Search results for: access to veterinary care

Authors: Wynne De Jong, Robert Miller, Ross Riggs

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Beyond the number of nurses providing care for patients, having nurses with the right skills, experience and education is essential to ensure the best possible outcomes for patients. Research studies continue to link nurse staffing and skill mix with nurse-sensitive patient outcomes; numerous studies clearly show that superior patient outcomes are associated with higher levels of regulated staff. Due to the limited number of tools and processes available to assist nurse leaders with staffing models of care, nurse leaders are constantly faced with the ongoing challenge to ensure their staffing models of care best suit their patient population. In 2009, several hospitals in Ontario, Canada participated in a research study to develop and evaluate an RN/RPN utilization toolkit. The purpose of this study was to develop and evaluate a toolkit for Registered Nurses/Registered Practical Nurses Staff mix decision-making based on the College of Nurses of Ontario, Canada practice standards for the utilization of RNs and RPNs. This paper will highlight how an organization has further developed the Patient Care Needs Assessment (PCNA) questionnaire, a major component of the toolkit. Moreover, it will demonstrate how it has utilized the information from PCNA to clearly identify patient and family care needs, thus providing evidence-based results to assist leaders with matching the best staffing skill mix to their patients.

Keywords: nurse staffing models of care, skill mix, nursing health human resources, patient safety

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Authors: M. Shahadat Hossain

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People experiencing economic disadvantages have limited access to justice system. Employment status is a key indicator of economic disadvantage. There is a link between employment status and vulnerability to legal problems. This paper addresses the obstacles unemployed people experience to secure justice in Australia. This paper further explores exiting services for economically disadvantaged people to secure justice where these unemployment people can get access. It reveals that unemployed people are vulnerable to multifaced crime and violence. Due to high cost of legal services, these unemployed people are unable to afford legal services to access justice. They are often found higher levels of nonactions in terms of access to justice also due to lack of their initiatives. This paper further reveals that legal aid commissions are state and territory statutory agencies in Australia which provide free legal information, advice, duty lawyers, and legal representation services. Community legal centres are independent, non-profit government organizations with a focus of early advice, problem solving, and working with other agencies to address connected, financial, and health problems. Moreover, the private profession helps people who cannot afford to pay for a lawyer in several ways. But there are problems of shortage of funding for these legal services and making available to economically disadvantaged people. However, this paper argues that people experiencing long-term unemployment face barriers to secure justice due to their economic disadvantages. It further argues that services available for them to access to justice is inadequate.

Keywords: economic disadvantages, unemployment, access to justice, Australia

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Authors: Sandra Soca Lozano, Teresa Isabel Lozano Pérez, Germain Weber

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Cancer is a chronic disease of high prevalence in children and adolescents. Medical care in Cuba is carried out by a multidisciplinary team and family is the mediator between this team and the patient. Around this disease, there are interwoven many stereotypes and taboos by its relation to death. In this research report, we describe the work paradigm of psychological care to patients suffering from these diseases in the University Pediatric Hospital Juan Manuel Márquez of Havana, Cuba. We present the psychosocial factors that must be taken into account to provide comprehensive care and ensuring the quality of life of patients and their families. We also present the factors related to the health team and the management of information done with the patient. This is a descriptive proposal from the working experience accumulated in the named institution and in the review of the literature. As a result of this report we make a proposal of teamwork and the aspects in which psychological intervention should be continue performing in terms of increasing the quality of the care made by the health team. We conclude that it is necessary to continue improving the information management of children and adolescents with theses health problems and took into account their right to autonomy.

Keywords: comprehensive care, management of information, psychosocial factors, right to autonomy

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Authors: Khadiza Akter, Tammy Greer, Raegan Bishop

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An in-depth study of the psycho-social effects of gynecological health disparities among immigrant women in the USA is the goal of this integrative review paper. Immigrant women frequently encounter unique obstacles that have severe psycho-social repercussions when it comes to receiving high-quality gynecological treatment. The review investigates the interaction of psychological, sociological, and health factors that affect the psycho-social effects that immigrant women experience in recognition of the significance of addressing these imbalances. The difficulties that immigrant women face in providing high-quality gynecological treatment in the USA are examined in this study. These difficulties are caused by a variety of psychological issues, including acculturation stress and stigma, as well as by social problems like prejudice, language hurdles, and cultural norms. Additionally, variations in healthcare access and affordability have a role. This study highlights the particular challenges that immigrant women have in receiving high-quality gynecological treatment in the United States. These difficulties are caused by both social problems like language obstacles, cultural norms, and biases, as well as psychological ones like acculturation stress and stigma. Additionally, variations in gynecological care for immigrant women are greatly influenced by variances in healthcare availability and price. To find pertinent research looking at the psychological effects of gynecological health disparities among immigrant women in the USA, a thorough search of numerous databases was done. Numerous approaches, including mixed, quantitative, and qualitative ones, were used in the studies. The important findings from various investigations were extracted and synthesized after they underwent a careful evaluation. In order to lessen these discrepancies and enhance the overall well-being of immigrant women, healthcare professionals, legislators, and researchers must collaborate to create specialized treatments, regulations, and health system reforms.

