Search results for: traumatic experiences

Authors: Zyra Cheska Hidalgo, Joehiza Mae Renon, Kzarina Buen, Girlie Mitrado

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ABSTRACT: The global coronavirus disease (COVID-19) has dramatically impacted the lives of many, including education and our economy. Thus, it presents a massive challenge for medical education as instructors are mandated to deliver their lectures virtually to ensure the continuity of the medical education process and ensure students' safety. The purpose of this research paper is to determine the lived experiences of paramedical students who are engaged in virtual hands-on learning and to determine the different coping strategies they used to deal with virtual hands-on learning. The researchers used the survey method of descriptive research design to determine the lived experiences and coping strategies of twenty (20) paramedical students from Lorma Colleges (particularly the College of Medicine Department). The data were collected through online questionnaires, particularly with the use of google forms. This study shows technical issues, difficulty in adapting styles, distractions and time management issues, mental and physical health issues, and lack of interest and motivation are the most common problems and challenges experienced by paramedical students. On the other hand, the coping strategies used by paramedical students to deal with those challenges include time management, engagement in leisure activities, acceptance of responsibilities, studying, and adapting. With the data gathered, the researchers concluded that virtual hands-on learning effectively increases the knowledge of paramedical students. However, teaching and learning barriers must have to be considered to implement virtual hands-on learning successfully.

Keywords: virtual hands-on learning, E-learning, paramedical students, medical education

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Authors: Theresa Robinson Harris

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Small businesses are important to the United States economy, yet the majority struggle to remain relevant and close before their fifth year. This qualitative study explored small business failure by comparing the experiences of small-business owners to understand their involvement with leadership during the early stages of the business, and the impact of this on the firms’ ability to survive. Participants’ experiences from two groups were compared to glean an understanding of the leadership process, how leadership differs between the groups, and to see what themes or constructs emerged that could help to explain the high failure rate. Leadership was perceived to be important when envisioning a path for the future and when providing a platform for employees to succeed. Those who embraced leadership as a skillset were more likely to get through the challenges of the early developmental years while those ignoring the importance of leadership were more likely to close prematurely. These findings suggest a disconnect with regards to the understanding, role, and benefits of leadership in small organizations, particularly young organizations in the early stages of development.

Keywords: leadership, small business, entrepreneurship, success, failure

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Authors: Abdul Basit Kiani

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Web development, the art of creating and maintaining websites, has witnessed remarkable advancements. The aim is to provide an overview of some of the cutting-edge developments in the field. Firstly, the rise of responsive web design has revolutionized user experiences across devices. With the increasing prevalence of smartphones and tablets, web developers have adapted to ensure seamless browsing experiences, regardless of screen size. This progress has greatly enhanced accessibility and usability, catering to the diverse needs of users worldwide. Additionally, the evolution of web frameworks and libraries has significantly streamlined the development process. Tools such as React, Angular, and Vue.js have empowered developers to build dynamic and interactive web applications with ease. These frameworks not only enhance efficiency but also bolster scalability, allowing for the creation of complex and feature-rich web solutions. Furthermore, the emergence of progressive web applications (PWAs) has bridged the gap between native mobile apps and web development. PWAs leverage modern web technologies to deliver app-like experiences, including offline functionality, push notifications, and seamless installation. This innovation has transformed the way users interact with websites, blurring the boundaries between traditional web and mobile applications. Moreover, the integration of artificial intelligence (AI) and machine learning (ML) has opened new horizons in web development. Chatbots, intelligent recommendation systems, and personalization algorithms have become integral components of modern websites. These AI-powered features enhance user engagement, provide personalized experiences, and streamline customer support processes, revolutionizing the way businesses interact with their audiences. Lastly, the emphasis on web security and privacy has been a pivotal area of progress. With the increasing incidents of cyber threats, web developers have implemented robust security measures to safeguard user data and ensure secure transactions. Innovations such as HTTPS protocol, two-factor authentication, and advanced encryption techniques have bolstered the overall security of web applications, fostering trust and confidence among users. Hence, recent progress in web development has propelled the industry forward, enabling developers to craft innovative and immersive digital experiences. From responsive design to AI integration and enhanced security, the landscape of web development continues to evolve, promising a future filled with endless possibilities.

Keywords: progressive web applications (PWAs), web security, machine learning (ML), web frameworks, advancement responsive web design

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Authors: Se-Hwa Park, En-Kyung Han, Jae-Young Lim, Hye-Jung Ahn

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Purpose: The objective of this study is to provide basic data for understanding the substance of inpatient life with CRPS (Complex Regional Pain Syndrome) and developing efficient and effective nursing intervention. Methods: From September 2018 to November, we have interviewed 10 CRPS patients about inpatient experiences. To understand the implication of inpatient life experiences with CRPS and intrinsic structure, we have used the question: 'How about the inpatient experiences with CRPS'. For data analysis, the method suggested by Colaizzi was applied as a phenomenological method. Results: According to the analysis, the study participants' inpatient life process was structured in six categories: (a) breakthrough pain experience (b) the limitation of pain treatment, (c) worsen factors of pain during inpatient period, (d) treat method for pain, (e) positive experience for inpatient period, (f) requirements for medical team, family and people in hospital room. Conclusion: Inpatient with CRPS have experienced the breakthrough pain. They had expected immediate treatment for breakthrough pain, but they experienced severe pain because immediate treatment was not implemented. Pain-worsening factors which patients with CRPS are as follows: personal factors from negative emotions such as insomnia, stress, sensitive character, pain part touch or vibration stimulus on the bed, physical factors from high threshold or rapid speed during fast transfer, conflict with other people, climate factors such as humidity or low temperature, noise, smell, lack of space because of many visitors. Patients actively manage the pain committing into another tasks or diversion. And also, patients passively manage the pain, just suppress, give-up. They think positively about rehabilitation treatment. And they require the understanding and sympathy for other people, and emotional support, immediate intervention for medical team. Based on the results of this study, we suppose the guideline of systematic breakthrough pain management for the relaxation of sudden pain, using notice of informing caution for touch or vibration. And we need to develop non-medicine pain management nursing intervention.

