Search results for: evidence-based practice nursing
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4812

Search results for: evidence-based practice nursing

3912 Similarities and Differences between Psychotherapy, Coaching Psychology and Coaching

Authors: Ole Michael Spaten

Abstract:

This article presents similarities and differences between psychotherapy, coaching psychology and coaching, and hence discusses boundaries between these diverse fields of practice. The point of departure will be prevailing arguments and descriptions in the scientific community, and it shows both commonalities and major differences in relation to the application in daily practice. The results (the similarities and differences) are presented and discussed in the light of scientific research and different theoretical perspectives, including both classic and recent scholars. Some of the main differences presented are; the clinical/non-clinical perspective and the educational differences, including the different criteria and demands which professionals working in these three different professions, should undergo to obtain their certification. Further, one of the main similarities is presented: the importance of the relationship between the therapist/coach and the client/coachee. The goal and task oriented focus are also presented as a similarity between the three intervention forms – at least to some extent. Finally, some central concepts from the fields are presented in a table for a proposal of distinctions and interfaces. It is concluded that a comprehensive education in combination with an understanding of the differences and similarities between the three intervention forms is of significant importance for the professional working in either of the fields. Future studies should, however, include additional research on the similarities and differences and how to continue the educational progress in all three disciplines.

Keywords: boundaries, coaching, coaching psychology, interface, psychotherapy

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3911 Culturally Relevant Education Challenges and Threats in the US Secondary Classroom

Authors: Owen Cegielski, Kristi Maida, Danny Morales, Sylvia L. Mendez

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This study explores the challenges and threats US secondary educators experience in incorporating culturally relevant education (CRE) practices in their classrooms. CRE is a social justice pedagogical practice used to connect student’s cultural references to academic skills and content, to promote critical reflection, to facilitate cultural competence, and to critique discourses of power and oppression. Empirical evidence on CRE demonstrates positive student educational outcomes in terms of achievement, engagement, and motivation. Additionally, due to the direct focus on uplifting diverse cultures through the curriculum, students experience greater feelings of belonging, increased interest in the subject matter, and stronger racial/ethnic identities. When these teaching practices are in place, educators develop deeper relationships with their students and appreciate the multitude of gifts they (and their families) bring to the classroom environment. Yet, educators regularly report being unprepared to incorporate CRE in their daily teaching practice and identify substantive gaps in their knowledge and skills in this area. Often, they were not exposed to CRE in their educator preparation program, nor do they receive adequate support through school- or district-wide professional development programming. Through a descriptive phenomenological research design, 20 interviews were conducted with a diverse set of secondary school educators to explore the challenges and threats they experience in incorporating CRE practices in their classrooms. The guiding research question for this study is: What are the challenges and threats US secondary educators face when seeking to incorporate CRE practices in their classrooms? Interviews were grounded by the theory of challenge and threat states, which highlights the ways in which challenges and threats are appraised and how resources factor into emotional valence and perception, as well as the potential to meet the task at hand. Descriptive phenomenological data analysis strategies were utilized to develop an essential structure of the educators’ views of challenges and threats in regard to incorporating CRE practices in their secondary classrooms. The attitude of the phenomenological reduction method was adopted, and the data were analyzed through five steps: sense of the whole, meaning units, transformation, structure, and essential structure. The essential structure that emerged was while secondary educators display genuine interest in learning how to successfully incorporate CRE practices, they perceive it to be a challenge (and not a threat) due to lack of exposure which diminishes educator capacity, comfort, and confidence in employing CRE practices. These findings reveal the value of attending to emotional valence and perception of CRE in promoting this social justice pedagogical practice. Findings also reveal the importance of appropriately resourcing educators with CRE support to ensure they develop and utilize this practice.

Keywords: culturally relevant education, descriptive phenomenology, social justice practice, US secondary education

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3910 Dietary Diversity Practice and Associated Facrors Among Hypertension Patients at Tirunesh Beijing Hospital

Authors: Wudneh Asegedech Ayele

Abstract:

Background: Dietary diversity is strongly related with non-communicable disease (NCDs). Diet plays a key role as a risk factor for hypertension. Diets rich in fruits, vegetables, and low-fat dairy products that include whole grains, poultry, fish, and nuts, that contain only small amounts of red meat, sweets, and sugar-containing beverages, and that contain decreased amounts of total and saturated fat and cholesterol have been found to have a protective effect against hypertension. Methods: hospital based Cross-sectional study design was employed from June 1-June 25, 2021. Sampling technique was Systematic random sampling and data were collected using an interview method. Data were entered into Epi Data version 3.1 and exported to SPSS version 25 for processed and analysis respectively. Descriptive statistics were used to summarize data. Bivariate and multivariate logistic regression will employed to determine dietary diversity among hypertension patients. Results: Adequate dietary diversity score were 96 (24.68%). Most of them cereal, white roots and tubers, dark green leafy vegetables, Vitamin A rich fruits ,meat, egg and coffee or tea more intakes. Hypertensive patients who didn’t consume cereals four times less likely adequate dietary diversity than who consumed cereals [AOR= 4.083, 95%: CI (2.096 -7.352)]. Hypertensive patients who didn’t consume white roots and tubers 14 times less likely adequate dietary diversity than who consumed white roots and tubers [AOR= 13.733, 95% CI: (5.388-34.946)]. Conclusion and recommendation the study showed one of fourth part reported adequate dietary diversity score. Cereals, fruits, vegetables and milk and milk products were statistically associated with dietary diversity practice. Health education about dietary modifications and behavioral change to dietary diversity