Keywords: cultural barriers, gynecological health disparities, health care access, immigrant women, mental health, psycho-social consequences, social stigma

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Authors: Jadwiga Klukow, Anna Ksykiewicz-Dorota

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An analysis of the distribution of nurses’ working time constitutes vital information for the management in planning employment. The objective of the study was to analyze the distribution of nurses’ working time in an emergency department. The study was conducted in an emergency department of a teaching hospital in Lublin, in Southeast Poland. The catalogue of activities performed by nurses was compiled by means of continuous observation. Identified activities were classified into four groups: Direct care, indirect care, coordination of work in the department and personal activities. Distribution of nurses’ working time was determined by work sampling observation (Tippett) at random intervals. The research project was approved by the Research Ethics Committee by the Medical University of Lublin (Protocol 0254/113/2010). On average, nurses spent 31% of their working time on direct care, 47% on indirect care, 12% on coordinating work in the department and 10% on personal activities. The most frequently performed direct care tasks were diagnostic activities – 29.23% and treatment-related activities – 27.69%. The study has provided information on the complexity of performed activities and utilization of nurses’ working time. Enhancing the effectiveness of nursing actions requires working out a strategy for improved management of the time nurses spent at work. Increasing the involvement of auxiliary staff and optimizing communication processes within the team may lead to reduction of the time devoted to indirect care for the benefit of direct care.

Keywords: emergency nurses, nursing care, workload, work sampling

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Authors: Liesbeth Van Kelst, Jozefiene Jansens

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Background: All care providers within mother and child care are confronted, at some point in their career, with the care for parents who (will) lose or have lost a baby. Obtaining the correct attitude and communicating well during these difficult moments are aspects that many healthcare provides continue to struggle with. Parents still encounter well-intentioned but inappropriate communication from healthcare providers. Aim: To study how communication, both verbal and non-verbal, around the death of a baby during pregnancy, birth, or in the first ten days postnatal was experienced by parents and healthcare providers. Methods: A qualitative study using grounded theory principles was conducted. Data were collected through 22 individual face-to-face in-depth interviews with parents who had lost a baby (n = 12) and intramural caregivers, such as midwives, nurses, gynecologists and neonatologists (n=10). In the first phase, data were analyzed within each group separately (parents and healthcare providers) and in the second phase, findings from both groups were compared and analyzed according to meta-synthesis principles. Results: The themes that emerged from the data demonstrated congruent experiences between the group of the parents and the health care providers. Both strengths and weaknesses in current care were named and suggestions for appropriate communication were formulated. Conclusion: Since most health care providers only occasionally care for parents with a deceased baby, a communication tool can optimize communication between healthcare professionals and parents who lose a baby. This is very important as the words which are said at this difficult period last a lifetime in the heads of parents.

Keywords: communication, death, perinatal loss, stillbirth

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Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

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Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

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Authors: Soo-Bi Lee, Jun Young Jeong, Zehgn Lin, Chenminxi

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Background: In South Korea, a problematic phenomenon has recently arisen whereby adult children continue to receive parentalcaregivingin some cases. These phenomena has been shown to affect the mental health of mothers. Study Goals: The purposes of this study are to verify whether the mediating effects of stress on the relationship between a woman’s care burden for their adult children and depression are moderated by their satisfaction about their husbands’ sharing of the caregiving. Methodology: This study analyzed 3,053 married women with adult children using the most recent data from the “Korean Longitudinal Survey of Women & Families 7th(2018)" conducted at the national level. The analysis was conducted using the SPSS Process Macro Model 7 to verify the moderated mediating effects and subsequently confirm their significance based on the bootstrapping method. Results and Implications: (1) Stress was identified a mediating factor in the relationship between the care burden for adult children and depression; and (2) the mediating effects of stress on depression from the burden of caring for adult children are modulated by the woman's satisfaction with her husband’s sharing of the care burden. In other words, the higher the caring burden of adult children, the higher the mother's stress, which increases depression. At this time, the higher the their satisfaction with the husband's share of care in the path of mother's care burden and stress, the lower the mother's stress and, ultimately, the depression be alleviated. Conclusion: Programs that promote the mental health of married women heavily with the caring burden for their adult children, as well as those that improve social awareness regarding husbands' sharing of the care burden, should be implemented. Also, social welfare policy alternatives are needed at the national level to reduce the caring burden caused by adult children.

