Ward Leaders Research Articles

Livelihood Resilience Strategies to Climate Variability among Pastoralists in Longido District, Tanzania

This paper assessed the level of livelihood strategies practiced by Maasai pastoralists in Longido district, Tanzania. It focused on their resilience to climate variability. The main question that this sought to address was: How resilient are livelihood strategies to climate change and variability among the Maasai pastoralists in response to climate variability? This study employed the resilient theory by Holling and the DFID Livelihood Framework. The study used a mixed-method design, also known as a convergent parallel design. A multistage sampling technique was used to purposefully select wards, then villages, and then a simple random selection of the 373 households for the survey. This study purposively selected 21 key informants from traditional leaders, ward and village leaders, NGO officials, and livestock officers. While data gathered through interviews, observation and focus group discussions was analysed qualitatively. Data obtained through questionnaires was analysed quantitatively using IBM SPSS (version 20). The chi-square was used to test the association of the variables. Findings revealed that key strategies such as mobility, communal pooling, causal labour, livestock management, and others. Also, the role of education and sources of income were crucial in shaping resilience strategies. Household with more education were more likely to have reliable resilience strategies. The main challenge faced by Maasai pastoralists in building climate resilience strategies is increased variability in climate, in the form of frequent drought and unreliable rainfall. This paper recommends more efforts to understand and support these communities by blending their traditional strategies with technical ones for sustainable livelihoods

WP6.5 - Setting Up For Success: Supporting New General Surgical Registrars' Non-Operative Technical Skills Development

Abstract Aim Entry into Higher Surgical Training is associated with new challenges to trainees’ clinical, technical, professional and inter-personal skills. A three-day modular “bootcamp” course was designed for new General Surgery ST3s transitioning from Core Surgical Training to bridge the gap and support areas of developmental need. Methods Four varied modules were undertaken by candidates; one focussed on non-operative technical skills in surgery (NOTSS). Following pre-interviews with all stakeholders, immersive scenarios were developed. The programme encompassed operating in a stressful environment with a focus on crisis resource management principles, ward round leadership, theatre prioritisation, difficult communication, and a further workshop on managing bullying and sexual harassment. A multi-professional faculty included anaesthetists, theatre staff, psychiatrists and geriatricians alongside surgeons. Results All 26 trainees were invited to self-rate confidence using a 5-point Likert scale, as well as free text annotation. 13 (50%) completed both pre- and post-course confidence questionnaires. Data showed significant improvement in self-rated confidence across all NOTSS domains, particularly for operating in a stressful environment ("Confident"/ "Strongly Confident" = 69% pre-course to 100% post-course). Free text responses included highly positive feedback for high faculty to trainee ratio allowing detailed personalised feedback, exposure to multi-professional perspectives and opportunities to reflect on difficult professional scenarios. Conclusion Following the success of this course, it has now become part of ST3 Induction in Yorkshire - an opportunity to promote a positive working culture and strengthen professional relationships. A multi-specialty faculty allows for sharing of transferable inter-specialty skills. We recommend all transitional training stages would benefit from embedded induction courses.

Registered general nurses' health assessment practices in a tertiary hospital: A focused ethnography study.

To explore the assumptions and values that influence nursing health assessment practices among registered general nurses in general medical and surgical wards. The study was designed as a focused ethnography. A semi-structured interview guide was used to explore prevailing nursing health assessment practices of 13 registered general nurses in an attempt to explore the assumptions and values influencing health assessment practices in the study setting. Data were analysed inductively using an interpretive qualitative content analysis method. Nursing health assessment practices, and underlying assumptions and values were underpinned by a central theme of a culture of low expectation relating to nursing health assessment. The culture of low expectation was highlighted in five themes: (1) Unsystematic Assessment of Health Status, (2) Purpose of Nursing Health Assessment, (3) The Role of Nursing Educational and Regulatory Institutions, (4) Ward Ethos and (5) The Role of Organizational and Ward Leadership. The adoption of a holistic nursing health assessment framework with a clearly defined purpose of aiding nursing diagnoses can guide patient-centred care delivery and facilitate early recognition of physiological deterioration. Thirteen registered general nurses were interviewed, and the initial findings returned to them for validation. The potential contribution of nursing health assessment to nursing practice and patient outcomes may not be fully realized if nursing health assessment is not situated within a holistic health assessment model with a clearly defined purpose for nursing practice.

Implementing a ward-level intervention to improve nursing handover communication with a focus on bedside handover-A qualitative study.