Keywords: breakthrough pain, CRPS, complex regional pain syndrome, inpatient life experiences, phenomenological method

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Authors: Stephanie Cornish

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The use of synthetic dermal templates, also known as dermal matrices, such as PolyNovo® Biodegradable Temporising Matrix (BTM), has been well established in the reconstruction of acute wounds with a full thickness defect of the skin. Its use has become common place in the treatment of full thickness burns and is not unfamiliar in the realm of necrotising fasciitis, free flap donor site reconstruction, and the management of acute traumatic wounds. However, the use of dermal templates for more chronic wounds is rare. The authors present the successful use of BTM in the reconstruction of a chronic scalp wound following the excision of a malignancy and multiple previous failed attempts at repair, thus demonstrating the potential for an increased scope of use.

Keywords: dermal template, BTM, chronic, scalp wound, reconstruction

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Authors: Nomcebo N. Mpili, Cynthia Z. Madlabana

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The South African Primary Health Care (PHC) system has undergone a number of transformations such as the introduction of National Health Insurance (NHI) to bring about easily accessible universal health coverage and to meet the health needs for all its citizens. This provides ongoing challenges to ensure that health workers are equipped with appropriate knowledge, support, and skills to meet these changes. Therefore it is crucial to understand the experiences and challenges of nurses as the backbone of PHC in providing quality healthcare services. In addition there has been a need to understand nurses’ experiences with management support, role ambiguity and role conflict amongst other challenges in light of the current reforms in healthcare. Indeed these constructs are notorious for having a detrimental impact on the outcomes of change initiatives within any organisation, this is no different in healthcare. This draws a discussion on professional nurses within the South African health care system especially since they have been labelled as the backbone of PHC, meaning any healthcare backlog falls on them. The study made use of semi-structured interviews and adopted the interpretative phenomenological approach (IPA) as the researcher aimed to explore the lived experiences of (n= 18) participants. The study discovered that professional nurses experienced a lack of management support within PHC facilities and that management mainly played an administrative and disciplinary role. Although participants mainly held positive perceptions with regards to changes happening in health care however they also expressed negative experiences in terms of how change initiatives were introduced resulting in role conflict and role ambiguity. Participants mentioned a shortage of staff, inadequate training as well as a lack of management support as some of the key challenges faced in facilities. This study offers unique findings as participants have not only experienced the various reforms within the PHC system however they have also been part of NHI pilot. The authors are not aware of any other studies published that examine management support, role conflict and role ambiguity together especially in South African PHC facilities. In conclusion understanding these challenges may provide insight and opportunities available to improve the current landscape of PHC not only in South Africa but internationally.

Keywords: management support, professional nurse, role ambiguity, role conflict

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Authors: Samantha Burns, Melissa Brown, Judith Rankin

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Background: As a specialised intervention, NEWPIP provides a service which supports both parents and their babies from conception to two years, who are experiencing issues which may affect the quality of their relationship and development of the infant. This evaluation of the NEWPIP approach was undertaken in response to the need for rich, in-depth data to understand the lived experiences of the parents who experienced the service to improve the service. NEWPIP is currently one of 34 specialised parent–infant relationship teams across England. This evaluation contributes to increasing understanding of the impact and effectiveness of this specialised service to inform future practice. Aim: The aim of this evaluation was to explore the perspectives and experiences of parents or caregivers (service users), to assess the impact of the NEWPIP service on the parents themselves and the relationship with their baby. Methods: The exploratory nature of the aim and focus on service users’ experience and perspectives provided scope for a qualitative approach for this evaluation. This consisted of 10 semi-structured interviews with parents who had received the service within the last two years. Recruitment involved both purposive and convenience sampling. The interviews took place between February 2021 – March 2021, lasting between 30-90 minutes and were guided by open-ended questions from a topic guide. The interviews adopted a narrative approach to enable the parents to share their lived experiences. The researchers transcribed the interviews and analysed the data thematically by using a coding method which is grounded in the data. Results: The analysis and findings from the data gathered illuminated an approach which supports parents to build a better bond with their baby and provides a safe space for parents to heal through their relationships. While the parents shared their experiences, the interviews were intended to receive feedback, so questions were asked about what could be improved and what recommendations could be offered to Children North East. Guided by the voice of the parents, this evaluation provides recommendations to support the future of the NEWPIP approach. Conclusions: The NEWPIP approach appears to successfully provide early and flexible support for new parents, increasing a parent’s confidence in their ability to not only cope but thrive as a new parent.