Keywords: married women, adult children care burden, stress, depression, satisfaction with husbands sharing of the care

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Authors: Sadeeq Launi

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NGOs, the world over, have been recognized as part of the institutions that complement government activities in providing services to the people, particularly in respect of human development. This study examined the role played by the NGOs in human development in Bauchi State, Nigeria, between 2004 and 2013. The emphasis was on reproductive health and access to education role of the selected NGOs. All the research questions, objectives and hypotheses were stated in line with these variables. The theoretical framework that guided the study was the participatory development approach. Being a survey research, data were generated from both primary and secondary sources with questionnaires and interviews as the instruments for generating the primary data. The population of the study was made up of the staff of the selected NGOs, beneficiaries, health staff and school teachers in Bauchi State. The sample drawn from these categories were 90, 107 and 148 units respectively. Stratified random and simple random sampling techniques were adopted for NGOs staff, and Health staff and school teachers data were analyzed quantitatively and qualitatively and hypotheses were tested using Pearson Chi-square test through SPSS computer statistical package. The study revealed that despite the challenges facing NGOs operations in the study area, NGOs rendered services in the areas of health and education This research recommends among others that, both government and people should be more cooperative to NGOs to enable them provide more efficient and effective services. Governments at all levels should be more dedicated to increasing accessibility and affordability of basic education and reproductive health care facilities and services in Bauchi state through committing more resources to the Health and Education sectors, this would support and facilitate the complementary role of NGOs in providing teaching facilities, drugs, and other reproductive health services in the States. More enlightenment campaigns should be carried out by governments to sensitize the public, particularly women on the need to embrace immunization programmes for their children and antenatal care services being provided by both the government and NGOs.

Keywords: access to education, human development, NGOs, reproductive health

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Authors: Huang Chiung Chiu

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This article is about the nursing experience of assisting an outpatient with premature menopause, osteoporosis and sarcopenia through a multi-discipline care model. The nursing period is from September 22nd, 2020, to December 7th, 2020, collecting data through interviews with the patient, observation, and physical assessment. It was found that the main health problems were insufficient nutrition, less physical need, insomnia, and potentially dangerous falls. As an outpatient nurse, the author observed that in recent years, the age group of women with premature menopause, osteoporosis and sarcopenia had shifted downward. Integrated multi-disciplinary interventions were provided upon the initial diagnosis of osteoporosis and sarcopenia. Under the outpatient care setting, the collaborative team works between the doctors, nutritionists, osteoporosis educators, rehabilitates, physical therapists and other specialized teams were applied to provide individualized, integrated multi-disciplinary care. Through empathy and the establishment of attentive care, companionship and trust, we discussed care plans and treatment guidelines with the case, providing accurate, complete disease information and feedback education to strengthen the patient’s knowledge and motivation for exercise. Nursing guidance regarding the dietary nutrition and adjustment of daily routine was provided to increase the self-care ability, improve the health problems of muscle weakness and insomnia, and prevent falls. For patients with postmenopausal osteoporosis and sarcopenia, it is recommended that the nurses coordinate the multi-discipline integrated care model, adjust patients’ lifestyle and diet, and establish a regular exercise plan so that the cases can be evaluated holistically to improve the quality of care and physical and mental comfort.

Keywords: multi-discipline care model, premature menopause, osteoporosis, sarcopenia, insomnia

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Authors: Kaleb Shiferaw, Berhanu Geberemedhin, Dereje Legesse

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Access to credit is often viewed as a key to transform semi-subsistence smallholders into market oriented producers. However, only a few studies have examined factors that affect farmers’ decision to allocate credit on farm activities in general and livestock production in particular. A trivariate probit model with double selection is employed to identify factors that affect farmers’ decision to allocate credit on livestock production using data collected from smallholder farmers in Ethiopia. After controlling for two sample selection bias – taking credit for the production season and decision to allocate credit on farm activities – land ownership and access to a livestock centered extension service are found to have a significant (p<0.001) effect on farmers decision to use credit for livestock production. The result showed farmers with large land holding, and access to a livestock centered extension services are more likely to utilize credit for livestock production. However since the effect of land ownership squared is negative the effect of land ownership for those who own a large plot of land lessens. The study highlights the fact that improving access to credit does not automatically translate into more productive households. Improving farmers’ access to credit should be followed by a focused extension services.

Keywords: livestock production, credit access, credit allocation, household decision, double sample selection

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Authors: Taner Ersoz, Filiz Ersoz

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This study was designed enable application of multivariate technique in the interpretation of categorical data for measuring health care services satisfaction in Turkey. The data was collected from a total of 17726 respondents. The establishment of the sample group and collection of the data were carried out by a joint team from The Ministry of Health and Turkish Statistical Institute (Turk Stat) of Turkey. The multiple correspondence analysis (MCA) was used on the data of 2882 respondents who answered the questionnaire in full. The multiple correspondence analysis indicated that, in the evaluation of health services females, public employees, younger and more highly educated individuals were more concerned and complainant than males, private sector employees, older and less educated individuals. Overall 53 % of the respondents were pleased with the improvements in health care services in the past three years. This study demonstrates the public consciousness in health services and health care satisfaction in Turkey. It was found that most the respondents were pleased with the improvements in health care services over the past three years. Awareness of health service quality increases with education levels. Older individuals and males would appear to have lower expectancies in health services.