Keywords: dietary diversity practice and associated facrors among hypertension patients at tirunesh beijing hospital, hypertension, dietary, diversity and tirunesh beijing hospital, associated facrors among hypertension patient, at tirunesh beijing hospita

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3909 The Effects of Physician-Family Communication from the Point View of Clinical Staff

Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng

Abstract:

Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.

Keywords: clinical staff, communication, family meeting, physician-family

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3908 Investigations on the Seismic Performance of Hot-Finished Hollow Steel Sections

Authors: Paola Pannuzzo, Tak-Ming Chan

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In seismic applications, hollow steel sections show, beyond undeniable esthetical appeal, promising structural advantages since, unlike open section counterparts, they are not susceptible to weak-axis and lateral-torsional buckling. In particular, hot-finished hollow steel sections have homogeneous material properties and favorable ductility but have been underutilized for cyclic bending. The main reason is that the parameters affecting their hysteretic behaviors are not yet well understood and, consequently, are not well exploited in existing codes of practice. Therefore, experimental investigations have been conducted on a wide range of hot-finished rectangular hollow section beams with the aim to providing basic knowledge for evaluating their seismic performance. The section geometry (width-to-thickness and depth-to-thickness ratios) and the type of loading (monotonic and cyclic) have been chosen as the key parameters to investigate the cyclic effect on the rotational capacity and to highlight the differences between monotonic and cyclic load conditions. The test results provide information on the parameters that affect the cyclic performance of hot-finished hollow steel beams and can be used to assess the design provisions stipulated in the current seismic codes of practice.

Keywords: bending, cyclic test, finite element modeling, hollow sections, hot-finished sections

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3907 Investigations of Effective Marketing Metric Strategies: The Case of St. George Brewery Factory, Ethiopia

Authors: Mekdes Getu Chekol, Biniam Tedros Kahsay, Rahwa Berihu Haile

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The main objective of this study is to investigate the marketing strategy practice in the Case of St. George Brewery Factory in Addis Ababa. One of the core activities in a Business Company to stay in business is having a well-developed marketing strategy. It assessed how the marketing strategies were practiced in the company to achieve its goals aligned with segmentation, target market, positioning, and the marketing mix elements to satisfy customer requirements. Using primary and secondary data, the study is conducted by using both qualitative and quantitative approaches. The primary data was collected through open and closed-ended questionnaires. Considering the size of the population is small, the selection of the respondents was carried out by using a census. The finding shows that the company used all the 4 Ps of the marketing mix elements in its marketing strategies and provided quality products at affordable prices by promoting its products by using high and effective advertising mechanisms. The product availability and accessibility are admirable with the practices of both direct and indirect distribution channels. On the other hand, the company has identified its target customers, and the company’s market segmentation practice is geographical location. Communication effectiveness between the marketing department and other departments is very good. The adjusted R2 model explains 61.6% of the marketing strategy practice variance by product, price, promotion, and place. The remaining 38.4% of variation in the dependent variable was explained by other factors not included in this study. The result reveals that all four independent variables, product, price, promotion, and place, have a positive beta sign, proving that predictor variables have a positive effect on that of the predicting dependent variable marketing strategy practice. Even though the marketing strategies of the company are effectively practiced, there are some problems that the company faces while implementing them. These are infrastructure problems, economic problems, intensive competition in the market, shortage of raw materials, seasonality of consumption, socio-cultural problems, and the time and cost of awareness creation for the customers. Finally, the authors suggest that the company better develop a long-range view and try to implement a more structured approach to attain information about potential customers, competitor’s actions, and market intelligence within the industry. In addition, we recommend conducting the study by increasing the sample size and including different marketing factors.