Keywords: maternal health, mental health, parent infant relationship, therapy

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Authors: Lucksini Raveendran

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Introduction: This mixed-methods study focuses on the experiences of ethnocultural youth and families in Canada, identifying key barriers and opportunities to inform service programming and policies that can better meet their mental health needs during the COVID-19 pandemic and beyond. Methods: Mental Health Commission of Canada's Headstrong initiative administered the youth survey (April – June 2020) and family survey (June – August 2020) with a total sample size of 137 and 481 respondents, respectively. Thematic analysis was conducted to identify key challenges faced, coping strategies used, and help-seeking behaviours. A similar approach was also applied to the family survey data, but instead, a representative sample was collated to analyze geographically variable and ethnically diverse subgroups. Results and analysis: Multiple challenges have impacted families, including increased feelings of loneliness and distress from border travel restrictions, especially among those navigating pregnancy alone or managing children with developmental needs, which is often understudied. Also, marginalized groups were disproportionately affected by inequitable access to communication technologies, further deepening the digital divide. Some reported living in congregated homes with regular conflicts, thus leading to increased anxiety and exposure to violence. For many families, urbanicity and ethnicity played a key role in how families reported coping with feelings of uncertainty while managing work commitments, navigating community resources, fulfilling care responsibilities, and homeschooling children of all ages. Despite these challenges, there was evidence of post-traumatic growth and building community resiliency. Conclusions and implications for policy, practice, or additional research: There is a need to foster opportunities to promote and sustain mental health, wellness, and resilience for families through social connections. Also, intersectionality must be embedded in the collection, analysis, and application of data to improve equitable access to evidence-based and recovery-oriented mental health supports among diverse families in Canada. Lastly, address future research on the long-term COVID-19 impacts of travel border restrictions on family wellness.

Keywords: mental health, youth mental health, family wellness, health equity

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Authors: Rajendra Chetty

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This paper analyses the experiences of teachers of literacy in underprivileged schools in the Western Cape, South Africa. The purpose is to provide teachers in poorly resourced schools within economically deprived areas an opportunity to voice their experiences of teaching literacy. The paper is based on an empirical study using interviews and classroom observation. A descriptive account of the observation data was followed by an interpretive analysis. The content analysis of the interview data led to the development of themes and patterns for the discussion. The study reveals key factors for literacy underachievement that include lack of critical and emancipatory pedagogies, resources, parental support, lack of teacher knowledge, absence of cognitive activities, and the social complexity of poverty. The paper recommends that a new model of literacy that is underpinned by critical pedagogy challenge inequality and provides strategic and sustained teacher support in disadvantaged schools is crucial in a society emerging from oppression and racism.

Keywords: critical pedagogy, disadvantaged schools, literacy, poverty

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Authors: Omer Zvi Shaked

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Intimate Partner Violence (IPV) is a widespread social problem. Since the 1970's, and due to political changes resulting from the feminist movement, western society has been changing its attitude towards the phenomenon and has been taking an active approach to reduce its magnitude. Enterprises in the form of legislation, awareness and prevention campaigns, women's shelters, and community intervention programs became more prevalent as years progressed. Although many initiatives were found to be productive, the effectiveness of one, however, remained questionable throughout the years: intervention programs for men's intimate violence. Surveys outline two main intervention models for men's intimate violence. The first is the Duluth model, which argued that men are socialized to be dominant - while women are socialized to be subordinate - and men are therefore required by social imperative to enforce, physically if necessary, their dominance. The Duluth model became the chief authorized intervention program, and some states in the US even regulated it as the standard criminal justice program for men's intimate violence. However, meta-analysis findings demonstrated that based on a partner's reports, Duluth treatment completers have 44% recidivism rate, and between 40% and 85% dropout range. The second model is the Cognitive-Behavioral Model (CBT), which is a highly accepted intervention worldwide. The model argues that cognitive misrepresentations of intimate situations precede violent behaviors frequently when anger predisposition exists. Since anger dysregulation mediates between one's cognitive schemes and violent response, anger regulation became the chief purpose of the intervention. Yet, a meta-analysis found only a 56% risk reduction for CBT interventions. It is, therefore, crucial to understand the background behind the domination of both the Duluth model and CBT interventions. This presentation will discuss the ways in which theoretical conceptualizations of men's intimate violence, as well as ideologies, had contributed to the above-mentioned interventions' wide acceptance, despite known lack of scientific and evidential support. First, the presentation will review the prominent interventions for male intimate violence, the Duluth model, and CBT. Second, the presentation will review the prominent theoretical models explaining men's intimate violence: The Patriarchal model, the Abusive Personality model, and the Post-Traumatic Stress model. Third, the presentation will discuss the interrelation between theory and practice, and the nature of affinity between research and practice regarding men's intimate violence. Finally, the presentation will set new directions for further research, aiming to improve intervention's efficiency with men's intimate violence and advance social work practice in the field.