Keywords: multiple correspondence analysis, multivariate categorical data, health care services, health satisfaction survey

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Authors: Hakim Benoumelghar

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The launch in 1999 of the open access Initiative (OAI) and the protocol for sharing metadata, OAI-PMH, in parallel with the provision of deposit platforms, open-source software, such as DSpace in 2002, which allow libraries to develop digital repositories and play a leading role in the open access movement, and by building institutional open archives alongside the theme. This study focuses on Algerian universities and their projects and platforms for digital repositories of theses and scientific papers and the possibilities of access to the university community to develop research and access to archives of scientific digital content offered by the scientific community. This contribution attempts to compare Algerian and foreign institutional deposits in developed countries in order to have development and perspectives to facilitate scientific research and give more possibilities to the scientific community in documentary matters.

Keywords: digital repository, repository software, university, algeria

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Authors: Oluwaseun Adeleke, Grace Amarachi Omenife, Jennifer Adebambo, Mopelola Raji, Anthony Nwala, Mogbonjubade Adesulure

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Introduction: The incorporation of digital technology in healthcare systems is instrumental in transforming the delivery, management, and overall experience of healthcare and holds the potential to scale up access through over 200 million active mobile phones used in Nigeria. Digital tools enable increased access to care, stronger client engagement, progress in research and data-driven insights, and more effective promotion of self-care and do-it-yourself practices. The Delivering Innovation in Self-Care (DISC) project 2021 has played a pivotal role in granting women greater autonomy over their sexual and reproductive health (SRH) through a variety of approaches, including information and training to self-inject contraception (DMPA-SC). To optimize its outcomes, the project also leverages digital technology platforms like social media: Facebook, Instagram, and Meet Tina (Chatbot) via WhatsApp, Customer Relationship Management (CRM) applications Freshworks, and Viamo. Methodology: The project has been successful at optimizing in-person digital cyberspace interaction to sensitize individuals effectively about self-injection and provide linkages to SI services. This platform employs the Freshworks CRM software application, along with specially trained personnel known as Cyber IPC Agents and DHIS calling centers. Integration of Freshworks CRM software with social media allows a direct connection with clients to address emerging issues, schedule follow-ups, send reminders to improve compliance with self-injection schedules, enhance the overall user experience for self-injection (SI) clients, and generate comprehensive reports and analytics on client interactions. Interaction covers a range of topics, including – How to use SI, learning more about SI, side-effects and its management, accessing services, fertility, ovulation, other family planning methods, inquiries related to Sexual Reproductive Health as well as uses an address log to connect them with nearby facilities or online pharmaceuticals. Results: Between the months of March to September, a total of 5,403 engagements were recorded. Among these, 4,685 were satisfactorily resolved. Since the program's inception, digital advertising has created 233,633,075 impressions, reached 12,715,582 persons, and resulted in 3,394,048 clicks. Conclusion: Leveraging digital technology has proven to be an invaluable tool in client management and improving client experience. The use of Cyber technology has enabled the successful development and maintenance of client relationships, which have been effective at providing support, facilitating delivery and compliance with DMPA-SC self-injection services, and ensuring overall client satisfaction. Concurrently, providing qualitative data, including user experience feedback, has enabled the derivation of crucial insights that inform the decision-making process and guide in normalizing self-care behavior.

Keywords: selfcare, DMPA-SC self-injection, digital technology, cyber technology, freshworks CRM software

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Authors: Said Abdul Ahad Ahadi, Elyas Baray, Nitin Rakesh, Sudeep Varshney

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Wi-Fi is a widely used internet source that is used to provide internet access in many areas such as Stores, Cafes, University campuses, Restaurants and so on. This technology brought more facilities in communication and networking. On the other hand, due to the transmission of data over the air, which makes the network vulnerable, so it becomes prone to various threats such as Evil Twin and etc. The Evil Twin is a kind of adversary which impersonates a legitimate access point (LAP) as it can happen by spoofing the name (SSID) and MAC address (BSSID) of a legitimate access point (LAP). And this attack can cause many threats such as MITM, Service Interruption, Access point service blocking. Various Evil Twin Attack Detection Techniques are proposed, but they require additional hardware, or they require protocol modification. In this paper, we proposed a new technique based on Access Point’s two fingerprints, Received Signal Strength Indicator (RSSI) and Hop Count, that is hard to copy by an adversary. And we implemented the technique in a system called “ETDetector,” which can detect and prevent the attack.

Keywords: evil twin, LAP, SSID, Wi-Fi security, signal variation, ETAD, kali linux, scapy, python

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Authors: S. Kurian, S. Satpathy, S. K. Gupta, S. Arya, D. K. Sharma

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Advances in the use of health care technology have resulted in increased adverse events (AEs) related to the use of medical devices. The study focused on the existing reporting systems. This study was conducted in a tertiary care public sector hospital. Devices included Syringe infusion pumps, Cardiac monitors, Pulse oximeters, Ventilators and Defibrillators. A total of 211 respondents were recruited. Interviews were held with 30 key informants. Medical records were scrutinized. Relevant statistical tests were used. Resident doctors reported maximum frequency of AEs, followed by nurses; and least by consultants. A significant association was found between the cadre of health care personnel and awareness that the patients and bystanders have a risk of sustaining AE. Awareness regarding reporting of AEs was low, and it was generally done verbally. Other critical findings are discussed in the light of the barriers to reporting, reasons for non-compliance, recording system, and so on.