To improve the effectiveness of nursing clinical handover through a qualitative, tailored communication intervention. A multisite before and after intervention using qualitative ethnography combined with discourse analysis of nursing handover interactions. We implemented a tailored ward-based intervention to redesign nursing handover practice with co-constructed recommendations for organisational and cultural change on seven wards across three affiliated metropolitan hospitals between February 2020 and November 2022. The intervention was informed by pre-implementation interviews and focus groups with nursing, medical and allied health staff and patients (n = 151) and observed and/or audio-recorded handover events (n = 233). Post-intervention we conducted interviews and focus groups (n = 79) and observed and/or audio-recorded handover events (n = 129) to qualitatively evaluate impact. Our translational approach resulted in substantial changes post-intervention. Nurses conducted more shift-to-shift handovers at the bedside, with greater patient interaction and better structured and more comprehensive information transfer, supported by revised handover documentation. Redesigned group handovers were focused and efficient, communicating critical patient information. Contextualised training combined with changes to ward-level systemic factors impeding communication results in improved nursing handovers. Practice change requires strong executive leadership and project governance, combined with effective ward-level leadership, collaboration and mentoring. The speed and degree of change post-intervention demonstrates the power of interdisciplinary collaborative research between hospital executive, ward leadership and communication specialists. Nurses are more likely to conduct efficient group handovers and informative, patient-centred bedside handovers in line with policy when they understand the value of handover and have practical strategies to support communication. Communication training should be combined with broader ward-level changes to handover practice tailored to the ward context. A multilevel approach results in more effective practice change. We adhered to the COREQ guidelines. We interviewed patients on study wards pre and post intervention.

Revitalizing Degraded and Abandoned Lands: Reflections from Local Government Involvement in Mud Brick Production - Tanzania

The study assessed local government involvement in revitalising abandoned holes and degraded lands around brick-making sites in Morogoro Municipality. Specifically, it delineated the effects of mudbrick-making activities on the communities surrounding the brick-making sites, identified alternative uses of the abandoned holes in the brick-making sites, and established the knowledge required by the community and brick-makers for improving abandoned land use for sustainability. Several techniques were utilised in data collection, including interviews and focus group discussions with village and ward leaders, district environmental officers, district community development officers, district planners, mud brick makers, and some members of the community from three specific wards, namely Kauzeni, Mindu, and Kihonda Maghorofani. The findings revealed a significant contribution of the mudbrick-making industry to enhancing income and improving the living standards of communities through employment creation. Particularly, women were involved in selling food to brick makers, while youth actively participated in brick-making activities. The abandoned holes resulting from soil extraction were repurposed for fishing, vegetable cultivation, and sugar cane production. The income accrued from these activities improved housing standards and increased social interaction among people from different regions, including seasonal migrants attracted to brick-making activities. Despite the noted positive effects, mud brick activities contributed significantly to land degradation due to the traditional technologies used in the process, resulting in large holes that posed risks to human and livestock lives. The study recommends enhancing brick makers' and landowners' awareness of implementing mud brick-making activities with appropriate sustainable environmental protection to improve the socio-economic status of both brick makers and the broader community.

Central aspects when implementing an electronic monitoring system for assessing hand hygiene in clinical settings: A grounded theory study.

New technologies, such as electronic monitoring systems, have been developed to promote increased adherence to hand hygiene among healthcare workers. However, challenges when implementing these technologies in clinical settings have been identified. The aim of this study was to explore healthcare workers' experiences when implementing an electronic monitoring system to assess hand hygiene in a clinical setting. Interviews with healthcare workers (registered nurses, nurse assistants and leaders) involved in the implementation process of an electronic monitoring system (n = 17) were conducted and data were analyzed according to the grounded theory methodology formulated by Strauss and Corbin. Healthcare workers' experiences were expressed in terms of leading and facilitating, participating and contributing, and knowing and confirming. These three aspects were merged together to form the core category of collaborating for progress. Leaders were positive and committed to the implementation of the electronic monitoring system, endeavouring to enable facilitation and support for their co-workers (registered nurses and nurse assistants). At the same time, co-workers were positive about the support they received and contributed by raising questions and demands for the product to be used in clinical settings. Moreover, leaders and co-workers were aware of the objective of implementing the electronic monitoring system. We identified dynamic collective work between leaders and co-workers during the implementation of the electronic monitoring system. Leadership, participation and knowledge were central aspects of enhancing a collaborative process. We strongly recommend involving both ward leaders and users of new technologies to promote successful implementation.