Keywords: intimate partner violence, theory and practice relationship, Duluth, CBT, abusive personality, post-traumatic stress

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Authors: Anagha Pavithran Vattamparambil, Niranjana Regimon

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Dalit and tribal communities in India have the largest suicide rate; however, the current literature does not reflect this reality. While existing research acknowledges socio-cultural risk factors, it fails to discuss structural issues pertaining to marginalized communities in India. Furthermore, the language is framed in an individualistic manner which denies room for recognizing systemic violence and injustice among causative agents of suicide. We aim to examine the representation of Dalit and tribal identities and their experiences of marginalisation as a contributive factor of suicide, as well as discuss the epistemic injustice involved in its exclusion. Electronic searches of PubMed, PsychInfo, and Web of Science databases will be carried out from inception till January 2023 to conduct a systematic scoping review of peer-reviewed articles; it will include all studies involving psychological autopsy in India. A narrative synthesis will be performed to gain insight into the inclusion of the experiences of Dalits and Tribals, the absence of which indicates a lacking understanding of suicide in India. It is also expected to highlight the alienation of lived experiences and narratives of marginalisation from mainstream discourse on suicide that constitutes epistemic injustice. There is a complex interplay of psychological, socio-cultural, economic, and political factors for suicide in the Indian setting. But, political and systemic issues are often downplayed in suicide etiology, including casteist assault, rape, violence, public humiliation, and discrimination which deserves more research attention.

Keywords: dalits, marginalisation, psychological autopsy, suicide, tribals

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Authors: M. Abdul Jalil

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Parents caring for a child with a profound disability encounter different experiences compared to the parents caring for a child without a disability. The aim of this paper is to develop a greater understanding of parenting of a child with profound disabilities in the context of developing countries with reference to Bangladesh. The paper reveals that parents caring for a child with a profound disability are experiencing increased financial burden, affiliate and courtesy stigma and negative impact on mothers in terms of additional caregiving role, instability of conjugal relations, giving up of involvement in economic activities, and shrinking kinship and social relationships. In addition, government and non-government services for children with disabilities are very limited. Moreover, the information about the services is also not available to the parents. Therefore, parents find it difficult to cope with the challenges that lead to the alienation of the parents. The paper recommended the strategies to address the issues in the context of Bangladesh, which in turn might be applicable to the developing countries as well.

Keywords: caregiving, coping, parenting, profound disability

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Authors: Sibel Çaynak, Nur Elçin Boyacıoğlu

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This study was conducted to evaluate the bereavement experiences of families of elderly individuals who died due to the COVID-19 pandemic. One of the qualitative research methods, the case study method, was used in the study. The sample of the research consisted of 19 people who agreed to participate in the research between April and July 2022. The research data were collected using a Personal Information Form and a Semi-Structured Interview Form, which was created to conduct individual in-depth interviews. As a result of the descriptive analysis, four main themes, the ability to perform religious rituals related to the bereavement experience, feelings and thoughts about death, attitudes of those around after death, and coping strategies in the COVID-19 process. It was determined that individuals had difficulty accepting death, felt inadequate about spirituality due to limited religious rituals, had feelings of despair and guilt, and limitedly utilized social support systems.

Keywords: COVID-19 pandemic, bereavement, psychiatric nursing, qualitative study

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Authors: Parker Murray, Marci Johnson, Tyson S. Burnham, Alina K. Fong, Mark D. Allen, Bruce McIff

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Purpose: Pathological dysregulation of Neurovascular Coupling (NVC) caused by mild traumatic brain injury (mTBI) is the predominant source of chronic post-concussion syndrome (PCS) symptomology. fNCI has the ability to localize dysregulation in NVC by measuring blood-oxygen-level-dependent (BOLD) signaling during the performance of fMRI-adapted neuropsychological evaluations. With fNCI, 57 brain areas consistently affected by concussion were identified as PCS neural markers, which were validated on large samples of concussion patients and healthy controls. These neuromarkers provide the basis for a computation of PCS severity which is referred to as the Severity Index Score (SIS). The SIS has proven valuable in making pre-treatment decisions, monitoring treatment efficiency, and assessing long-term stability of outcomes. Methods and Materials: After being scanned while performing various cognitive tasks, 476 concussed patients received an SIS score based on the neural dysregulation of the 57 previously identified brain regions. These scans provide an objective measurement of attentional, subcortical, visual processing, language processing, and executive functioning abilities, which were used as biomarkers for post-concussive neural dysregulation. Initial SIS scores were used to develop individualized therapy incorporating cognitive, occupational, and neuromuscular modalities. These scores were also used to establish pre-treatment benchmarks and measure post-treatment improvement. Results: Changes in SIS were calculated in percent change from pre- to post-treatment. Patients showed a mean improvement of 76.5 percent (σ= 23.3), and 75.7 percent of patients showed at least 60 percent improvement. Longitudinal reassessment of 24 of the patients, measured an average of 7.6 months post-treatment, shows that SIS improvement is maintained and improved, with an average of 90.6 percent improvement from their original scan. Conclusions: fNCI provides a reliable measurement of NVC allowing for identification of concussion pathology. Additionally, fNCI derived SIS scores direct tailored therapy to restore NVC, subsequently resolving chronic PCS resulting from mTBI.