Keywords: adverse events, health care technology, medical devices, public sector hospital, reporting systems

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Authors: Wesley Too, Christine Chesiror

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Hypertension is a public health challenge that globally, with the World Health Organization estimating that by 2025, more than 1.5 billion people would have been diagnosed with it. Kenya’s prevalence of hypertension is estimated at 24.6 percent; however, 55% of the affected have uncontrolled blood pressure, which is worst in some parts of the country with different lifestyle: nomads and migratory communities. Kenyan pastoralists comprise 20% of the nation's population and are constantly on the move for search of water, pasture for their herd, and desertification have driven nomadic populations to the brink, given their unique and dynamic challenges. Nomads face myriad of challenges and barriers towards the management of their health care problems. Nomadic area is predominantly rural, with a low population density and a nomadic population. Health care access and quality are further hampered by poor telecommunications, infrastructure, and security. In Kenya, nomadic communities experience the worst health outcomes, disproportionate health disparities, and inequalities due to unresponsive, culturally sensitive health care system to nomad’s lifestyle and their health care needs. Marsabit covering a surface area of 66,923.1 km2, is the second largest county in Kenya, constituting about 2.3 million people of North-Eastern region, with only 2.3 percent and 1.9 percent of Kenya's total number of doctors and nurses in the country. In Kenya, there are scanty research on hypertension managementin this region and, at best, non-existent study on hypertension among nomads-migratory communities of Northern Kenya. Therefore, the purpose seeks to determine the prevalence of hypertension among nomads and document nomads' practices regarding early detections, management, and levels of control of hypertension in one of the Counties in Kenya with high- hypertensive case load per year. Methods: A cross-sectional study design was used to collect data from multiple sites and health facilities. A total of 260 participants were enrolled into the study. The study is currently ongoing. It is anticipated that by September, we will have initial findings & recommendations to share for conference

Keywords: pastoralists, hypertension, health, kenya

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Authors: A. Sathiya Susuman

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Background: The importance of maternal and child healthcare services cannot be stressed enough. These services are very important for the health and health outcomes of the mother and that of the child and in ensuring that both maternal and child deaths are prevented. The objective of the study is to inspire good quality maternal and child health care services in Swaziland. Specifically, is Swaziland on track with the 2015 Millennium Development Goals? Methods: The study used secondary data from the Swaziland Demographic and Health Survey 2006-07. This is an explorative and descriptive study which used pre-selected variables to study factors influencing the use of maternal and child healthcare services in Swaziland. Different types of examinations, such as univariate, bivariate, and multivariate statistical analysis were adopted. Results: The study findings showed a high use rate of antenatal care (97.3%) and delivery care (74.0%), and a low rate of postnatal care use (20.5%). The uptake childhood immunization is also high in the country, averaging more than 80.0%. Moreover, certain factors which were found to be influencing the use of maternal healthcare and childhood immunization include: woman’s age, parity, media exposure, maternal education, wealth status, and residence. The findings also revealed that these factors affect the use of maternal and child health differently. Conclusion: It is important to study factors related to maternal and child health uptake to inform relevant stakeholders about possible areas of improvement. Programs to educate families about the importance of maternal and child healthcare services should be implemented. Swaziland needs to work hard on child survival and maternal health care services, no doubt it is on track with the MDG 4 & 5.

Keywords: maternal healthcare, antenatal care, delivery care, postnatal care, child health, immunization, socio-economic and demographic factors

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Authors: M. A. Marlow, R. Sørly, H. K. Kaatrakoski

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Social work practice produces and circulates dominant narratives of young women in residential care. These stories are characterised by negative descriptions and hopelessness while dismissing the capabilities of narrative practice. This paper gives an account of how young women with histories in residential care can resist the dominant narratives. The analysis is based on a study of five young women aged 17 to 26 years old with different backgrounds and experiences with Norwegian residential care. The meaning of the context is analysed based on two interviews that were completed and one that was cancelled in the field. The contextual narrative analysis was oriented around the understanding of stories as performances and provided insight into a possible future storytelling practice in social work. The first author’s field notes are included as part of the data material in the analysis and provide a picture of important knowledge development related to stories and the value of being able to tell one’s own experiences. Faced with the dominant narratives that define young women with negative experiences with residential care, we provide a more contextualised understanding of storytelling as a possibility for positive change. To allow young women to create new stories from their lives, we, as both social workers and researchers, must be aware of what kinds of stories we relate to our own practices.