Keywords: marketing strategy, market segmentation, target marketing, market positioning, marketing mix

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3906 Malaria and Environmental Sanitation

Authors: Soorya Vennila

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A comprehensive study of malaria in 165 villages (hamlets) in Harur block, Dharmapuri district, has revealed the fact that there are distinct episodes of malaria due to An. culicifacies, the vector, causes persistent transmission in the revenue village called Vedakatamaduvu. A total of 300 household adult samples are randomly selected to study both quantitatively and qualitatively the vulnerability of malaria. On the basis of the response, the problem uncommon with groups was identified as the outdoor routine, particularly open defecation, with which the samples needed to be stratified into two major groups; users of toilets 21 and those who practice open defecation 279. Open defecation, as the habit-based vulnerability, is measured with the Pearson correlation coefficient to estimate the relationship between malaria and open defecation. It is also verified from the literature that plant fluids provide mosquitoes not only with energy but also with nutrition, to the extent that they can develop fertile eggs. In the endemic areas, the bushy Presopis Juliflora, which naturally serves as a feeding and resting spot for mosquitoes, serves as a cover to practice open defecation as well. Eventually, those who get resort to Presopis for open defecation have a higher chance of getting exposed to mosquito bites and being infected with malaria. The study concludes that the combination of bushy Prosopis Juliflora and open defecation leaves the place perpetually vulnerable to malaria.

Keywords: Malaria, open defecation, endemic, presopis juliflora

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3905 Shariah Perspective on Legal Framework and Practice of Margin Financing in Pakistan

Authors: Anees Tahir

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Margin financing plays a significant role in Pakistan's stock market (PSX), offering investors the opportunity to maximize profits by borrowing funds from financiers to purchase marginable stocks. However, this financial practice raises several Shariah-related concerns. The study follows legal doctrinal research methodology. It explains and analyzes the law of margin financing prevailing in PSX and compares it with the principles of Shariah. It also examines and investigates the practices of margin financing from the perspective of Shariah. As part of the study, the researcher has conducted structured interviews with the Shariah advisors of the finance industry, academicians, market practitioners, and regulators. Thus, the study analyzes the findings of interviews. This article explores the legal framework and practice of margin financing in Pakistan from a Shariah perspective. The article investigates various issues relating to margin financing, including the fundamental concern of interest-based lending, which contravenes Islamic principles. It also highlights the problematic subject matter of margin financing, often involving non-Shariah compliant securities. Additionally, the article addresses the restriction on proprietary rights and the problematic element of speculation associated with margin financing. To provide a Shariah-compliant alternative, the Securities and Exchange Commission of Pakistan (SECP) introduced Murabahah Shares Financing (MSF) in 2019. However, the focus of the market is still on conventional margin financing. In the opinion of the researcher, the effective implementation of MSF is imperative because in the absence of such an alternative, the faith sensitive investor will remain deprived of a level playing field, and he is unable to get required financing opportunities through a halal and Shariah-compliant manner. This article argues that margin financing in its current form is incompatible with Shariah principles and should be discontinued. It is recommended that the SECP should gradually phase out the use of margin financing and increase reliance on MSF to provide faith-sensitive and committed investors with Shariah-compliant financing options.

Keywords: margin financing, marginable stocks, faith sensitive investor, Murabahah shares financing

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3904 The Association of Excessive Work Stress with Job Satisfaction and Turnover Intention in Operating Room Nurses: A Cross-Sectional Study in a Metropolitan Teaching Hospital in Southern Taiwan

Authors: Chia Yu Chen, Shu Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Shu Jiuan Chen, Yen Ling Liu

Abstract:

Aim: It remains undetermined that whether increased work stress may affect the job satisfaction and career loyalty among nursing staffs in the operating room. The long-term goal of this study is to lengthen the professional life of operating room nurses by attenuating the work stress and enhancing their contentment in work. Method: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in the southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses. Chi-square test was used to analyze the categorical data and Pearson correlation was used to analyze the association between two numerical datasets (SPSS version 20.0). Results: The response rate was 80% (80/100) and a total of 73 (73%) completed forms were eventually proceeded for analysis. The average scores for work stress and job satisfaction of the operating room nurses were 145.96±32.91 and 47.38±6.07, respectively. The correlation coefficients of work stress versus job satisfaction and organizational identity were (r=-0.338, p=0.003 and r=-0.354, p=0.002), respectively. There were more nurses who took rotating shift quitted works from the operating room than those who took only dayshift (2=5.176, p<0.05). Nurses who reported of having lower job satisfaction were associated with significantly higher turnover intention (t=3.714, p< 0.01). Following multivariate regression analysis, rotating shift and low job satisfaction were identified as the two independent predictors of intention to quit from working in the operating room. Conclusion: Our study clearly demonstrates that increased work stress significantly attenuates job satisfaction and organizational identity. Rotating shift is associated with higher work stress, lower job satisfaction, and higher turnover intention, which is consistent with the previous surveys carried out in the department of medical technology. Therefore, improvement of working quality in the operating rooms is essential to increase the retain intention of the well-trained nursing staffs. Further investigation into types of work shifts and other strategies of attenuating stress in workplace is currently undertaken in order to improve the job satisfaction and to decrease turnover intention in the operating room.