Keywords: concussion, functional magnetic resonance imaging (fMRI), neurovascular coupling (NVC), post-concussion syndrome (PCS)

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Authors: Joy Chadwick

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There is no doubt that classrooms of today are more complex and diverse than ever before. Preparing teacher candidates to meet these challenges is essential to ensure the retention of teachers within the profession and to ensure that graduates begin their teaching careers with the knowledge and understanding of how to effectively meet the diversity of students they will encounter. Creating inclusive classrooms requires teachers to have a repertoire of effective instructional skills and strategies. Teachers must also have the mindset to embrace diversity and value the uniqueness of individual students in their care. This qualitative study analyzed teacher candidates' experiences as they completed a fourteen-week teaching practicum while simultaneously completing a university course focused on inclusive pedagogy. The research investigated the challenges and successes teacher candidates had in navigating the translation of theory related to inclusive pedagogy into their teaching practice. Applying threshold concept theory as a framework, the research explored the troublesome concepts, liminal spaces, and transformative experiences as connected to inclusive practices. Threshold concept theory suggests that within all disciplinary fields, there exists particular threshold concepts that serve as gateways or portals into previously inaccessible ways of thinking and practicing. It is in these liminal spaces that conceptual shifts in thinking and understanding and deep learning can occur. The threshold concept framework provided a lens to examine teacher candidate struggles and successes with the inclusive education course content and the application of this content to their practicum experiences. A qualitative research approach was used, which included analyzing twenty-nine course reflective journals and six follow up one-to-one semi structured interviews. The journals and interview transcripts were coded and themed using NVivo software. Threshold concept theory was then applied to the data to uncover the liminal or stuck spaces of learning and the ways in which the teacher candidates navigated those challenging places of teaching. The research also sought to uncover potential transformative shifts in teacher candidate understanding as connected to teaching in an inclusive classroom. The findings suggested that teacher candidates experienced difficulties when they did not feel they had the knowledge, skill, or time to meet the needs of the students in the way they envisioned they should. To navigate the frustration of this thwarted vision, they relied on present and previous course content and experiences, collaborative work with other teacher candidates and their mentor teachers, and a proactive approach to planning for students. Transformational shifts were most evident in their ability to reframe their perceptions of children from a deficit or disability lens to a strength-based belief in the potential of students. It was evident that through their course work and practicum experiences, their beliefs regarding struggling students shifted as they saw the value of embracing neurodiversity, the importance of relationships, and planning for and teaching through a strength-based approach. Research findings have implications for teacher education programs and for understanding threshold concepts theory as connected to practice-based learning experiences.

Keywords: inclusion, inclusive education, liminal space, teacher education, threshold concepts, troublesome knowledge

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Authors: Hanh Thi My Nguyen

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The purpose of this research is to examine the experiences of parents of children who are deaf or hard of hearing in supporting their children to access education in Vietnam. Parents play a crucial role in supporting their children to gain full access to education. It was widely reported that parents of those children confronted a range of problems to support their children to access education. To author’s best knowledge, there has been a lack of research exploring the experiences of those parents in literature. This research examines factors affecting those parents in supporting their children to access education. To conduct the study, qualitative approach using a phenomenological research design was chosen to explore the central phenomena. Ten parents of children who were diagnosed as deaf or hard of hearing and aged 6-9 years were recruited through the support of the Association of Parents of Children with Hearing Impairment. Participants were interviewed via telephone with a mix of open and closed questions; interviews were audio recorded, transcribed and thematically analysed. The research results show that there are nine main factors that affected the parents in this study in making decisions relating to education for their children including: lack of information resources, perspectives of those parents on communication approaches, the families’ financial capacity, the psychological impact on the participants after their children’ diagnosis, the attitude of family members, attitude of school administrators, lack of local schools and qualified teachers, and current education system for the deaf in Vietnam. Apart from those factors, the lack of knowledge of the participants’ partners about deaf education and the partners’ employment are barriers to educational access and successful communication with their child.

Keywords: access to education, deaf, hard of hearing, parents experience

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Authors: Florence Matsveru

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The 21st-century church in Africa is faced with a myriad of challenges, which need attention. One of those challenges is pastoral ministry to congregants in high positions. This paper is based on a Ph.D. study entitled, ‘Wellbeing and work performance of Christians in managerial positions: A Namibian case study’ conducted between 2015 and 2018. The study was conducted with 32 purposively selected Christians working in managerial positions in Ohangwena Region, Namibia. The study employed a mixed-methods approach, i.e., both qualitative (to get participants’ feelings and perceptions) and quantitative (to get proportions of the experiences and perceptions). The research process involved a questionnaire survey and interviews. The study revealed that Christians in managerial positions have both common and unique experiences in three spheres: the workplace, the family and the church. The experiences lead to physical, emotional, psychological, social and spiritual needs. The findings also showed that some of the expectations placed upon Christians in managerial positions in the church may be unrealistic, while at the same time this group of congregants want to use their work experiences for the benefit of the church. A worrying finding was that pastors are generally not well-trained for ministry to congregants in high positions. Since these were perceptions of the participants (some of whom were also pastors), the researcher went further to do a short internet survey of the curricula of a number of theological colleges in Southern Africa. This survey did not show any ‘manager-sensitive’ modules in the surveyed colleges. Theological education for pastors, especially in African theological institutions, seems to ignore the unique needs of congregants in high positions. This paper argues that the needs of Christians in high positions should be considered in pastoral care and that theological education is key in equipping pastors with the necessary knowledge and skills. This paper is, therefore, a call to theological institutions to include ministry to people in high positions in their curricula. Pastors who are already beyond theological school may find it helpful to attend or hold workshops that focus on congregants in high positions so that this kind of 'sheep' will find good pasture in the church. A paper of this nature helps to strengthen pastoral ministry and to enhance the relevance of theological education.