SIN-BARRSS – Developing a mnemonic to support nurses’ participation in interprofessional ward rounds in intensive care: An appreciative inquiry for quality improvement

ObjectivesTo develop and pilot a mnemonic to increase the willingness and ability of bedside nurses to contribute to patient reviews in the daily interprofessional ward round. Research methodology/designAppreciative inquiry quality improvement study, using ethnographic observations and appreciative inquiry discussions, augmented by quantitative data collection of basic facts. SettingLarge (44 beds) critical care unit in the United Kingdom. Main outcome measuresInterprofessional development and acceptance of mnemonic; successful preparation for pilot; use and usability of mnemonic; improvements in bedside nurses’ contributions to ward round discussions (frequency and focus). Result/findingsInterprofessional development of a usable and useful mnemonic was successful, pilot implementation showed promising levels of take up and acceptance. Compared to before the quality improvement project bedside nurses were more willing and able to participate in ward round discussions, did so more often, and used the mnemonic script with insight and flexibility. ConclusionsThe implementation of a mnemonic supported bedside nurses’ contributions to the ward round. This could provide a framework for introducing similar programmes to other intensive care units. Appreciative inquiry methodology could be replicated in other settings to aid the improvement of interprofessional ward rounds, or to address other quality improvement priorities. Implications for clinical practiceA mnemonic can provide a structure which supports bedside nurses’ contributions in ways that make good use of bedside nurses’ professional expertise and most up to date knowledge of patients’ clinical state. Furthermore, a well-designed mnemonic can be used flexibly and provides an outline script that supports less experienced and less confident nurses to make well-focused and well received contributions to rapid interprofessional discussions. In turn, this can increase these nurses’ confidence and capability. More experienced and confident nurses, and ward round leaders, can use the same mnemonic flexibly as an aide memoir that guards against missing information and insights that could affect the quality and safety of patient care.

Technical Challenges Facing Water Users in Accessing Water Services from the Public Water Supply Authority in Dodoma City, Tanzania

Water service is essential for human survival. For it to be easily accessed with adequate amount in an increasing population, there are number of challenges that need to be addressed with existing expertise, protocols and operations. Thus, this study aimed to examine the Technical Challenges Facing Water Users on Accessing Water Service from the Public Water Supply Authority in Dodoma City namely Dodoma Urban Water and Sanitation Authority (DUWASA). The study employed a mixed research approach where a cross sectional research design was used to collect data at one time from July to August 2021. A sample size of the study was 96 respondents drawn from three wards in Dodoma City who are clients of DUWASA, 3 local government leaders and 5 officials from DUWASA. A Multi-stage random sampling was chosen to collect data accurately represents the technical water-related challenges faced by water users. Three wards were selected to represents Dodoma City residents, two streets were then selected from each of the three wards. Sixteen households were randomly selected from one street in each ward, resulting in a total of 32 households per ward. The study used purposive technique in selection of 5 key informants who are the DUWASA officials, one local ward leaders from each of the selected wards. Both qualitative and quantitative data collection techniques were employed in the study. Using descriptive statistical analysis, the findings revealed that, limited number of days and number of hours, limited water resources, poor infrastructures which leads to the loss of water through water leakage as technical challenges hindering accessibility of water services. The study recommends for construction of modernized water networks and efforts to increase more sources of water that will lead to exploit more water.

Psychosocial Problems among Psychiatric Nurses for Caring Patients with Mental Disorders during the COVID-19 Pandemic.

COVID-19 has a negative effect on the psychological well-being of psychiatric nurses. Thus, examining the psychosocial response of nurses is important for preventing more serious mental health problems and disruption of the quality of nursing care. This study aimed to evaluate the psychosocial problems of nurses who provided nursing care to patients with mental health disorders during the COVID-19 pandemic. A quantitative study with a cross-sectional design was conducted. The 101 nurses at Central Mental Health Hospital who provide nursing care to patients with mental health disorders were recruited through consecutive sampling. The instruments used were the demographic questionnaire, the Expanded Nursing Stress Scale, Zung Self-Rating Anxiety Scale, and The Connor-Davidson Resilience Scale 25. Univariate and bivariate analyses were used to process the data. The mean score of 45.1 (±24.3) was obtained for the ENSS; around 97% of nurses have a work stress score below the average, 4.95% have mild-moderate anxiety, and 28.7% have a low level of resilience. Work stress and contact frequency, work stress and gender, anxiety and contact frequency, as well as resilience and contact frequency all correlated significantly (p value <0.05). The Pearson test showed a significant positive correlation between work stress and anxiety (p: 0.002, r: 0.299). However, there was no significant correlation between anxiety and resilience (p: 0.643, r: 0.47), nor between work stress and resilience (p: 0.643; r: 0.47). Psychosocial disorders that psychiatric nurses face include occupational stress, mild-moderate anxiety, and low resilience. The government can create specific infection control guidelines for the mental health setting, and hospital management or ward leaders can also provide support to psychiatric nurses to increase resilience in reducing psychosocial problems.