Keywords: rotating shift, work stress, job satisfaction, turnover intention

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3903 A Comparative Analysis on the Perspectives of Secular and Non-Secular Male Groups on Female Masturbation

Authors: Marc Angelo C. Balon, Maxine Joy A. Yongoyong

Abstract:

Female masturbation has been an age-old controversy. In fact, it is not widely talked about specifically in the Philippines since the Filipino culture still preserves the space for conservativeness. Although, considering the numerous and emerging studies on female masturbation, this study will focus on the perspectives of secular and non-secular male groups with regard to female masturbation. The objectives of this study is to identify the perceptions of these male groups and their taking on considering women who masturbate as their sexual partner, as a sexual object, and as a life partner and lastly, to have a comparative analysis of the perceptions of these male groups drawing out their sense of meaning on the masturbation of women. The researchers made use of purposive sampling technique and interview guide questionnaire. The secular male group were psychology students while the non-secular male group was drawn from a Catholic Church seminary in Tagaytay City, Cavite. Results showed that the secular male group had scientific perspectives such as exploring the genitals, contradicting moral perspectives on masturbation as a regular practice, while the non-secular male groups had theological perspectives in accordance with the fundamental moral theology, moral perspectives and perspectives on masturbation as a regular practice. Moreover, men who came from the non-secular group highly believe that masturbation is immoral. Otherwise, men who came from the secular group noted that masturbation is primary physiological need.

Keywords: secular, non-secular, masturbation, comparative analysis

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3902 Site Specific Ground Response Estimations for the Vulnerability Assessment of the Buildings of the Third Biggest Mosque in the World, Algeria’s Mosque

Authors: S. Mohamadi, T. Boudina, A. Rouabeh, A. Seridi

Abstract:

Equivalent linear and non-linear ground response analyses are conducted at many representative sites at the mosque of Algeria, to compare the free field acceleration spectra with local code of practice. Spectral Analysis of Surface Waves (SASW) technique was adopted to measure the in-situ shear wave velocity profile at the representative sites. The seismic movement imposed on the rock is the NS component of Keddara station recorded during the earthquake in Boumerdes 21 May 2003. The site-specific elastic design spectra for each site are determined to further obtain site specific non-linear acceleration spectra. As a case study, the results of site-specific evaluations are presented for two building sites (site of minaret and site of the prayer hall) to demonstrate the influence of local geological conditions on ground response at Algerian sites. A comparison of computed response with the standard code of practice being used currently in Algeria for the seismic zone of Algiers indicated that the design spectra is not able to capture site amplification due to local geological conditions.

Keywords: equivalent linear, non-linear, ground response analysis, design response spectrum

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3901 Teachers' Beliefs About the Environment: The Case of Azerbaijan

Authors: Aysel Mehdiyeva

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As a driving force of society, the role of teachers is important in inspiring, motivating, and encouraging the younger generation to protect the environment. In light of these, the study aims to explore teachers’ beliefs to understand teachers’ engagement with teaching about the environment. Though teachers’ beliefs about the environment have been explored by a number of researchers, the influence of these beliefs in their professional lives and in shaping their classroom instructions has not been widely investigated in Azerbaijan. To this end, this study aims to reveal the beliefs of secondary school geography teachers about the environment and find out the ways teachers’ beliefs of the environment are enacted in their classroom practice in Azerbaijan. Different frameworks have been suggested for measuring environmental beliefs stemming from well-known anthropocentric and biocentric worldviews. The study addresses New Ecological Paradigm (NEP) by Dunlap to formulate the interview questions as discussion with teachers around these questions aligns with the research aims serving to well-capture the beliefs of teachers about the environment. Despite the extensive applicability of the NEP scale, it has not been used to explore in-service teachers’ beliefs about the environment. Besides, it has been used as a tool for quantitative measurement; however, the study addresses the scale within the framework of the qualitative study. The research population for semi-structured interviews and observations was recruited via purposeful sampling. Teachers’ being a unit of analysis is related to the gap in the literature as to how teachers’ beliefs are related to their classroom instructions within the environmental context, as well as teachers’ beliefs about the environment in Azerbaijan have not been well researched. 6 geography teachers from 4 different schools were involved in the research process. The schools are located in one of the most polluted parts of the capital city Baku where the first oil well in the world was drilled in 1848 and is called “Black City” due to the black smoke and smell that covered that part of the city. Semi-structured interviews were conducted with the teachers to reveal their stated beliefs. Later, teachers were observed during geography classes to understand the overlap between teachers’ ideas presented during the interview and their teaching practice. Research findings aim to indicate teachers’ ecological beliefs and practice, as well as elaborate on possible causes of compatibility/incompatibility between teachers’ stated and observed beliefs.