Keywords: Christian managers, theological curricula, pastoral care, African

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Authors: Harun Bozna

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MOOC (massive open online course) is a groundbreaking education platform and a current buzzword in higher education. Although MOOCs offer many appreciated learning experiences to learners from various universities and institutions, they have considerably higher dropout rates than traditional education. Only about 10% of the learners who enroll in MOOCs actually complete the course. In this case, perceptions of participants and a comprehensive analysis of MOOCs have become an essential part of the research in this area. This study aims to explore the MOOCs in detail for better understanding its content, purpose and primarily drop out issues. The researcher conducted an online questionnaire to get perceptions of graduate students on their learning experiences in MOOCs and arranged a semi- structured oral interview with some participants. The participants are Turkish graduate level students doing their MA and Ph.D. in various programs. The findings show that participants are more likely to drop out courses due to lack of time and lack of pressure.

Keywords: distance education, MOOCs, drop out, perception of graduate students

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Authors: Averill Reindle T. Camilo, Veena Jaye B. Cosme, Hazel Kaye a Mabborang, Johannah a Magayam, Julie May D. Magguiya, Trisha Irish W. Maique, Klein Van M. Maloc, Jaydee B. Masadao, Yvonne Mae P. Ματεο

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The City of Tabuk had the highest number of registered births in the province of Kalinga, indicating the need to study birth spacing trends in Tabuk City further. The study investigates women's experiences with poor birth spacing in Bulanao, Tabuk City, Kalinga, focusing on their views, practices, challenges, and strategies to cope with these issues. A qualitative research approach was used, specifically the Descriptive Phenomenological Research Design with eight (8) participants from Bulanao, Tabuk City, Kalinga. The study found that women's views on poor birth spacing, including intense desire, wanting to have more children, and their perception of children as blessings and helpers, are prevalent and including side effects of contraceptives. The challenges faced by women due to poor birth spacing include financial constraints, sickness, lack of support, and time constraints. These issues can lead to increased living costs for stay-at-home parents, including food, clothing, transportation, medical care, housing, childcare, and budget modifications. The participants also face difficulties in handling sick children and adjusting to uneven birth spacing. To cope, they focus on earning money, patience, andcontraception, while seeking family support fromin-laws andmothers.

Keywords: birth spacing, contraception, coping strategies, maternal health, women experiences

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Authors: Birhanu Abera Kibret

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The abstract highlights findings from a seismicity study conducted in the Ethiopian Rift Valley and adjacent cities, including Semera, Adama, and Hawasa, located in Afar and the Main Ethiopian Rift system. The region experiences high seismicity, characterized by small to moderate earthquakes situated in the mid-to-upper crust. Additionally, the capital city of Ethiopia, Addis Ababa, situated in the rift margin, experiences seismic activity, with small to relatively moderate earthquakes observed to the east and southeast of the city, alongside the rift valley. These findings underscore the seismic vulnerability of the region, emphasizing the need for comprehensive seismic risk assessment and mitigation strategies to enhance resilience and preparedness.

Keywords: seismic hazard, seismicity, crustal structure, magmatic intrusion, partial meltung

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Authors: Jessie André

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In the past 10 years, more studies have begun exploring the psychological impact of those who have been subjected to and have adopted two different cultures. Currently, there is no existing literature regarding how individuals with a bicultural identity navigate their often-conflicting cultures on topics such as sexual pleasure and sexual scripts. The purpose of this study was to explore how first-generation Afro/Black Caribbean-American women navigate their multiple cultural identities with regards to sexual pleasure and sexual scripts. This study contains an exploration of participants self-described challenges, attitudes, and beliefs associated to how they navigate and experience their sexuality. This research study uses an explanatory, qualitative method design with semi structured interviews to answer the primary and secondary research question. Research findings indicate that the later the age of immigration, the stronger their ties were to the culture from their country of origin, which affected their self-assessments of sexual desirability and sexual self-esteem. Findings also suggest that even though women who immigrated at a younger age had higher rates of difficulty navigating and identifying with their adopted culture’s sexual mores. These women also reported lower ratings of comfort voicing sexual desires and concerns to their partner and had lower self-ratings of feeling connected to their cultural identity. These participants had challenges utilizing the dual and conflicting sexual mores and rules they received from U.S. society and their country of origin, resulting in less pleasurable sexual experiences. Whereas women who immigrated at an older age reported having more pleasurable sexual experiences.

Keywords: bicultural identity, sexual pleasure, first-generation immigrants, afro/black caribbean-American

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Authors: Ahlam Alnatour

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Background: To our knowledge, there is lack of studies that describe the experience of studying health promotion courses using an interactive approach, and compare students’ and teachers perceptions about this method of teaching. The purpose of this study is to provide a comparison between student and teacher experiences and perspectives in learning health promotion course using interactive learning. Design: A descriptive qualitative design was used to provide an in-depth description and understanding of students’ and teachers experiences and perceptions of learning health promotion courses using an interactive learning. Study Participants: About 14 fourteen students (seven male, seven female) and eight teachers at governmental university in northern Jordan participated in this study. Data Analysis: Conventional content analysis approach was used for participants’ scripts to gain an in-depth description for both students' and teacher’s experiences. Results: The main themes emerged from the data analysis describing the students’ and teachers perceptions of the interactive health promotion class: teachers’ and students positive experience in adopting interactive learning, advantages and benefits of interactive teaching, barriers to interactive teaching, and suggestions for improvement. Conclusion: Both teachers and students reflected positive attitudes toward interactive learning. Interactive learning helped to engage in learning process physically and cognitively. Interactive learning enhanced learning process, promote student attention, enhanced final performance, and satisfied teachers and students accordingly. Interactive learning approach should be adopted in teaching graduate and undergraduate courses using updated and contemporary strategies. Nursing scholars and educators should be motivated to integrate interactive learning in teaching different nursing courses.