Person-centred oral hydration care for older people with dementia admitted to acute hospital wards: Empirical research qualitative.

To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework. Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. A qualitative, multiple-case study. The cases were three acute wards in one hospital. Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care. This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised. Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards.

The experiences of physiotherapists and occupational therapists working as rehabilitation ward leaders

Background/Aims Rehabilitation teams have piloted the deployment of physiotherapists and occupational therapists into the role of ward leader. This was the first research study designed specifically to explore the experiences of physiotherapists and occupational therapists working as ward leaders on wards with a patient rehabilitation focus and how to optimise this workforce transformation. Methods An interpretivist qualitative study was designed to enable the detailed exploration of physiotherapists' and occupational therapists' working experiences during their time as ward leaders. A total of 11 physiotherapists and occupational therapists with between 6 months' and 3 years' experience of working as ward leaders participated in semi-structured interviews. Thematic analysis was undertaken. Results Four themes were derived from the data analysis that related to participants' experiences: becoming a rehabilitation ward leader; responsibilities of physiotherapists and occupational therapists; perceptions of the role; and impact of allied health professionals in ward leader roles. Although taking on the role of a rehabilitation ward leader was reported as ‘challenging’, participants would recommend it. Success was perceived by interviewees to be relative to the presence of personal leadership qualities, the belief of the individual in their unique skill set and the confidence in the leadership team to value the unique and shared skills of the profession or individual and thus reinvent the role. Conclusions This study identifies the key attributes that evidence the unique contribution that physiotherapists and occupational therapists working as rehabilitation ward leaders can make. The findings of this study are significant and highly relevant for the ongoing pandemic, which has seen a need for increased rehabilitation capability.

World Without Masks

World Without Masks

Developing ward leadership skills.

Nurses who are responsible for a clinical area do not only have a management role but also, crucially, a leadership role. The role of ward leader is complex and demanding. Ward leaders are accountable for patient safety and the quality of patient care, act as role models, motivate staff and cascade organisational goals to them. They also ensure the correct skill mix on the ward, alleviate pressures on staff and provide opportunities for staff development. This article describes several leadership models which all have something to offer to nurses looking to develop their ward leadership skills. It discusses core elements of effective ward leadership, notably providing support and direction to the team through coaching and mentoring, developing the ward as a learning environment, understanding the wider care context and taking time for self-care.

Impacts of Traditional Extraction of Building Materials on Biodiversity Conservation and Livelihoods of Residing Communities in Mwanza City- Tanzania

Traditional extraction of building material is one of the economic activities in Mwanza City that supplies aggregates, sands, gravels, and stones. This study aimed at investigating the impacts of traditional extraction of building materials on biodiversity conservation and the livelihood of residing communities. Purposive sampling was used to obtain mining sites. Data were collected using households survey, focus group discussions, field visits, and the experiment. The sample size was 180 respondents. The sampling unit was people near mining sites, miners and ward leaders. The study revealed positive and negative impacts on biodiversity conservation and residing communities. The noted positive impacts included a source of income and a strategy for levelling building sites. On another hand, the perceived negative impacts were found to be land degradation, the disappearance of biodiversity, air pollution, uncovered areas/lands, effects on human health, and is the source of conflict. The study concluded that traditional extraction of building materials in residential has impacts on biodiversity and livelihoods of residing people. The study recommends that the government should develop an efficient and effective legal framework with strict laws. In addition, ward and wards leaders should be involved in the inspection and verification of genuine permits.

Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study.

To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication. Sub-optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice. Cross sectional, descriptive observation study. We undertook structured observation of mealtimes examining patient positioning, mealtime set-up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed-effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines. We included 60 patients with a median age of 82years (IQR 76-87) and clinical frailty score of 5 IQR (4-6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less-meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient-level factors were higher values for frailty (OR 0.34 [0.11-1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08-0.62]). The average nurse-to-patient ratio was 1:5.5. Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy. Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels.

Nursing home leaders' perception of factors influencing the reporting of elder abuse and neglect: a qualitative study

PurposeThe purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice.Design/methodology/approachA qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses.FindingsBoth ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect.Originality/valueThis paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

A case study of frontline nurse leadership informed by complex responsive processes of relating.