Keywords: environmental education, anthropocentric beliefs, biocentric beliefs, new ecological paradigm

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3900 Depth of Field: Photographs, Narrative and Reflective Learning Resource for Health Professions Educators

Authors: Gabrielle Brand, Christopher Etherton-Beer

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The learning landscape of higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practice in today’s complex Australian health care systems, including responding to changing demographics of population ageing. To counteract a widespread perception of health professions students’ disinterest in caring for older persons, the authors will report on an exploratory, mixed method research study that used photographs, narrative and small group work to enhance medical and nursing students’ reflective learning experience. An innovative photo-elicitation technique and reflective questioning prompts were used to increase engagement, and challenge students to consider new perspectives (around ageing) by constructing shared storylines in small groups. The qualitative themes revealed how photographs, narratives and small group work created learning spaces for reflection whereby students could safely explore their own personal and professional values, beliefs and perspectives around ageing. By providing the space for reflection, the students reported how they found connection and meaning in their own learning through a process of self-exploration that often challenged their assumptions of both older people and themselves as future health professionals. By integrating cognitive and affective elements into the learning process, this research demonstrates the importance of embedding visual methodologies that enhance reflection and transformative learning. The findings highlight the importance of integrating the arts into predominantly empirically driven health professional curricula and can be used as a catalyst for individual and/or collective reflection which can potentially enhance empathy, insight and understanding of the lived experiences of older patients. Based on these findings, the authors have developed ‘Depth of Field: Exploring Ageing’ an innovative, interprofessional, digital reflective learning resource that uses Prezi Inc. software (storytelling tool that presents ideas on a virtual canvas) to enhance students’ reflective capacity in the higher education environment.

Keywords: narrative, photo-elicitation, reflective learning, qualitative research

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3899 Relevance of Lecture Method in Modern Era: A Study from Nepal

Authors: Hari Prasad Nepal

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Research on lecture method issues confirm that this teaching method has been practiced from the very beginnings of schooling. Many teachers, lecturers and professors are convinced that lecture still represents main tool of contemporary instructional process. The central purpose of this study is to uncover the extent of using lecture method in the higher education. The study was carried out in Nepalese context with employing mixed method research design. To obtain the primary data this study employed a questionnaire involving items with close and open answers. 120 teachers, lecturers and professors participated in this study. The findings indicated that 75 percent of the respondents use the lecture method in their classroom teaching. The study reveals that there are advantages of using lecture method such as easy to practice, less time to prepare, high pass rate, high students’ satisfaction, little comments on instructors, appropriate to large classes and high level students. In addition, the study divulged the instructors’ reflections and measures to improve the lecture method. This research concludes that the practice of lecture method is still significantly applicable in colleges and universities in Nepalese contexts. So, there are no significant changes in the application of lecture method in the higher education classroom despite the emergence of new learning approaches and strategies.

Keywords: instructors, learning approaches, learning strategies, lecture method

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3898 Field-Testing a Digital Music Notebook

Authors: Rena Upitis, Philip C. Abrami, Karen Boese

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The success of one-on-one music study relies heavily on the ability of the teacher to provide sufficient direction to students during weekly lessons so that they can successfully practice from one lesson to the next. Traditionally, these instructions are given in a paper notebook, where the teacher makes notes for the students after describing a task or demonstrating a technique. The ability of students to make sense of these notes varies according to their understanding of the teacher’s directions, their motivation to practice, their memory of the lesson, and their abilities to self-regulate. At best, the notes enable the student to progress successfully. At worst, the student is left rudderless until the next lesson takes place. Digital notebooks have the potential to provide a more interactive and effective bridge between music lessons than traditional pen-and-paper notebooks. One such digital notebook, Cadenza, was designed to streamline and improve teachers’ instruction, to enhance student practicing, and to provide the means for teachers and students to communicate between lessons. For example, Cadenza contains a video annotator, where teachers can offer real-time guidance on uploaded student performances. Using the checklist feature, teachers and students negotiate the frequency and type of practice during the lesson, which the student can then access during subsequent practice sessions. Following the tenets of self-regulated learning, goal setting and reflection are also featured. Accordingly, the present paper addressed the following research questions: (1) How does the use of the Cadenza digital music notebook engage students and their teachers?, (2) Which features of Cadenza are most successful?, (3) Which features could be improved?, and (4) Is student learning and motivation enhanced with the use of the Cadenza digital music notebook? The paper describes the results 10 months of field-testing of Cadenza, structured around the four research questions outlined. Six teachers and 65 students took part in the study. Data were collected through video-recorded lesson observations, digital screen captures, surveys, and interviews. Standard qualitative protocols for coding results and identifying themes were employed to analyze the results. The results consistently indicated that teachers and students embraced the digital platform offered by Cadenza. The practice log and timer, the real-time annotation tool, the checklists, the lesson summaries, and the commenting features were found to be the most valuable functions, by students and teachers alike. Teachers also reported that students progressed more quickly with Cadenza, and received higher results in examinations than those students who were not using Cadenza. Teachers identified modifications to Cadenza that would make it an even more powerful way to support student learning. These modifications, once implemented, will move the tool well past its traditional notebook uses to new ways of motivating students to practise between lessons and to communicate with teachers about their learning. Improvements to the tool called for by the teachers included the ability to duplicate archived lessons, allowing for split screen viewing, and adding goal setting to the teacher window. In the concluding section, proposed modifications and their implications for self-regulated learning are discussed.

