Search results for: professional documentation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2310

Search results for: professional documentation

1860 Evaluating 8D Reports Using Text-Mining

Authors: Benjamin Kuester, Bjoern Eilert, Malte Stonis, Ludger Overmeyer

Abstract:

Increasing quality requirements make reliable and effective quality management indispensable. This includes the complaint handling in which the 8D method is widely used. The 8D report as a written documentation of the 8D method is one of the key quality documents as it internally secures the quality standards and acts as a communication medium to the customer. In practice, however, the 8D report is mostly faulty and of poor quality. There is no quality control of 8D reports today. This paper describes the use of natural language processing for the automated evaluation of 8D reports. Based on semantic analysis and text-mining algorithms the presented system is able to uncover content and formal quality deficiencies and thus increases the quality of the complaint processing in the long term.

Keywords: 8D report, complaint management, evaluation system, text-mining

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1859 Quality of Working Life and Occupational Stress in High School Teachers

Authors: S. Silva

Abstract:

Some professions had an increased risk for occupational stress and less quality of working life. Among several professions this risk is particularly preoccupant in teachers, namely high school teachers. This study aims to characterize the work stress in teachers and understand how the work stress influences their quality of working life. One hundred teachers, 60 women and 40 men with mean age of 43,2 years (SD=7,8), from North Portugal teaching in several high schools filled in the following questionnaires: Social-Demographic Questionnaire, Teacher Stress Questionnaire and the Survey of Professional Life, during January to March 2015. The results of our study show that high school teachers have several occupational stressors (M=5) and poor perceived quality of working life. They are unsatisfied with their current job and they refer to a considerable job frustration. 33% referred to no expectations about a better future in these profession and 40% have no career development. There is a strong negative correlation between stress and teacher quality of working life (r=-.775). Moderate levels of stress are related to more favorable quality of working life (r=.632). Stress, frequent in teachers, is a significant predictor of poor quality of working life. There are several stressors affecting the teachers’ performance. Career development is not considered among this professional class and it seems related to current job frustration. Considering the role of high school teacher in the development and learning of students, these results should be taken in consideration when planning the graduation and interventions with teachers.

Keywords: career, quality of working life, stress, teachers

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1858 Neurodiversity in Post Graduate Medical Education: A Rapid Solution to Faculty Development

Authors: Sana Fatima, Paul Sadler, Jon Cooper, David Mendel, Ayesha Jameel

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Background: Neurodiversity refers to intrinsic differences between human minds and encompasses dyspraxia, dyslexia, attention deficit hyperactivity disorder, dyscalculia, autism spectrum disorder, and Tourette syndrome. There is increasing recognition of neurodiversity in relation to disability/diversity in medical education and the associated impact on training, career progression, and personal and professional wellbeing. In addition, documented and anecdotal evidence suggests that medical educators and training providers in all four nations (UK) are increasingly concerned about understanding neurodiversity and identifying and providing support for neurodivergent trainees. Summary of Work: A national Neurodiversity Task and Finish group were established to survey Health Education England local office Professional Support teams about insights into infrastructure, training for educators, triggers for assessment, resources, and intervention protocols. This group drew from educational leadership, professional and personal neurodiverse expertise, occupational medicine, employer human resource, and trainees. An online, exploratory survey was conducted to gather insights from supervisors and trainers across England using the Professional Support Units' platform. Summary of Results: This survey highlighted marked heterogeneity in the identification, assessment, and approaches to support and management of neurodivergent trainees and highlighted a 'deficit' approach to neurodiversity. It also demonstrated a paucity of educational and protocol resources for educators and supervisors in supporting neurodivergent trainees. Discussions and Conclusions: In phase one, we focused on faculty development. An educational repository for all supervising trainees using a thematic approach was formalised. This was guided by our survey findings specific for neurodiversity and took a triple 'A' approach: awareness, assessment, and action. This is further supported by video material incorporating stories in training as well as mobile workshops for trainers for more immersive learning. The subtle theme from both the survey and Task and finish group suggested a move away from deficit-focused methods toward a positive holistic, interdisciplinary approach within a biopsychosocial framework. Contributions: 1. Faculty Knowledge and basic understanding of neurodiversity are key to supporting trainees with known or underlying Neurodiverse conditions. This is further complicated by challenges around non-disclosure, varied presentations, stigma, and intersectionality. 2. There is national (and international) inconsistency in the approach to how trainees are managed once a neurodiverse condition is suspected or diagnosed. 3. A carefully constituted and focussed Task and Finish group can rapidly identify national inconsistencies in neurodiversity and implement rapid educational interventions. 4. Nuanced findings from surveys and discussion can reframe the approach to neurodiversity; from a medical model to a more comprehensive, asset-based, biopsychosocial model of support, fostering a cultural shift, accepting 'diversity' in all its manifestations, visible and hidden.

Keywords: neurodiversity, professional support, human considerations, workplace wellbeing

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1857 Mathematics Professional Development: Uptake and Impacts on Classroom Practice