To understand the social construction of frontline nurse leadership and how power operates at this level. It is argued that frontline nurse leaders are central to the negotiation of care. Evidence suggests they feel ill-equipped to lead and lack confidence in their ability to do so. Disempowerment has been proposed as a barrier to effective ward leadership. There is a lack of studies about daily frontline leadership practice. Single instrumental case study with embedded cases. A purposive sample of one acute National Health Service Trust, with a convenience sample of embedded cases, was selected. Multiple methods of data collection were used including semi-structured interviews, nonparticipant observations, field notes and documentary evidence. Thematic analysis using constant comparison and categorisation of data within, between and across cases was used to generate a theory of ward leadership in its organisational context. COREQ Checklist compliant. These findings suggest the frontline nurse leaders' power is a dynamic and situation-dependent phenomenon that shapes and is shaped by ongoing interactions between stakeholders in the NHS. In these interactions, power ebbs and flows. These leaders, like all actors involved, were paradoxically both powerful and powerless at the same time. This study offers a new contribution to the discussion about the power of ward leaders and problematises the theoretical assumptions that perpetuate calls for increased power. In their efforts to resolve the spontaneous dilemmas that arise in practice, frontline nurse leaders would benefit from regularly participating in communities of reflexive practice.

Creating room for evidence-based practice: Leader behavior in hospital wards.

The integration (routinizing and sustaining) of evidence-based practice (EBP) into hospital management is a key element for improving patient safety and ensuring better patient outcomes. Hospital managers and clinical leaders play crucial roles in this integration. Interactions between leaders and integration context influence the improvement's quality, but leader-based actions that are effective for improving nursing practice remain unclear. The relationship between leaders could also either hinder or enable this implementation process. The aim of this study was to generate a theory about patterns of leader behavior that leaders are engaged in when attempting to integrate EBP in a clinical setting. We used a classic grounded theory methodology to generate a substantive EBP theory. In this study, through participant observation, we observed 63 nurses (15 specialist, 39 registered, and 9 assistant nurses). From these, five ward leaders (two head nurses, one assistant head nurse, and two teaching nurses) participated in individual interviews, and 18 clinical nurses participated in four focus groups. "Creating room for EBP" emerged as a theory for explaining the way in which the leaders attempted to resolve their main concern: How to achieve EBP treatment and care with tight resources and without overextending the nurses. Creating room for EBP encompasses a process of interactions, including positioning for, executing, and interpreting responses to EBP.

Incentivising a career in older adult nursing: The views of student nurses.

Nurse vacancy rates in older adult services are disproportionately high compared to other areas of nursing. This is partly because few student nurses consider it an attractive career option once qualified due to perceptions of low-status, strenuous nature of the work and impoverished care environments. The study aimed to explore students' perceptions of incentives that could counterbalance the barriers for new graduate nurses joining this speciality. A qualitative descriptive design using focus group interviews was carried out with six groups of student nurses (n=27) following completion of their acute care older adult placements in three hospitals. Data were analysed using thematic analysis. The barriers from students' perspectives were constructed as a vicious cycle of staff shortages and inadequate resources that created impoverished environments leading to a dissonance between ideal and delivered care. Over one-third of students were unlikely to consider a career in older adults nursing, but the remaining students could identify incentives that may tempt them. Four main themes and eight subthemes were identified: gerontological status and leadership (ward leadership; respected others); relational care (legitimising emotional support, care vs. cure goals); quality work environment (pay as recognition, 12-hr shifts); and education-career pathways (gerontological knowledge, career progression). Radical new approaches, based on student and nurse engagement, are required to incentivise a career in gerontological nursing. A combination of shorter and longer term strategies that include education-career pathways, a focus on relation care, and improved work conditions including financial incentives should be trialled. In terms of practice, addressing high nurse vacancy rates in older adult services that negaively impacts on patient outcomes requires a suite of incentives informed by 'what matters' to students and nurses working in the speciality.

Informal Settlements and Migrant Challenges in Yangon

This article explores the challenges and survival strategies of poor informal migrants in Hlaing Thayar township, which has the largest concentration of informal settlements in Yangon. Based on interviews with informal settlers, local leaders, and city authorities in early 2017, I show that the informal settlers rely on loose networks of relatives and on local ward and religious leaders to cope with the challenges they face. However, this does not lead to any stable form of self-organization. Constant threats of evictions and securitization by city authorities are creating high levels of mobility and feelings of insecurity, which also cause social disputes and lack of social cohesion. Simultaneously, the informal settlements sustain an informal economy and informal forms of governance by local “big people” (lue kyi), including some government officials, who benefit from illegal land sales and from providing legal documents, like household registers and land papers to the informal migrants. A core argument of the article is that the securitization of newcomers and informal settlers by the government is perpetuating rather than curbing insecurity in Yangon’s informal settlements, which could, if not reversed, lead to deeper instability.