Keywords: digital music technologies, electronic notebooks, self-regulated learning, studio music instruction

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3897 Pharmaceutical Innovation in Jordan: KAP Analysis

Authors: Abdel Qader Al Bawab, Mohannad Odeh, Rami Amer

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Recently, there has been an increasing interest in innovative business development. Nevertheless, in the pharmacy practice field, there seems to be a gap in perceptions, attitudes, and knowledge about innovation between practicing pharmacists and academia. This study explores this gap and aspects of pharmaceutical innovation in Jordan, comparing pharmacists and last-year pharmacy students. A validated (r2 = 0.74) and reliable (Pearson’s r = 0.88) online questionnaire was designed to assess and compare knowledge, attitude, and perceptions about pharmaceutical innovation. A total of 397 participants (215 pharmacy students and 182 pharmaceutical professionals) responded. Compared with 50% of the pharmacists, only 32.1% of the students claimed that they knew the differences between pharmaceutical innovation, discovery, invention, and entrepreneurship [x2 (2) = 14.238, p = 0.001; Cramer’s V = 0.189]. Pharmacists demonstrated a higher level of trust in the innovative website design for their institution compared with students (25.3% vs. 16.3%, p < 0.001, Cramer’s V = 0.327). However, 60% of the students did not know the innovative design standards for websites, while the corresponding percentage was 37% for the pharmacists (p < 0.001; Cramer’s V = 0.327). The majority of the students were interested in pharmaceutical innovation (81.9%). Unfortunately, 76.3% never studied innovation in their pharmacy curricula. Similarly, most pharmacists (76.4%) considered adopting innovation, but only 30% had a concrete plan. For the field where pharmacists aim to innovate in the next 5 years, new pharmaceutical services were the dominant field (34.6%). Despite a positive attitude and perception, pharmacists and pharmacy students expressed poor knowledge about innovation. Policies to enhance awareness about innovation and professional educational tools should be implemented.

Keywords: pharmacy, innovation, knowledge, attitude, practice

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3896 Trajectories of Physical Activity Intensity and Associated Factors in Men and Women from Elsa-Brasil

Authors: André Luis Messias Dos Santos Duque, Daniela Polessa Paula, Rosane Harter Griep

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The intensity of physical activity (PA) over time is essential for health promotion. However, there are few studies that have analyzed the practice of different intensities of PA longitudinally. The objective was to identify PA intensity trajectories in men and women from a Brazilian multicentric cohort and their associated factors. Data from 10,367 participants (5,777 women and 4,590 men) aged 35 to 74 years from the baseline and two follow-up visits (2012-2014 and 2017-2019) of the Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. PA intensity (low, moderate, or high) was assessed using the leisure-time PA module of the International Physical Activity Questionnaire (IPAQ), and sociodemographic, behavioral, and clinical variables were included. Chi-square and T-student tests were used, considering a significant level of 5%. Four intensity trajectories were identified: low, moderate, high, and no pattern. Most participants (82.5% of women and 75.7% of men) had low PA intensity trajectories, and only 2% of women and 4.8% of men had high PA intensity trajectories. For both sexes, a significant difference (p<0.05) was found for age group, education level, income, smoking, type 2 diabetes, obesity, hypertriglyceridemia, and hypertension. Actions that promote the practice of high-intensity PA over time and consider sociodemographic, clinical, and behavioral factors are necessary.

Keywords: lifestyle, longterm effects, physical activity, socioeconomic factors

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3895 Clinically-Based Improvement Project Focused on Reducing Risks Associated with Diabetes Insipidus, Syndrome of Inappropriate ADH, and Cerebral Salt Wasting in Paediatric Post-Neurosurgical and Traumatic Brain Injury Patients

Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen

Abstract:

Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.

Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric

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3894 An Analysis of Millennials Using Secondhand Clothing as an Ongoing Fashion Trend

Authors: Patricia Sumod

Abstract:

There is a unique movement of fashion that features a trend around secondhand clothing. This is especially observed in the lifestyles of the millennials, where the concept of reusing apparel and accessories is noticeable and, therefore, slowly diminishing the high consumption of fast fashion and generating environmental awareness. This paper will focus on how this clothing trend influences and engages consumers in buying secondhand clothing and creating fashionable looks simultaneously. To further examine the millennials’ motivation towards consumption and using secondhand fashion, a concept as a trendsetter, this paper will take a closer look at their idea of concern for the environment. Considering second-hand clothing is a sustainable consumption practice, it will investigate the role of social influencers, trendsetters, and millennials in overall fashion consumption in this context. This study aims to understand how secondhand clothing and millennials differ from other consumers regarding the perception of fast-depleting natural resources, price sensitivity, vintage attachments, and psychographics. Secondly, the paper will also present the connection of emotion between millennials and secondhand clothing that may not be necessarily purchased but received. This study will reflect on the already identified influences in increased purchase behavior and an uncharted positive relationship between the consumer and the products. This behavior will further formulate into a habit by consumer segments, creating an expanded market for secondhand clothing. There is no definite indication that fast fashion will cease to exist, but slowing its rapid movement is an attempt to work toward a sustainable future. The conclusion will present possibilities for consumers to engage in C2C online interaction, thereby reinforcing a notable change in consumer behavior and attitude in contradiction to today’s extreme consumerism and willingness to be adaptable to a minimalist way of life. Fashion brands will then begin a new forecast to actively accommodate the new millennial concept of fashion that will advertise more concern than insatiability. The research will be with literature from various authors, insights provided by researchers on this new wave of consumers, and a qualitative approach with face-to-face interviews with a sample group who are in the practice of secondhand clothing consumption.

Keywords: second-hand clothing, millennials, sustainability, consumption practice, fashion environment.

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3893 Collapse Capacity Assessment of Inelastic Structures under Seismic Sequences

Authors: Shahrzad Mohammadi, Ghasem Boshrouei Sharq

Abstract:

All seismic design codes are based on the determination of the design earthquake without taking into account the effects of aftershocks in the design practice. In regions with a high level of seismicity, the occurrence of several aftershocks of various magnitudes and different time lags is very likely. This research aims to estimate the collapse capacity of a 10-story steel bundled tube moment frame subjected to as-recorded seismic sequences. The studied structure is designed according to the seismic regulations of the fourth revision of the Iranian code of practice for the seismic-resistant design of buildings (Code No.2800). A series of incremental dynamic analyses (IDA) is performed up to the collapse level of the intact structure. Then, in order to demonstrate the effects of aftershock events on the collapse vulnerability of the building, aftershock IDA analyzes are carried out. To gain deeper insight, collapse fragility curves are developed and compared for both series. Also, a study on the influence of various ground motion characteristics on collapse capacity is carried out. The results highlight the importance of considering the decisive effects of aftershocks in seismic codes due to their contribution to the occurrence of collapse.

Keywords: IDA, aftershock, bundled tube frame, fragility assessment, GM characteristics, as-recorded seismic sequences

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3892 Speaking Difficulties Encountered by EFL Learners in Secondary School in Morocco

Authors: Bellali Assia, Bellali Fatima

Abstract:

Speaking is one of the most difficult English skills for non-English learners. This study investigated English-speaking difficulties encountered by non-English secondary school students in a private school in Casablanca, Morocco. The subjects were students of 63 (male and female) from 2ed year classes level. It also aims to investigate the degree of main speaking difficulties and the factors effecting non-English students to speak English. This research used a descriptive qualitative and quantitative approach with a questionnaire and an interview to collect the data. In linguistically related difficulties, there were four difficulties, namely vocabulary, grammar, conversation and pronunciation. The results revealed that there were 40.32% of students agreed that they do not have sufficient grammar knowledge, 45.16% of students agreed that they do not have enough vocabulary, 45.90% of students agreed that they have difficulty in conversation, and 39.34% of students agreed that they have poor pronunciation. Also, the results indicated that 63.33 % of students agreed that they have problems with self-confidence. The factors causing the problem of speaking English in this study were lack of general knowledge, lack of speaking practice, fear of mistakes and grammar practice, low participation, shyness, nervousness, fear of criticism, and unfamiliar word pronunciation. Furthermore, recommendations and suggestions were presented to solve the problem and eliminate difficulties for teachers and students.

Keywords: English speaking, difficulties, factors, non-English students

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3891 Information Technology for Business Process Management in Insurance Companies

Authors: Vesna Bosilj Vukšić, Darija Ivandić Vidović, Ljubica Milanović Glavan

Abstract:

Information technology plays an irreplaceable role in introducing and improving business process orientation in a company. It enables implementation of the theoretical concept, measurement of results achieved and undertaking corrective measures aimed at improvements. Information technology is a key concept in the development and implementation of the business process management systems as it establishes a connection to business operations. Both in the literature and practice, insurance companies are often seen as highly process oriented due to the nature of their business and focus on customers. They are also considered leaders in using information technology for business process management. The research conducted aimed to investigate whether the perceived leadership status of insurance companies is well deserved, i.e. to establish the level of process orientation and explore the practice of information technology use in insurance companies in the region. The main instrument for primary data collection within this research was an electronic survey questionnaire sent to the management of insurance companies in the Republic of Croatia, Bosnia and Herzegovina, Slovenia, Serbia and Macedonia. The conducted research has shown that insurance companies have a satisfactory level of process orientation, but that there is also a huge potential for improvement, especially in the segment of information technology and its connection to business processes.