Keywords: context analysis, narrative research, rejection, residential care, social work practice

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Authors: Adrita Banerjee, Ajeet Kumar Singh

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Antenatal care (ANC) from a skilled provider is important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery. The quality of antenatal care can be monitored through the content of services received and the kind of information mothers are given during their visit. Objective: The paper tries to examine the association between ANC check-ups and size/ birth weight. It also focuses on investigating the relationship between utilization of recommended prenatal care for mothers and its effect on infant survival in Nepal. Data and methods: This paper uses data from Nepal demographic Health Survey 2011. To understand the relationship bi-variate statistical analysis and logistic regressions has been done. Maternal health care utilization include ANC check-ups i.e. the type of ante-natal care providers, the number and timing of the visit. The various components of the check-ups include intake of iron tablets/syrups, intestinal parasitic drugs, etc. Results: The results show that women who had no antenatal care visits about 40% had small sized babies at the time of birth compared to women to had at least 3 ANC check up. Women who had at least 3 check-ups 17% of the babies have a small size. It has also been found that about 50 % of the women prefer ANC check-ups during pregnancies which have resulted in lowering the infant mortality by about 40% during 1996-2011. Conclusion: Ante natal care check is care and monitoring of the pregnant woman and her foetus throughout pregnancy. ANC checks have an effect on the infant health and child survival. A woman who had at least three check-ups the possibilities of adverse effect on infant health and infant survival was significantly lower. The findings argue for a more enhanced focus on ANC check-ups for improving the maternal and child health in Nepal.

Keywords: maternal, health, pregnancy, outcome

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Authors: Anthoni Jeorge

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Throughout the history of the world, servant leadership has been researched, and favourable results such as individual, team, and organizational have been linked to the construct. This research paper designates St. Camillus de Lellis, a practitioner of servant leadership and founder of the Ministers of the Sick as a servant leader in his approach to care for the sick. Service is the visible face of his servant leadership. First of all, despite many challenges, St. Camillus de Lellis practiced leadership by the example of compassionate service to the sick. Second, he made service to the sick the highest priority of his life. Third, Camillus displayed servant leadership such that his manner of leadership gave birth to a New School of Service to the Sick. The paper identifies the distinctive dimensions and essential elements which characterized his service-centered leadership. Furthermore, discuss the six major characteristics of a servant leader as set forth by St. Camillus’s life example. The research illustrates the transformational power of servant leadership infield healthcare in general and, in doing so, provides servant leadership seekers ways servant leadership can transform elder care in one’s own field (St. Camillus Health Systems). Thus, it ascertains that servant leadership is best-fit for humanized elder care. Supported by the review of literature, the paper ascertains that Camillus, by identifying himself with the sick, gained deeper insights concerning the pain and suffering of the population. Uniquely drawn from his true grit, Camillus’ service-centered leadership is value-based, people-oriented, and compassion-filled. His way of service to the sick is the prolongation of gestures of mercy and compassion. It is hoped that the results of this study will help health care workers and servant leadership practitioners to humanize elder care and cultivate servant leadership attitude in their health care services to the sick. By incorporating such service-oriented elements into their leadership orientation, health care workers will be true servant leaders of the sick.

Keywords: leadership, service, healthcare, compassion

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Authors: Jui-Hung Hung, Ching-Liang Hsieh, Yi-Wen Lin

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Modern medicine highly emphasizes the importance of palliative treatment. The inception of palliative and hospice care recently developed into the concept of caring for the patients’ and families’ physical, psychological and spiritual problems. There are several benefits related to palliative care such as reducing medical expenses, decreasing patients’ suffer, and supporting patient go through the finale of the life. Nowadays, in Taiwan, over 60-70% terminal cancer patients were covered in hospice care, and the coverage rate increased annually. Acupuncture is a well-known therapy used more than thousand years to relieve symptoms of cancer patient. Many reports showed that, even in the Western society, many reputable medical centers can provide Acupuncture therapy for patients. Accordingly, using Acupuncture for cancer patient care is a global trend. There are increased evidences indicate that Acupuncture can relieve the symptoms for cancer patients including pain, reduce the dosage of anesthetic, improve the cancer-related fatigue, relieve the chemotherapy-related nausea and vomiting, ease anxiety mood and even improving the quality of life. Furthermore, some trials show that Acupuncture may help relieve xerostomia, hot flash, sleep disorders, and some GI discomfort and so on. Acupuncture therapy has many advantages for clinical use with effective, low-cost, minimal side effect, suitable for cancer patients and even for elderly population. Especially in nowadays, there are more diversified challenges in modern medicine, all of them will make the higher medical budget. We suggest that Acupuncture will be one of methods for palliative care for cancer patients.

Keywords: Acupuncture, cancer, integrative medicine, palliative care

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Authors: Chizzoniti Domenico, Beggiora Klizia, Cattani Letizia, Moscatelli Monica

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This paper concerns the study of sustainable construction materials applied on the "Health Post", a prototype for the primary health care situated in alienated areas of the world. It's suitable for social and climatic Sub-Saharan context; however, it could be moved in other countries of the world with similar urgent needs. The idea is to create a Health Post with local construction materials that have a low environmental impact and promote the local workforce allowing reuse of traditional building techniques lowering production costs and transport. The aim of Primary Health Care Centre is to be a flexible and expandable structure identifying a modular form that can be repeated several times to expand its existing functions. In this way it could be not only a health care centre but also a socio-cultural facility.