Authors: Karen Koellner, Nanette Seago, Jennifer Jacobs, Helen Garnier

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Although studies of teacher professional development (PD) are prevalent, surprisingly most have only produced incremental shifts in teachers’ learning and their impact on students. There is a critical need to understand what teachers take up and use in their classroom practice after attending PD and why we often do not see greater changes in learning and practice. This paper is based on a mixed methods efficacy study of the Learning and Teaching Geometry (LTG) video-based mathematics professional development materials. The extent to which the materials produce a beneficial impact on teachers’ mathematics knowledge, classroom practices, and their students’ knowledge in the domain of geometry through a group-randomized experimental design are considered. Included is a close-up examination of a small group of teachers to better understand their interpretations of the workshops and their classroom uptake. The participants included 103 secondary mathematics teachers serving grades 6-12 from two US states in different regions. Randomization was conducted at the school level, with 23 schools and 49 teachers assigned to the treatment group and 18 schools and 54 teachers assigned to the comparison group. The case study examination included twelve treatment teachers. PD workshops for treatment teachers began in Summer 2016. Nine full days of professional development were offered to teachers, beginning with the one-week institute (Summer 2016) and four days of PD throughout the academic year. The same facilitator-led all of the workshops, after completing a facilitator preparation process that included a multi-faceted assessment of fidelity. The overall impact of the LTG PD program was assessed from multiple sources: two teacher content assessments, two PD embedded assessments, pre-post-post videotaped classroom observations, and student assessments. Additional data were collected from the case study teachers including additional videotaped classroom observations and interviews. Repeated measures ANOVA analyses were used to detect patterns of change in the treatment teachers’ content knowledge before and after completion of the LTG PD, relative to the comparison group. No significant effects were found across the two groups of teachers on the two teacher content assessments. Teachers were rated on the quality of their mathematics instruction captured in videotaped classroom observations using the Math in Common Observation Protocol. On average, teachers who attended the LTG PD intervention improved their ability to engage students in mathematical reasoning and to provide accurate, coherent, and well-justified mathematical content. In addition, the LTG PD intervention and instruction that engaged students in mathematical practices both positively and significantly predicted greater student knowledge gains. Teacher knowledge was not a significant predictor. Twelve treatment teachers self-selected to serve as case study teachers to provide additional videotapes in which they felt they were using something from the PD they learned and experienced. Project staff analyzed the videos, compared them to previous videos and interviewed the teachers regarding their uptake of the PD related to content knowledge, pedagogical knowledge and resources used. The full paper will include the case study of Ana to illustrate the factors involved in what teachers take up and use from participating in the LTG PD.

Keywords: geometry, mathematics professional development, pedagogical content knowledge, teacher learning

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1856 Gamification Teacher Professional Development: Engaging Language Learners in STEMS through Game-Based Learning

Authors: Karen Guerrero

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Kindergarten-12th grade teachers engaged in teacher professional development (PD) on game-based learning techniques and strategies to support teaching STEMSS (STEM + Social Studies with an emphasis on geography across the curriculum) to language learners. Ten effective strategies have supported teaching content and language in tandem. To provide exiting teacher PD on summer and spring breaks, gamification has integrated these strategies to engage linguistically diverse student populations to provide informal language practice while students engage in the content. Teachers brought a STEMSS lesson to the PD, engaged in a wide variety of games (dice, cards, board, physical, digital, etc.), critiqued the games based on gaming elements, then developed, brainstormed, presented, piloted, and published their game-based STEMSS lessons to share with their colleagues. Pre and post-surveys and focus groups were conducted to demonstrate an increase in knowledge, skills, and self-efficacy in using gamification to teach content in the classroom. Provide an engaging strategy (gamification) to support teaching content and language to linguistically diverse students in the K-12 classroom. Game-based learning supports informal language practice while developing academic vocabulary utilized in the game elements/content focus, building both content knowledge through play and language development through practice. The study also investigated teacher's increase in knowledge, skills, and self-efficacy in using games to teach language learners. Mixed methods were used to investigate knowledge, skills, and self-efficacy prior to and after the gamification teacher training (pre/post) and to understand the content and application of developing and utilizing game-based learning to teach. This study will contribute to the body of knowledge in applying game-based learning theories to the K-12 classroom to support English learners in developing English skills and STEMSS content knowledge.

Keywords: gamification, teacher professional development, STEM, English learners, game-based learning

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1855 Performance of the Kindergarten Teachers and Its Relation to Pupils Achievement in Different Learning Areas

Authors: Mary Luna Mancao Ninal

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This study aimed to determine the performance of the kindergarten teachers and its relation to pupils’ achievement in different learning areas in the Division of Kabankalan City. Using the standardized assessment and evaluation of the Department of Education secondary data, 100 kinder teachers and 2901 kinder pupils were investigated to determine the performance of the kindergarten teachers based on their Competency–Based Performance Appraisal System for Teachers and the periodic assessment of kinder pupils collected as secondary data. Weighted mean, Pearson–r, chi-square, Analysis of Variance were used in the study. Findings revealed that the kindergarten teacher respondents were 26-31 years old and most of them were female and married; they spent teaching for two years and less and passed the Licensure Examination for Teachers. They were very satisfactory as to instructional competences, school, and home and community involvement, personal, social, and professional characteristics. It also revealed that performance of the kindergarten pupils on their period of assessment shows that they were slightly advanced in their development. It also shows that domain as to performance of the kindergarten pupils were average overall development. Based on the results, it is recommended that Kindergarten teacher must augment their educational qualification and pursue their graduate studies and must develop the total personality of the children for them to achieve high advanced development to become productive individual.

Keywords: performance, kindergarten teacher, learning areas, professional, pupil

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1854 Mealtime Talk as a Context of Learning: A Multiple Case Study of Australian Chinese Parents' Interaction with Their Preschool Aged Children at Dinner Table