Keywords: interactive learning, nursing, health promotion, qualitative study

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Authors: Jill Stephenson, Marie Vaganay, Robert Cameron, Caoimhe McGurk, Neil Hewitt

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Purpose: The key aim of the research was to identify the secondary stressors experienced by businesses affected by single or repeated flooding and to determine to what extent businesses were affected by these stressors, along with any resulting impact on health. Additionally, the research aimed to establish the likelihood of businesses being re-exposed to the secondary stressors through assessing awareness of flood risk, implementation of property protection measures and level of community resilience. Design/methodology/approach: The chosen research method involved the distribution of a questionnaire survey to businesses affected by either single or repeated flood events. The questionnaire included the Impact of Event Scale (a 15-item self-report measure which assesses subjective distress caused by traumatic events). Findings: 55 completed questionnaires were returned by flood impacted businesses. 89% of the businesses had sustained internal flooding while 11% had experienced external flooding. The results established that the key secondary stressors experienced by businesses, in order of priority, were: flood damage, fear of reoccurring flooding, prevention of access to the premise/closure, loss of income, repair works, length of closure and insurance issues. There was a lack of preparedness for potential future floods and consequent vulnerability to the emergence of secondary stressors among flood affected businesses, as flood resistance or flood resilience measures had only been implemented by 11% and 13% respectively. In relation to the psychological repercussions, the Impact of Event scores suggested that potential prevalence of post-traumatic stress disorder (PTSD) was noted among 8 out of 55 respondents (l5%). Originality/value: The results improve understanding of the enduring repercussions of flood events on businesses, indicating that not only residents may be susceptible to the detrimental health impacts of flood events and single flood events may be just as likely as reoccurring flooding to contribute to ongoing stress. Lack of financial resources is a possible explanation for the lack of implementation of property protection measures among businesses, despite 49% experiencing flooding on multiple occasions. Therefore it is recommended that policymakers should consider potential sources of financial support or grants towards flood defences for flood impacted businesses. Any form of assistance should be made available to businesses at the earliest opportunity as there was no significant association between the time of the last flood event and the likelihood of experiencing PTSD symptoms.

Keywords: flood event, flood resilience, flood resistance, PTSD, secondary stressors

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Authors: Mary Cheptanui Sambu

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Teaching practice is an integral component of students who are training to be teachers, as it provides them with an opportunity to gain experience in an actual teaching and learning environment. This study explored the experiences of trainee teachers from a local university in Kenya, undergoing a three-month teaching practice in Special Secondary schools in the country. The main aim of the study was to understand the trainees’ experiences, their expectations, and the realities encountered during the teaching practice period. The study focused on special secondary schools for learners with hearing impairment. A descriptive survey design was employed and a sample size of forty-four respondents from special secondary schools for learners with hearing impairment was purposively selected. A questionnaire was administered to the respondents and the data obtained analysed using the Statistical Package for the Social Sciences (SPSS). Preliminary analysis shows that challenges facing special secondary schools include inadequate teaching and learning facilities and resources, low academic performance among learners with hearing impairment, an overloaded curriculum and inadequate number of teachers for the learners. The study findings suggest that the Kenyan government should invest more in the education of special needs children, particularly focusing on increasing the number of trained teachers. In addition, the education curriculum offered in special secondary schools should be tailored towards the needs and interest of learners. These research findings will be useful to policymakers and curriculum developers, and will provide information that can be used to enhance the education of learners with hearing impairment; this will lead to improved academic performance, consequently resulting in better transitions and the realization of Vision 2030.

Keywords: hearing impairment, special secondary schools, trainee, teaching practice

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Authors: Nicole Banton

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The maternal and infant mortality rate of Blacks is three times that of Whites in the US. Research indicates that breastfeeding lowers both. In this paper, the researcher examines how the ideas that Black/African American mothers had about breastfeeding before, during, and after pregnancy (postpartum) affected whether or not they initiated breastfeeding. The researcher used snowball sampling to recruit thirty African-American mothers from the Orlando area. At the time of her interview, each mother had at least one child who was at least three years old. Through in-depth face-to-face interviews, the researcher investigated how mothers’ healthcare providers affected their decision-making about infant feeding, as well as how the type of birth that she had (e.g., preterm, vaginal, c-section, full term) affected her actual versus idealized infant feeding practice. Through our discussions, we explored how pre-pregnancy perceptions, birth and postpartum experiences, social support, and the discourses surrounding motherhood within an African-American context affected the perceptions and experiences that the mothers in the study had with their infant feeding practice(s). Findings suggest that the pregnancy and birth experiences of the mothers in the study influenced whether or not they breastfed exclusively, combined breastfeeding and infant formula use, or used infant formula exclusively. Specifically, the interplay of invocation of agency (the ability to control their bodies before, during, and after birth), birth outcomes, and the interaction that the mothers in this study had with resources, human and material, had the highest impact on the initiation, duration, and attitude toward breastfeeding.