Keywords: low costs building, sustainable construction materials, green construction system, prototype, health care, emergency

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Kumari Bandana Bhatt, Navin Bhatt

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Background: Orphans and vulnerable children (OVC) are high risk of physical, mental, sexual and emotional abuse and face social stigma and discrimination which significantly increase the risk of mental and behavioral disorders such as anxiety, depression or emotional problems even they stay in well run child care homes. The objective of this study was to estimate the prevalence of depression and determine the determinants among OVC in child care homes in Nepal. Methods: An institutional-based analytical cross-sectional study was conducted in twenty orphanages of five districts of Nepal. Six hundred two children were recruited into the study. After the informed consent form obtaining, the guardian and assent were interviewed by a semi-structured questionnaire and Beck Depression Inventory-II (BDI-II). Logistic regression was used for detecting the association between variables at the significant level of =0.05. Results: The study revealed that 33.20% of OVC had depression. Among them 66.80% of children experienced minimal depression, 17.40% had mild depression, 11.30% had moderate depression 4.50% had severe depression. Sex, alcohol drinking, congenital problem, social support and bully were the main variables associated with depression among OVC of the child care homes in Nepal. Conclusion: Prevalence of depression was high among the orphans and vulnerable children living in child care homes especially among the female children in Nepal. Therefore, early identification and instituting of preventive measures of depression are essential to reduce this problem in this special group of children living in child care homes.

Keywords: Mental health, Depression, Orphans and vulnerable children, child care homes

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Authors: Stephen McCarthy, Joanne Gray, Esther Carr, Gerard Danjoux, Paul Baker, Rhiannon Hackett

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Background: The Go Well Health (GWH) platform is a web-based programme that allows patients to access personalised care plans and resources, aimed at prehabilitation prior to surgery. The online digital platform delivers essential patient education and support for patients prior to undergoing total hip replacements (THR) and total knee replacements (TKR). This study evaluated the impact of an online digital platform (ODP) in terms of functional health outcomes, health related quality of life and hospital length of stay following surgery. Methods: A retrospective cohort study comparing a cohort of patients who used the online digital platform (ODP) to deliver patient education and support (PES) prior to undergoing THR and TKR surgery relative to a cohort of patients who did not access the ODP and received usual care. Routinely collected Patient Reported Outcome Measures (PROMs) data was obtained on 2,406 patients who underwent a knee replacement (n=1,160) or a hip replacement (n=1,246) between 2018 and 2019 in a single surgical centre in the United Kingdom. The Oxford Hip and Knee Score and the European Quality of Life Five-Dimensional tool (EQ5D-5L) was obtained both pre-and post-surgery (at 6 months) along with hospital LOS. Linear regression was used to compare the estimate the impact of GWH on both health outcomes and negative binomial regressions were used to impact on LOS. All analyses adjusted for age, sex, Charlson Comorbidity Score and either pre-operative Oxford Hip/Knee scores or pre-operative EQ-5D scores. Fractional polynomials were used to represent potential non-linear relationships between the factors included in the regression model. Findings: For patients who underwent a knee replacement, GWH had a statistically significant impact on Oxford Knee Scores and EQ5D-5L utility post-surgery (p=0.039 and p=0.002 respectively). GWH did not have a statistically significant impact on the hospital length of stay. For those patients who underwent a hip replacement, GWH had a statistically significant impact on Oxford Hip Scores and EQ5D-5L utility post (p=0.000 and p=0.009 respectively). GWH also had a statistically significant reduction in the hospital length of stay (p=0.000). Conclusion: Health Outcomes were higher for patients who used the GWH platform and underwent THR and TKR relative to those who received usual care prior to surgery. Patients who underwent a hip replacement and used GWH also had a reduced hospital LOS. These findings are important for health policy and or decision makers as they suggest that prehabilitation via an ODP can maximise health outcomes for patients following surgery whilst potentially making efficiency savings with reductions in LOS.

Keywords: digital prehabilitation, online digital platform, orthopaedics, surgery

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Authors: Ali Soroush, Mehdi Mirzaei Alavijeh, Touraj Ahmadi Jouybari, Fazel Zinat-Motlagh, Abbas Aghaei, Mari Ataee

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Diabetes is a disease with long cardiovascular, renal, ophthalmic and neural complications. It is prevalent all around the world including Iran, and its prevalence is increasing. The aim of this study was to determine the factors related to self-care behavior based on health belief model among sample of Iranian diabetic patients. This cross-sectional study was conducted among 301 type 2 diabetic patients in Gachsaran, Iran. Data collection was based on an interview and the data were analyzed by SPSS version 20 using ANOVA, t-tests, Pearson correlation, and linear regression statistical tests at 95% significant level. Linear regression analyses showed the health belief model variables accounted for 29% of the variation in self-care behavior; and perceived severity and perceived self-efficacy are more influential predictors on self-care behavior among diabetic patients.