Authors: Jiangbo Hu, Frances Hoyte, Haiquan Huang

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Research identifies that mealtime talk can be a significant learning context that provides children with rich experiences to foster their language and cognitive development. Middle-classed parents create an extended learning discourse for their children through sophisticated vocabulary, narrative and explanation genres at dinner table. However, mealtime opportunities vary with some parents having little interaction with their children and some parents focusing on directive of children’s behaviors. This study investigated five Chinese families’ parent-child interaction during mealtime that was rarely reported in the literature. The five families differ in terms of their living styles. Three families are from professional background where both mothers the fathers work in Australian companies and both of them present at dinner time. The other two families own business. The mothers are housemakers and the fathers are always absent at dinner time due to their busy business life. Employing case study method, the five Chinese families’ parent-child interactions at dinner table were recorded using a video camera. More than 3000 clauses were analyzed with the framework of 'systems of clause complexing' from systemic functional linguistic theory. The finding shows that mothers played a critical role in the interaction with their children by initiating most conversations. The three mothers from professional background tended to use more language in extending and expanding pattern that is beneficial for children’s language development and high level of thinking (e.g., logical thinking). The two house making mothers’ language focused more on the directive of their children’s social manners and dietary behaviors. The fathers though seemed to be less active, contributing to the richness of the conversation through their occasional props such as asking open questions or initiating a new topic. In general, the families from professional background were more advantaged in providing learning opportunities for their children at dinner table than the families running business were. The home experiences of Chinese children is an important topic in research due to the rapidly increasing number of Chinese children in Australia and other English speaking countries. Such research assist educators in the education of Chinese children with more awareness of Chinese children experiences at home that could be very unlike the settings in English schools. This study contributes to the research in this area through the analysis of language in parent-child interaction during mealtime, which is very different from previous research that mainly investigated Chinese families through survey and interview. The finding of different manners in language use between the professional families and business families has implication for the understanding of the variation of Chinese children’s home experiences that is influenced not only by parents’ socioeconomic status but their lifestyles.

Keywords: Chinese children, Chinese parents, mealtime talk, parent-child interaction

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1853 Translating Creativity to an Educational Context: A Method to Augment the Professional Training of Newly Qualified Secondary School Teachers

Authors: Julianne Mullen-Williams

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This paper will provide an overview of a three year mixed methods research project that explores if methods from the supervision of dramatherapy can augment the occupational psychology of newly qualified secondary school teachers. It will consider how creativity and the use of metaphor, as applied in the supervision of dramatherapists, can be translated to an educational context in order to explore the explicit / implicit dynamics between the teacher trainee/ newly qualified teacher and the organisation in order to support the super objective in training for teaching; how to ‘be a teacher.’ There is growing evidence that attrition rates among teachers are rising after only five years of service owing to too many national initiatives, an unmanageable curriculum and deteriorating student discipline. The fieldwork conducted entailed facilitating a reflective space for Newly Qualified Teachers from all subject areas, using methods from the supervision of dramatherapy, to explore the social and emotional aspects of teaching and learning with the ultimate aim of improving the occupational psychology of teachers. Clinical supervision is a formal process of professional support and learning which permits individual practitioners in frontline service jobs; counsellors, psychologists, dramatherapists, social workers and nurses to expand their knowledge and proficiency, take responsibility for their own practice, and improve client protection and safety of care in complex clinical situations. It is deemed integral to continued professional practice to safeguard vulnerable people and to reduce practitioner burnout. Dramatherapy supervision incorporates all of the above but utilises creative methods as a tool to gain insight and a deeper understanding of the situation. Creativity and the use of metaphor enable the supervisee to gain an aerial view of the situation they are exploring. The word metaphor in Greek means to ‘carry across’ indicating a transfer of meaning form one frame of reference to another. The supervision support was incorporated into each group’s induction training programme. The first year group attended fortnightly one hour sessions, the second group received two one hour sessions every term. The existing literature on the supervision and mentoring of secondary school teacher trainees calls for changes in pre-service teacher education and in the induction period. There is a particular emphasis on the need to include reflective and experiential learning, within training programmes and within the induction period, in order to help teachers manage the interpersonal dynamics and emotional impact within a high pressurised environment

Keywords: dramatherapy supervision, newly qualified secondary school teachers, professional development, teacher education

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1852 Applying Program Theory-Driven Approach to Design and Evaluate a Teacher Professional Development Program

Authors: S. C. Lin, M. S. Wu

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Japanese Scholar Manabu Sato has been advocating the Learning Community, which changed Japanese fundamental education during the last three decades. It was also called a “Quiet Revolution.” Manabu Sato criticized that traditional education only focused on individual competition, exams, teacher-centered instruction, and memorization. The students lacked leaning motivation. Therefore, Manabu Sato proclaimed that learning should be a sustainable process of “constantly weaving the relationship and the meanings” by having dialogues with learning materials, with peers, and with oneself. For a long time, secondary school education in Taiwan has been focused on exams and emphasized reciting and memorizing. The incident of “giving up learning” happened to some students. Manabu Sato’s learning community program has been implemented very successfully in Japan. It is worth exploring if learning community can resolve the issue of “Escape from learning” phenomenon among secondary school students in Taiwan. This study was the first year of a two-year project. This project applied a program theory-driven approach to evaluating the impact of teachers’ professional development interventions on students’ learning by using a mix of methods, qualitative inquiry, and quasi-experimental design. The current study was to show the results of using the method of theory-driven approach to program planning to design and evaluate a teachers’ professional development program (TPDP). The Manabu Sato’s learning community theory was applied to structure all components of a 54-hour workshop. The participants consisted of seven secondary school science teachers from two schools. The research procedure was comprised of: 1) Defining the problem and assessing participants’ needs; 2) Selecting the Theoretical Framework; 3) Determining theory-based goals and objectives; 4) Designing the TPDP intervention; 5) Implementing the TPDP intervention; 6) Evaluating the TPDP intervention. Data was collected from a number of different sources, including TPDP checklist, activity responses of workshop, LC subject matter test, teachers’ e-portfolio, course design documents, and teachers’ belief survey. The major findings indicated that program design was suitable to participants. More than 70% of the participants were satisfied with program implementation. They revealed that TPDP was beneficial to their instruction and promoted their professional capacities. However, due to heavy teaching loadings during the project some participants were unable to attend all workshops. To resolve this problem, the author provided options to them by watching DVD or reading articles offered by the research team. This study also established a communication platform for participants to share their thoughts and learning experiences. The TPDP had marked impacts on participants’ teaching beliefs. They believe that learning should be a sustainable process of “constantly weaving the relationship and the meanings” by having dialogues with learning materials, with peers, and with oneself. Having learned from TPDP, they applied a “learner-centered” approach and instructional strategies to design their courses, such as learning by doing, collaborative learning, and reflective learning. To conclude, participants’ beliefs, knowledge, and skills were promoted by the program instructions.

