ethics committees on duration of stay in the ICU, and on prolonged non-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Background Adolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. Methods An exploratory descriptive qualitative design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis. Results Qualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame. Conclusion Lack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania.

Background Regardless, the known benefits of voluntary testing and counseling (VCT) in the fight against HIV/AIDS, its uptake is still low among youth. This study explored ethical challenges facing voluntary counseling and testing for HIV/AIDS among youth engaged in commercial motorcycling in Kinondoni municipality, Dar es Salaam city. Methods Qualitative exploratory study was carried out to 35 people using key informants’ interviews (KIIs), in-depth interviews (IDIs), and focus group discussions (FGDs). Key informants were purposefully selected based on their roles in VCT services, while the FGD participants and in-depth interview respondents were purposefully selected among youth commercial motorcyclists. Qualitative content data analysis was used to analyze the gathered information. Findings Results of this study show that lack of privacy during counseling and treatment, fear of HIV status disclosure to others by counselors and difficulties in counseling are the main ethical challenges facing VCT services among youth in Kinondoni municipality. Shortage of counselors to match the number of VCT services’ clients and lack of on-job training on HIV/AIDS testing and counseling among counselors partly contributed to the revealed ethical challenges. In an attempt to address the ethical challenges, youth peer educators and routine supervision were the available initiatives on improving VCT services among youth. Conclusion VCT services face ethical challenges which are either health facility-based, community-based or are at the national level. Addressing the ethical challenges is necessary in order to improve the uptake of VCT services and thus strengthen the fight against HIV/AIDS. Deployment of enough counselors, refresher training to counselors, and raising community awareness on HIV/AIDS and the negative impacts of stigma are among the initial strategies for remedying the situation.

Like researchers, clinicians (i.e. nurses, physicians and other healthcare providers) face complex ethical issues in the delivery of patient care in Tanzania. However, there are few resources to aid those faced with making difficult ethical decisions in clinical practice. Healthcare practitioners must individually handle clinical ethics problems that arise within their respective clinics, hospitals or other settings, making decisions based on their own beliefs about what is morally right or wrong, when no ethics committee or ethics support system exists. This can lead to frustration, dissatisfaction and high turnover of the clinicians who are critical to the country's infrastructure and overall quality of healthcare. Healthcare ethics committees (HECs) are common within US hospital-based institutions, and assist clinicians, patients, families and others with difficult ethical problems that arise in patient care delivery. An analysis of data from 300 HEC chairpersons in the USA, for example, showed that the most successful functions reported by HEC members were patient, family, community and provider education and conflict mediation. [1] Additionally, the most frequent clinical issue that HEC chairpersons reported, and also the one best handled, was that of making end-of-life decisions (including 'do not resuscitate' , advance directives and withdrawing and withholding treatment), which remains a ubiquitous issue in many healthcare institutions. In their survey of 600 US general hospitals, Fox et al. [2] also identified reported goals of ethics consultations as intervening to protect patients' rights, addressing conflicts, discussing ethical issues with staff and providing moral support as needed, among other issues. Moreover, in a randomised trial of 551 patient cases in the USA in 2001, the majority (87%) of healthcare professionals, patients and families claimed that ethics consultations in the intensive care unit (ICU) were beneficial in alleviating conflict, and perceived as facilitative. [3] The majority of patients and surrogates also indicated that they would seek an ethics consultation again, and recommend it to others. This same study investigated the effects of ethics committees on duration of stay in the ICU, and on prolonged non-This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.