Keywords: diabetes, patients, self-care behaviors, health belief model

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Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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Background: A mixed method systematic review was undertaken in order to explore issues related to the experiences of health care providers and parents in the care of children with palliative care needs. The aims of this systematic review were to identify existing evidence about the experiences of communication in the care of children with palliative care needs, to appraise the research conducted in this area and to identify gaps in the literature in order to recommend for future related studies. Method: A mixed method systematic review of research on the experience of communication in the care of children with palliative care needs, conducted with parents and health professionals was undertaken. The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period of 2000-2016. Inclusion was limited to studies of communication experience in the care of children with palliative care needs. Result: Thirty-eight studies were found. The studies were conducted in a variety of countries: Uganda, Jordan, USA, UK, Taiwan, Turkey, Ireland, Poland, Brazil, Australia, Switzerland, Sweden, Netherland, Lebanon, Spain, Greece, and China. The current review shows that parents tend to protect their children when they are discussing their illnesses with them, particularly where they have a life-threatening or life-limiting condition. The approach of parents towards the discussion of sensitive issues concerning death with their children is significantly affected by the cultural background of the families. Conservative cultures encourage collusion behaviours which tend to keep children unaware of the incurable nature of the disease. The major communication challenges reported by health professionals are facing difficulties in judging how much information should be given to parents, responding to difficult questions, conflicts with families and inadequate skills to support grieving families. Conclusion: It is probably significant for the future studies to consider the change of parent-child communication experience over time in order to understand how the parents could change their interaction styles with their children according to the different stages of their children’s disease. Moreover, further studies are required to investigate the experience of communication of parents of children with non-malignant life-threatening and life-limiting illnesses.

Keywords: children with life-threatening or life- limiting illnesses, end of life, experience of communication, healthcare care providers, paediatric palliative care

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Authors: Jiranun Sreecharit, Anongnat Boonrut, Kunvadee Munvaradee, Phechnoy Singchungchai

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Hatyai Hospital as center of hospital with a capacity of 670 beds. Medicine intensive care units (MICU240) provide care for critically ill patients who are at high risk need to be monitored closely. Intravenous catheter is vital to help assess the level of water in the body fluids and medications. Potential complications such as infection. We need to have guidelines for the care of patients who received intravenous catheter used to achieve good results. The operations research in this study was intended 1) To study the effects of practice for nurses in caring for patients with central venous catheter to infection rate and 2) To assess the satisfaction of nurses and patient care practices in central venous catheterization patients in the MICU 240. The sample of the patient's central venous catheter crisis that everyone who admitted in MICU 240 during the period from October 2013 to May 2014. Samples prior to practice and 148 samples with 249 case of practice. A systematic review of the research NSWHealth Statewide Guideline for Intensive Care. Data were analyzed by statistics, percentages and frequency NON-PARAMETRICS with Mann-Whitney U. The finding revealed that: 1. Results of the practice patient care central venous catheter infection rates were found to be reduced from 35.14 percent to 25.3 percent. 2. The results of the evaluation of nurses and patients in the patient care practices central venous catheter found to be satisfied and happy to work 85 percent.

Keywords: clinical practice guidelines, central venous catheter, infection satisfaction

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Authors: Tyler T. Procko, Steve Collins

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New features in .NET (6 and above) permit streamlined access to information residing in JSON-capable relational databases, such as SQL Server (2016 and above). Traditional methods of data access now comparatively involve unnecessary steps which compromise system performance. This work posits that the established ORM (Object Relational Mapping) based methods of data access in applications and APIs result in common issues, e.g., object-relational impedance mismatch. Recent developments in C# and .NET Core combined with a framework of modern SQL Server coding conventions have allowed better technical solutions to the problem. As an amelioration, this work details the language features and coding conventions which enable this streamlined approach, resulting in an open-source .NET library implementation called Codeless Data Access (CODA). Canonical approaches rely on ad-hoc mapping code to perform type conversions between the client and back-end database; with CODA, no mapping code is needed, as JSON is freely mapped to SQL and vice versa. CODA streamlines API data access by improving on three aspects of immediate concern to web developers, database engineers and cybersecurity professionals: Simplicity, Speed and Security. Simplicity is engendered by cutting out the “middleman” steps, effectively making API data access a whitebox, whereas traditional methods are blackbox. Speed is improved because of the fewer translational steps taken, and security is improved as attack surfaces are minimized. An empirical evaluation of the speed of the CODA approach in comparison to ORM approaches ] is provided and demonstrates that the CODA approach is significantly faster. CODA presents substantial benefits for API developer workflows by simplifying data access, resulting in better speed and security and allowing developers to focus on productive development rather than being mired in data access code. Future considerations include a generalization of the CODA method and extension outside of the .NET ecosystem to other programming languages.

Keywords: API data access, database, JSON, .NET core, SQL server

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