Keywords: program theory-driven approach, learning community, teacher professional development program, program evaluation

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1851 Autism and Work, From the Perception of People Inserted in the Work

Authors: Nilson Rogério Da Silva, Ingrid Casagrande, Isabela Chicarelli Amaro Santos

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Introduction: People with Autism Spectrum Disorder (ASD) may face difficulties in social inclusion in different segments of society, especially in entering and staying at work. In Brazil, although there is legislation that equates it to the condition of disability, the number of people at work is still low. The United Nations estimates that more than 80 percent of adults with autism are jobless. In Brazil, the scenario is even more nebulous because there is no control and tracking of accurate data on the number of individuals with autism and how many of these are inserted in the labor market. Pereira and Goyos (2019) found that there is practically no scientific production about people with ASD in the labor market. Objective: To describe the experience of people with ASD inserted in the work, facilities and difficulties found in the professional exercise and the strategies used to maintain the job. Methodology: The research was approved by the Research Ethics Committee. As inclusion criteria for participation, the professional should accept to participate voluntarily, be over 18 years of age and have had some experience with the labor market. As exclusion criteria, being under 18 years of age and having never worked in a work activity. Participated in the research of 04 people with a diagnosis of ASD, aged 22 to 32 years. For data collection, an interview script was used that addressed: 1) General characteristics of the participants; 2) Family support; 3) School process; 4) Insertion in the labor market; 5) Exercise of professional activity; (6) Future and Autism; 7) Possible coping strategies. For the analysis of the data obtained, the full transcription of the interviews was performed and the technique of Content Analysis was performed. Results: The participants reported problems in different aspects: In the school environment: difficulty in social relationships, and Bullying. Lack of adaptation to the school curriculum and the structure of the classroom; In the Faculty: difficulty in following the activities, ealizar group work, meeting deadlines and establishing networking; At work: little adaptation in the work environment, difficulty in establishing good professional bonds, difficulty in accepting changes in routine or operational processes, difficulty in understanding veiled social rules. Discussion: The lack of knowledge about what disability is and who the disabled person is leads to misconceptions and negatives regarding their ability to work and in this context, people with disabilities need to constantly prove that they are able to work, study and develop as a human person, which can be classified as ableism. The adaptations and the use of technologies to facilitate the performance of people with ASD, although guaranteed in national legislation, are not always available, highlighting the difficulties and prejudice. Final Considerations: The entry and permanence of people with ASD at work still constitute a challenge to be overcome, involving changes in society in general, in companies, families and government agencies.

Keywords: autism spectrum disorder (ASD), work, disability, autism

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1850 Langerian Mindfulness and School Manager’s Competencies: A Comprehensive Model in Khorasan Razavi Educational Province

Authors: Reza Taherian, Naziasadat Naseri, Elham Fariborzi, Faride Hashmiannejad

Abstract:

Effective management plays a crucial role in the success of educational institutions and training organizations. This study aims to develop and validate a professional competency model for managers in the education and training sector of Khorasan Razavi Province using a mindfulness approach based on Langerian theory. Employing a mixed exploratory design, the research involved qualitative data collection from experts and top national and provincial managers, as well as quantitative data collection using a researcher-developed questionnaire. The findings revealed that 81% of the competency of education and training managers is influenced by the dimensions of Langerian mindfulness, including engagement, seeking, producing, and flexibility. These dimensions were found to be predictive of the competencies of education and training managers, which encompass specialized knowledge, professional skills, pedagogical knowledge, commitment to Islamic values, personal characteristics, and creativity. This research provides valuable insights into the essential role of mindfulness in shaping the competencies of education and training managers, shedding light on the specific dimensions that significantly contribute to managerial success in Khorasan Razavi province.

Keywords: school managers, school manager’s competencies, mindfulness, Langerian mindfulness

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1849 Teacher's Health: Evaluation of the Health Status of Portuguese and Spanish Teachers

Authors: Liberata Borralho, Saúl N. de Jesus, Adelinda Candeias, Victória Fernández-Puig

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In the last decades, we have witnessed a deterioration in the health of teachers worldwide, reflecting the constant social, political and economic changes. The quality of teaching and the success of students depends on the health status of the teachers, which justifies the importance of periodically evaluating their health. With this purpose, the Teacher’s Health Questionnaire was applied to 15.394 teachers teaching in Portugal and Spain (6.208 Spanish and 9.186 Portuguese) of primary and secondary education (3.482 men, 11.911 women). This questionnaire is specific and includes both the main risks of the teaching profession and the manifestations of teacher well-being, according to the definition recommended by the World Health Organization. A descriptive analysis of the results was carried out, including a study of the dimensions and the differences according to some sociodemographic and professional variables, from an analysis of variance ANOVA, applying the Bonferroni correction. Cluster analysis (K-means) allowed us to obtain cutoff scores to assess health status. The results allow concluding that Portuguese teachers perceive a poor well-being in the performance of their professional activity and that more than half present manifestations in the various dimensions of health deterioration, highlighting the exhaustion and cognitive disorders. In turn, Spanish teachers demonstrate a high level of well-being, being the musculoskeletal dimensions and cognitive disorders the main manifestations of deterioration of health.