Keywords: African American mothers, maternal health, breastfeeding, birth, midwives, obstetricians, hospital birth, breast pumps, formula use, infant feeding, lactation consultant, postpartum, vaginal birth, c-section, familial support, social support, work, pregnancy

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Authors: M. Azugama, P. Okoro Ugo Chigozie, A. O. Nnamocha

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Emotional Intelligence constitutes powerful psychological forces that can strongly influence performance in behaviour, interaction and relationship management. Surprisingly how emotions are interpreted and employed in marketing of hospitality experience have had limited comprehension. Marketing of hospitality experiences have important emotional dimensions which the traditional marketing techniques tend to underplay. Guest and host relationship are challenged by mutual hospitableness obligations; suggesting that the commercial practice of delivering satisfactory guest experience has much to gain from traditional understanding of hospitality. By understanding the emotion-based hospitality transaction between guests and hosts, customers’ experiences can be delivered over and against competitor pressure. In this paper, marketing strategies and tactics in hospitality and tourism are principally concerned with adjusting each of the 6P & T elements (i.e. product, place, price and promotion; and adding people, processes and Time in service contexts), to provide a competitive offer (experience) to customers.

Keywords: Emotional intelligence, hospitality and tourism, relationship management, marketing

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Authors: Sarra Boukhari

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Refugee studies have lately emerged as a focused area of research, yet there is a vast knowledge gap vis-à-vis the integration experiences and socialization processes of diversified refugees in different educational settings. This research intends to study the diverse experiences of African refugee children in an Algerian mainstream secondary school. The study seeks to explore the nature and complexity of refugees’ experiences and their relevance to the integration processes. Highlighting these diverse perspectives will be for the sake of understanding ways by which integration could be facilitated amongst refugees within mainstream school classrooms. Subsequently, this study shall investigate the possibility of story-telling activities in exploring and dealing with different issues of integration met by refugees in the predefined context. Accordingly, stories and narratives will be used to discuss values designed by the Living Values Educational Programme (LVEP) that could change the negative effect of war and conflict. These stories can potentially develop young refugees’ understanding of the key social concepts that can facilitate acceptance and integration inside refugee communities and the host society. This study invokes the theoretical framework provided by Jerome Bruner’s works on constructing the narrative through real-life experiences. In practice, the idea is to voice children’ sense-making of their own world and integrate it with good values to help them construct a positive narrative. Qualitative methods will be integrated to investigate the readiness and acceptance of African refugee children to each other in an Algerian classroom. Two phases of data collection will be conducted. The first phase will attempt to answer the first research question about the challenges that refugee children encounter in their education in a host society. In this phase, classroom observation and semi-structured interviews will be held to explore the context regarding the research question. After issues and challenges have been identified in this phase, topics of discussion (values) that reflect these issues will be designed for the second phase. The use of participatory methods with children in the second stage of the data collection will help in discussing the core values by giving them the optionality of the arts-based tools through which they can express themselves. Story-telling was the idea behind the activities. It could help children express their thoughts and feelings about the discussed values freely. The methods used promoted a very integrating atmosphere in the classroom where both refugee and non-refugee students showed cohesion and integration. Children identified many issues in their integration processes that exceeded the classroom or the education setting. Political and economic opinions were openly shared in the class. Overall, the study is an attempt to reveal how refugee children in Algeria are experiencing integration in their education. The study will be unveiling the impact of the context on the integration of refugee children. The process of integration involved in this context helped to shape refugee experiences in a very unique way.

Keywords: children’s agency, narrative construction, refugee children, refugee experiences, story-telling

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Authors: Mark Linden, Michael Brown, Lynne Marsh, Maria Truesdale, Stuart Todd, Nathan Hughes, Trisha Forbes, Rachel Leonard

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Background: The COVID-19 pandemic exacerbated the already significant strain placed on family carers of people with profound and multiple intellectual disabilities (PMID), given the withdrawal of many services during lockdown. The aim of this study was to explore the experiences of family carers of people with PMID during the COVID-19 pandemic. Methods: Online focus groups were conducted with family carers (n=126) from across the UK and the Republic of Ireland. Participants were asked about their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. Focus groups were audio recorded, transcribed verbatim and analyzed through thematic analysis. Findings: Three themes emerged from our analysis of the data: (i) COVID-19 as a double-edged sword, (ii) The struggle for support (iii) the Constant nature of caring. These included 11 subthemes: (i) ‘COVID-19 as a catalyst for change’, ‘Challenges during COVID-19: dealing with change’, ‘Challenges during COVID-19: fear of COVID-19’, ‘The online environment: the new normal’ (ii) ‘Invisibility of male carers’, ‘Carers supporting carers’, ‘The only service you get is lip service: non-existent services’, ‘Knowing your rights’ (iii) ‘Emotional response to the caring role: Feeling devalued’, ‘Emotional response to the caring role: Desperation of caring’, ‘Multiple demands of the caring role.’ Conclusions: Poor or inconsistent access to services and support has been an ongoing difficulty for many family carers. The COVID-19 pandemic has only further intensified these difficulties, increasing family carers' stress. There is an urgent need to design services, such as online support programs, in partnership with family carers that adequately address their needs.

Keywords: intellectual disabilities, family carer, COVID-19, disability

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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