Keywords: job prevention, occupational health, teacher’s health, teachers work risks, teacher’s well-being

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1848 English for Specific Purposes: Its Definition, Characteristics, and the Role of Needs Analysis

Authors: Karima Tayaa, Amina Bouaziz

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The rapid expansion in the scientific fields and the growth of communication technology increased the use of English as international language in the world. Hence, over the past few decades, many researchers have been emphasizing on how the teaching and learning of English as a foreign or as an additional language can best help students to perform successfully. English for specific purpose is today quite literally regarded as the most global language discipline which existed practically in every country in the world. ESP (English for Specific Purposes) involves teaching and learning the specific skills and language needed by particular learners for a particular purpose. The P in ESP is always a professional purpose which is a set of skills that learners currently need in their work or will need in their professional careers. It has had an early origin since 1960’s and has grown to become one of the most prominent of English language teaching today. Moreover, ESP learners are usually adults who have some quittances with English and learn the language so as to communicate and perform particular profession. Related activities are based on specific purposes and needs. They are integrated into subject matter area important to the learners. Unlike general English which focuses on teaching general language courses and all four language skills are equally stressed, ESP and practically needs analysis determine which language skills are the most needed by the learners and syllabus designed accordingly. This paper looked into the origin, characteristics, development of ESP, the difference between ESP and general English. Finally, the paper critically reviews the role of needs analysis in the ESP.

Keywords: English language teaching, English for general purposes, English for specific purposes, needs analysis

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1847 Improving Screening and Treatment of Binge Eating Disorders in Pediatric Weight Management Clinic through a Quality Improvement Framework

Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

Abstract:

Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

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1846 Continuous Improvement of Teaching Quality through Course Evaluation by the Students

Authors: Valerie Follonier, Henrike Hamelmann, Jean-Michel Jullien

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The Distance Learning University in Switzerland (UniDistance) is offering bachelor and master courses as well as further education programs. The professors and their assistants work at traditional Swiss universities and are giving their courses at UniDistance following a blended learning and flipped classroom approach. A standardized course evaluation by the students has been established as a component of a quality improvement process. The students’ feedback enables the stakeholders to identify areas of improvement, initiate professional development for the teaching teams and thus continuously augment the quality of instruction. This paper describes the evaluation process, the tools involved and how the approach involving all stakeholders helps forming a culture of quality in teaching. Additionally, it will present the first evaluation results following the new process. Two software tools have been developed to support all stakeholders in the process of the semi-annual formative evaluation. The first tool allows to create the survey and to assign it to the relevant courses and students. The second tool presents the results of the evaluation to the stakeholders, providing specific features for the teaching teams, the dean, the directorate and EDUDL+ (Educational development unit distance learning). The survey items were selected in accordance with the e-learning strategy of the institution and are formulated to support the professional development of the teaching teams. By reviewing the results the teaching teams become aware of the opinion of the students and are asked to write a feedback for the attention of their dean. The dean reviews the results of the faculty and writes a general report about the situation of the faculty and the possible improvements intended. Finally, EDUDL+ writes a final report summarising the evaluation results. A mechanism of adjustable warnings allows it to generate quality indicators for each module. These are summarised for each faculty and globally for the whole institution in order to increase the vigilance of the responsible. The quality process involves changing the indicators regularly to focus on different areas each semester, to facilitate the professional development of the teaching teams and to progressively augment the overall teaching quality of the institution.

Keywords: continuous improvement process, course evaluation, distance learning, software tools, teaching quality

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1845 Integrating Cooperative Education Experience into Engineering Curriculum: An Approach

Authors: Robin Lok-Wang Ma

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The Center/Unit for Industry Engagement and Collaboration, as well as Internship, play a significant role at university. In general, the Center serves as the official interface between the industry and the School or Department to cultivate students’ early exposure to professional experience. The missions of the Center are not limited to provide a communication channel and collaborative platform for the industries and the university but also to assist students to build up their career paths early while still in the university. In recent years, a cooperative education experience (commonly known as a co-op) has been strongly advocated for students to make the school-to-work transition. The nature of the co-op program is not only consistent with the internships/final year design projects, but it is also more industrial-oriented with academic support from faculty at the university. The purpose of this paper is to describe an approach to how cooperative education experience can be integrated into Engineering Curriculum. It provides a mutual understanding and exchange of ideas for the approach between the university and the industry. A suggested format in terms of timeline, duration, selection of candidates, students, and companies’ expectations for the co-op program is described. Also, feedbacks from employers/industries show that a longer-term co-op program is well suited for students compared with a short-term internship. To this end, it provides a new insight into collaboration and/or partnership between the university and the industries to prepare professional work-ready graduates.

Keywords: cooperative education, industry, engagement, collaboration

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1844 Voices of Fear: A Case Study Of Tobephobia Experienced by Female Teachers

Authors: Prakash Singh

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In this exploratory qualitative case study, the voices of female teachers are captured that describe their fear of failure in coping with their daily anxieties, stresses, and tensions in their classrooms. When teachers are usually appointed, the curriculum forms the heart of all their professional obligations. The policy of quality and equality of education for all learners is a must as part of these deliberations, otherwise it would spell the inevitable failure for teachers. Yet, how often have teachers been asked whether they are happy during their professional tenure. Research affirms that this question is not a priority, seeing that the happiness of learners and the educational administrators enjoy precedence. Teachers are often subject to undue pressures and tensions because of environmental factors that extends beyond the curriculum. School violence, bullying, drug abuse, and gangsters are not uncommon to the school milieu, no matter where such schools can be located. In this case study, the voices of female teachers find space concerning their experiences of tobephobia (TBP). The questions that inevitably arise are: Are the educational authorities aware of the effects of TBP in education? What can be done to arrest and eliminate the debilitating effects of TBP? This exploratory study contributes to the growing concerns of TBP in education. It is therefore imperative that the effects of TBP on human resources in education must be accentuated so that meaningful solutions can be found to address challenging educational issues such as school violence, bullying, and drug abuse amongst learners.

Keywords: curriculum, female teachers, school violence, tobephobia

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1843 The Ultimate Challenge of Teaching Nursing

Authors: Crin N. Marcean, Mihaela A. Alexandru, Eugenia S. Cristescu

Abstract:

By definition, nursing means caring. It is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain or recover optimal health and quality of life. However, there is a subtle difference between the two: nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is on-going as professional nurses strive to maintain the concept, art, and act of caring as the moral centre of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviours during each nurse-patient interaction. The competencies, abilities, as well as the psycho-motor, cognitive, and relational skills necessary for the nursing practice are conveyed and improved by the nursing teachers’ art of teaching. They must select and use the teaching methods which shape the personalities of the trainers or students, enabling them to provide individualized, personalized care in real-world context of health problems. They have the ultimate responsibility of shaping the future health care system by educating skilful nurses.

Keywords: art of nursing, health care, teacher-student relationship, teaching innovations

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1842 Innovative Pedagogy and the Fostering of Soft Skills among Higher Education Students: A Case Study of Ben Ms’Ick Faculty of Sciences

Authors: Azzeddine Atibi, Sara Atibi, Salim Ahmed, Khadija El Kabab

Abstract:

In an educational context where innovation holds a predominant position, political discourses and pedagogical practices are increasingly oriented toward this concept. Innovation has become a benchmark value, gradually replacing the notion of progress. This term is omnipresent in discussions among policymakers, administrators, and academic researchers. The pressure to innovate impacts all levels of education, influencing institutional and educational policies, training objectives, and teachers' pedagogical practices. Higher education and continuing education sectors are not exempt from this trend. These sectors are compelled to transform to attract and retain an audience whose behaviors and expectations have significantly evolved. Indeed, the employability of young graduates has become a crucial issue, prompting us to question the effectiveness of various pedagogical methods in meeting this criterion. In this article, we propose to thoroughly examine the relationship between pedagogical methods employed in different fields of higher education and the acquisition of interpersonal skills, or "soft skills". Our aim is to determine to what extent these methods contribute to better-preparing students for the professional world. We will analyze how innovative pedagogical approaches can enhance the acquisition of soft skills, which are essential for the professional success of young graduates.

Keywords: educational context, innovation, higher education, soft skills, pedagogical practices, pedagogical approaches

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1841 An Audit of the Process of Care in Surveillance Services for Children with Sickle Cell Disease in Wales

Authors: Charlie Jeffkins

Abstract:

Sickle cell disease is a serious life-limiting condition which can reduce the quality of life for many patients. Public Health England (PHE), in partnership with the Sickle Cell Society (SCS), has created guidelines to prevent severe complications from sickle cell disease. Data was collected from Children’s Hospital for Wales between 15/03/21-26/03/21. Methods: A manual search of patient records for children under the care of Rocket Ward and a key term search of online records was used. Results: Penicillin prophylaxis was given at 90 days for 89%, 77% of TCDs scans were done at 2-3 years, and 72% have had a scan in the last year. 53% of patients have had discussions about hydroxycarbamide, whilst 65% have started it. PPV vaccination was documented for 19%. Conclusion: Overall, none of the four standards were reached; however, TCD uptake has improved. There is a need for better documentation of treatment and annual re-audits.

Keywords: paediatric, haematology, sickle cell, audit

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1840 Nurse Metamorphosis: Lived Experience in the RN HEALS Proram

Authors: Dennis Glen G. Ramos, Angelica S. Mendoza, Juliene Marie A. Alvarez, Claudette A. Nagal, Kayzee C. Blanza, Jayson M. Narbonita, John Anthony D. Dayot, Rebecca M. Reduca, Jermaine Jem M. Flojo, Michael E. Resultan, Clyde C. Fomocod, Cindy A. Vinluan, Jeffrie Aleona Mari C. Maclang

Abstract:

RN HEALS, an acronym for Registered Nurses for Health Enhancement and Local Service, is expected to address the shortage of skilled and experienced nurses in 1,221 rural and unserved or underserved communities for one year. The study would like to explore the lived experiences of the nurses deployed under this program.The study is a Descriptive Qualitative Research. Interview was utilized as a data gathering tool. Six community nurses who are deployed under the RN HEALS program are included in the study. Van Kaam method was used as data management. Data gathering was done from October to December 2013.Two themes emerged in the study; Value and Challenge. Under Value, it had three sub-themes; Job Satisfaction, Upholding Competency, including Personal Development and Professional Growth, and Employability. While under Challenge, it had one sub-theme, Job Stress. The study concludes that nurses adapt to strategies to pursue personal and professional competence and an evolutionary journey. The researchers recommend that Health Administrators improve the work environment of nurses to lessen the challenges experienced by nurses.

Keywords: lived experience, RN HEALS, health enhancement, local service

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1839 Levels of Reflection in Engineers EFL Learners: The Path to Content and Language Integrated Learning Implementation in Chilean Higher Education

Authors: Sebastián Olivares Lizana, Marianna Oyanedel González

Abstract:

This study takes part of a major project based on implementing a CLIL program (Content and Language Integrated Learning) at Universidad Técnica Federico Santa María, a leading Chilean tertiary Institution. It aims at examining the relationship between the development of Reflective Processes (RP) and Cognitive Academic Language Proficiency (CALP) in weekly learning logs written by faculty members, participants of an initial professional development online course on English for Academic Purposes (EAP). Such course was designed with a genre-based approach, and consists of multiple tasks directed to academic writing proficiency. The results of this analysis will be described and classified in a scale of key indicators that represent both the Reflective Processes and the advances in CALP, and that also consider linguistic proficiency and task progression. Such indicators will evidence affordances and constrains of using a genre-based approach in an EFL Engineering CLIL program implementation at tertiary level in Chile, and will serve as the starting point to the design of a professional development course directed to teaching methodologies in a CLIL EFL environment in Engineering education at Universidad Técnica Federico Santa María.

Keywords: EFL, EAL, genre, CLIL, engineering

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1838 Principles and Guidance for the Last Days of Life: Te Ara Whakapiri

Authors: Tania Chalton

Abstract:

In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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1837 Forensic Nursing in the Emergency Department: The Overlooked Roles

Authors: E. Tugba Topcu

Abstract:

The emergency services are usually the first places to encounter forensic cases. Hence, it is important to consider forensics from the perspective of the emergency services staff and the physiological and psychological consequences that may arise as a result of behaviour by itself or another person. Accurate and detailed documentation of the situation in which the patient first arrives at the emergency service and preservation of the forensic findings is pivotal for the subsequent forensic investigation. The first step in determining whether or not a forensic case exists is to perform a medical examination of the patient. For each individual suspected to be part of a forensic case, police officers should be informed at the same time as the medical examination is being conducted. Violent events are increasing every year and with an increase in the number of forensic cases, emergency service workers have increasing responsibility and consequently play a key role in protecting, collecting and arranging the forensic evidence. In addition, because the emergency service workers involved in forensic events typically have information about the accused and/or victim, as well as evidence related to the events and the cause of injuries, police officers often require their testimony. However, both nurses and other health care personnel do not typically have adequate expertise in forensic medicine. Emergency nurses should take an active role for determining that whether any patient admitted to the emergency services is a clinical forensic patient the emergency service with injury and requiring possible punishment and knowing of their roles and responsibilities in this area provides legal protection as well as the protection of the judicial affair. Particularly, in emergency services, where rapid patient turnover and high workload exists, patient registration and case reporting may not exist. In such instances, the witnesses, typically the nurses, are often consulted for information. Knowledge of forensic medical matters plays a vital role in achieving justice. According to the Criminal Procedure Law, Article 75, Paragraph 3, ‘an internal body examination or the taking of blood or other biological samples from the body can be performed only by a doctor or other health professional member’. In favour of this item, the clinic nurse and doctor are mainly responsible for evaluating forensic cases in emergency departments, performing the examination, collecting evidence, and storing and reporting data. The courts place considerable importance on determining whether a suspect is the victim or accused and, thus, in terms of illuminating events, it is crucial that any evidence is gathered carefully and appropriately. All the evidence related to the forensic case including the forensic report should be handed over to the police officers. In instances where forensic evidence cannot be collected and the only way to obtain the evidence is the hospital environment, health care personnel in emergency services need to have knowledge about the diagnosis of forensic evidence, the collection of evidence, hiding evidence and provision of the evidence delivery chain.

Keywords: emergency department, emergency nursing, forensic cases, forensic nursing

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1836 The Kafrah Dam (The Oldest Dam in History)

Authors: Mohamed Bekhit Gad Khalil

Abstract:

This dam is the oldest dam in history. It was built by the ancient Egyptian around (2650 B.C) control flooding. It is believed to have been built between the third and fourth dynasties .It contains the oldest dam in history. Many studies have been conducted for the dam. This report was prepared under my supervision and in cooperation with the Ministry of Tourism and Antiquities. The dam was re-documented and photographed again. The dam on the northern side Consists of irregularly shaped stones of varying sizes used randomly. Sand and soil fill the gaps between the stones. creating layers to form the body of the dam. The eastern. side of the dam Consists of a series of regular shaped stones that have been cut and constructed into a stepped pyramid-like structure with width of (15,7) meters and height of (10) meters. The surface has significant erosion and wear on the stones due to weather Conditions. which has resulted in deep cavities in most of the stone blocks forming the surface.

Keywords: ministry of tourism and antiquities, excavations, registration, documentation

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1835 Legal Responsibility of the External Auditor Qualitative Case Study of Libyan Environment

Authors: Bubaker F. Shareia

Abstract:

The aim of this paper is to determine a general frame of the auditor's legal responsibilities in Libya which were implied in professional codes and rules, these codes and rules were concerned with the auditor's rights and duties in conducting his professional duties. This will provide a background for the Libyan accounting profession, and the challenges in tailoring Auditors to meet third party's needs. Being informed of the kinds of legal responsibilities which the external auditors could face during conducting their duties. The study is based on a literature review and archival research, reinforced by a qualitative case study comprised of interviews, questionnaire and a study of internal documents. To reach such an understanding, the researcher designed two questionnaires for collecting the data. One questionnaire was distributed among the certified public accountant firms in Libya and the second was distributed among a group of randomly selected lawyers and judges in the same country. Most auditors agreed upon the determination of their responsibilities toward the state and they emphasized that their responsibilities toward their clients were limited to the accepted standards of auditing. Moreover, all auditors who were surveyed emphasized that there has never been any juridical claims against them, and as a consequence they have never paid any legal fines. This study focuses on one country, which does limit its generalisability. However, it also suggests fruitful research areas in considering the impact and challenge of the historic factors in the accounting profession in emerging economies.

Keywords: accounting, external auditor, legal responsibilities, libyan accounting profession

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1834 Music Therapy Intervention as a Means of Stimulating Communicative Abilities of Seniors with Neurocognitive Disorders – Theory versus Practice

Authors: Pavel Svoboda, Oldřich Müller

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The paper contains a screening of the opinions of helping professional workers working in a home for seniors with individuals with neurocognitive disorders and compares them with the opinions of a younger generation of students who are just preparing for this work. The authors carried out a comparative questionnaire survey with both target groups, focusing on the analysis and comparison of possible differences in their knowledge in the field of care for elderly people with neurocognitive disorders. Specifically, they focused on knowledge and experience with approaches, methods and tools applicable within the framework of music therapy interventions, as they are understood in practice in comparison with the theoretical knowledge of secondary school students focused on social work. The questionnaire was mainly aimed at assessing the knowledge of the possibilities of effective memory stimulation of the elderly and their communication skills using the means of music. The conducted investigation was based on the research of studies dealing with so-called non-pharmacological approaches to the given clientele; for professional caregivers, it followed music therapy lessons, which the authors regularly implemented from the beginning of 2022. Its results will, among other things, serve as the basis for an upcoming study with a scoping design review.

Keywords: neurocognitive disorders, seniors, music therapy intervention, melody, rhythm, text, memory stimulation, communication skills

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1833 Intercultural Strategies of Chinese Composers in the Organizational Structure of Their Works

Authors: Bingqing Chen

Abstract:

The Opium War unlocked the gate of China. Since then, modern western culture has been imported strongly and spread throughout this Asian country. The monologue of traditional Chinese culture in the past has been replaced by the hustle and bustle of multiculturalism. In the field of music, starting from school music, China, a country without the concept of composition, was deeply influenced by western culture and professional music composition, and entered the era of professional music composition. Recognizing the importance of national culture, a group of insightful artists began to try to add ‘China’ to musical composition. However, due to the special historical origin of Chinese professional musical composition and the three times of cultural nihilism in China, professional musical composition at this time failed to interpret the deep language structure of local culture within Chinese traditional culture, but only regarded Chinese traditional music as a ‘melody material library.’ At this time, the cross-cultural composition still takes Western music as its ‘norm,’ while our own music culture only exists as the sound of the contrast of Western music. However, after reading scores extensively, watching video performances, and interviewing several active composers, we found that at least in the past 30 years, China has created some works that can be called intercultural music. In these kinds of music, composers put Chinese and Western, traditional and modern in an almost equal position to have a dialogue based on their deep understanding and respect for the two cultures. This kind of music connects two music worlds, and links the two cultural and ideological worlds behind it, and communicates and grows together. This paper chose the works of three composers with different educational backgrounds, and pay attention to how composers can make a dialogue at the organizational structure level of their works. Based on the strategies adopted by composers in structuring their works, this paper expounds on how the composer's music procedure shows intercultural in terms of whole sound effects and cultural symbols. By actively participating in this intercultural practice, composers resorting to various musical and extra-musical procedures to arrive at the so-called ‘innovation within tradition.’ Through the dialogue, we can activate the space of creative thinking and explore the potential contained in culture. This interdisciplinary research promotes the rethinking of the possibility of innovation in contemporary Chinese intercultural music composition, spanning the fields of sound studies, dialogue theory, cultural research, music theory, and so on. Recently, China is calling for actively promoting 'the construction of Chinese music canonization,’ expecting to form a particular music style to show national-cultural identity. In the era of globalization, it is possible to form a brand-new Chinese music style through intercultural composition, but it is a question about talents, and the key lies in how composers do it. There is no recipe for the formation of the Chinese music style, only the composers constantly trying and tries to solve problems in their works.

Keywords: dialogism, intercultural music, national-cultural identity, organization/structure, sound

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1832 Development of National Guidelines for Conducting Research and Development of Herbal Medicine in Thailand According to International Standards

Authors: Patcharaporn Sudchada, Nuntika Prommee

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Background: Herbal medicines constitute a vital component of Thailand's healthcare system and possess significant potential for international recognition. However, the absence of standardized clinical research guidelines aligned with international standards, coupled with unique local challenges, has hindered the development and registration of Thai herbal medicines in the global market. Objective: To establish comprehensive research and development guidelines for herbal medicine formulations that comply with international standards, with particular emphasis on enhancing research quality, scientific credibility, and facilitating both domestic registration and international market acceptance. Methods: The research methodology comprised eight sequential phases: (1) systematic collection and review of relevant documentation and regulatory frameworks; (2) development of preliminary content structure and template designs; (3) systematic analysis and synthesis of scientific evidence and regulatory data; (4) creation of detailed research guidelines and accompanying templates; (5) execution of domestic and international consultation meetings and study visits involving nine stakeholder groups; (6) systematic expert review of the draft guidelines; (7) incorporation of feedback from relevant regulatory and research agencies; and (8) finalization and validation of the comprehensive guidelines. Results: The study produced comprehensive research and development guidelines for herbal medicines that meet international standards, encompassing the complete development pathway from initial concept through pre-clinical studies, product development, preparation protocols, clinical trial conduct, and product registration procedures. The guidelines include standardized templates and forms specifically designed for clinical research documentation. Conclusion: The established guidelines represent a significant advancement in standardizing clinical research for Thai herbal medicines, enhancing their scientific credibility and potential for international acceptance. Nevertheless, Thailand continues to face specific challenges, including insufficient specialized personnel in herbal research (particularly in clinical trials), challenges in integrating traditional Thai medicine principles with modern scientific methodology, limited research infrastructure, inadequate funding mechanisms, complex registration procedures, and public skepticism toward herbal products. The policy recommendations outlined in this research provide a strategic framework for addressing these challenges and promoting sustainable development of Thai herbal medicines within the national context.

Keywords: herbal medicine, clinical research, international standards, research guidelines, drug development, traditional thai medicine, regulatory compliance

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1831 The Two Question Challenge: Embedding the Serious Illness Conversation in Acute Care Workflows

Authors: D. M. Lewis, L. Frisby, U. Stead

Abstract:

Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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