Keywords: business processes management, process orientation, information technology, insurance companies

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3890 IT Investment Decision Making: Case Studies on the Implementation of Contactless Payments in Commercial Banks of Kazakhstan

Authors: Symbat Moldabekova

Abstract:

This research explores the practice of decision-making in commercial banks in Kazakhstan. It focuses on recent technologies, such as contactless payments and QR code, and uses interviews with bank executives and industry practitioners to gain an understanding of how decisions are made and the role of financial assessment methods. The aim of the research is (1) to study the importance of financial techniques to evaluate IT investments; (2) to understand the role of different expert groups; (3) to explore how market trends and industry features affect decisions on IT; (4) to build a model that defines the real practice of decision-making on IT in commercial banks in Kazakhstan. The theoretical framework suggests that decision-making on IT is a socially constructed process, where actor groups with different background interact and negotiate with each other to develop a shared understanding of IT and to make more effective decisions. Theory and observations suggest that the more parties involved in the process of decision-making, the higher the possibility of disagreements between them. As each actor group has their views on the rational decision on an IT project, it is worth exploring how the final decision is made in practice. Initial findings show that the financial assessment methods are used as a guideline and do not play a big role in the final decision. The commercial banks of Kazakhstan tend to study experience of neighboring countries before adopting innovation. Implementing contactless payments is widely regarded as pinnacle success factor due to increasing competition in the market. First-to-market innovations are considered as priorities therefore, such decisions can be made with exemption of some certain actor groups from the process. Customers play significant role and they participate in testing demo versions of the products before bringing innovation to the market. The study will identify the viewpoints of actors in the banking sector on a rational decision, and the ways decision-makers from a variety of disciplines interact with each other in order to make a decision on IT in retail banks.

Keywords: actor groups, decision making, technology investment, retail banks

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3889 Lessons from Seven Years of Teaching Mindfulness to Children Living in a Context of Vulnerability

Authors: Annie Devault

Abstract:

Mindfulness-based interventions (MBI) can be beneficial for the well-being of children. MBIs offered for children in contexts of vulnerability (poverty, neglect) report positive results in terms of emotion regulation and cognitive flexibility. Anxiety is a common issue for children living in a vulnerable context. It has a negative impact on children’s attention span, emotional regulation and self-esteem. The MBI (12 weeks) associated with this research has been developed for a total of 30 children suffering from anxiety (7 to 9 years old) and receiving services from a community center over the last seven years. The first objective is to describe in details the content of the mindfulness-based intervention. The second purpose is to document what helps and what hinders the practice of mindfulness for children living in a context of vulnerability. A special attention will be given to the importance of the way that the intervention is offered and the principles that are followed by the practitioners. Perceived effects of the intervention on children were collected through an individual semi-structured interview with each child at the end of the program. Parents were also interviewed to have their point of view on the effect of their children’s participation in the group. Anxiety was measure with the Beck youth pre-post and at follow up (2 months). Qualitative analysis of the interviews with children showed that most of them mentioned that the program helped them become calmer, more confident, less scared and more able to deal with difficult emotions. Almost all of them reported having used the material provided to them to practice at home. This result has been confirmed by parents. They reported that their child had gained confidence and were better at verbalizing emotions. Children also grew calmer, even though all anxiety was not gone. They would have liked more material to practice at home. The quantitative instrument used to measure anxiety did not corroborate the qualitative interviews about anxiety. Discussion will question the use of this questionnaire for children who have important cognitive limitations. Discussion will also report the importance of the personalized contact with children, along with other consideration, to enhance the adherence of children and parents. The MBI seems to have benefited children in different ways, which is corroborated by most parents. Since the sample was limited, we will need to continue documenting its effects with more children and parents. The major strength of this research is to have reported the subjective perspectives of children on their experience of mindfulness.

Keywords: anxiety, mindfulness, children, best practices

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3888 An Analysis of Language Borrowing among Algerian University Students Using Online Facebook Conversations

Authors: Messaouda Annab

Abstract:

The rapid development of technology has led to an important context in which different languages and structures are used in the same conversations. This paper investigates the practice of language borrowing within social media platform, namely, Facebook among Algerian Vernacular Arabic (AVA) students. In other words, this study will explore how Algerian students have incorporated lexical English borrowing in their online conversations. This paper will examine the relationships between language, culture and identity among a multilingual group. The main objective is to determine the cultural and linguistic functions that borrowing fulfills in social media and to explain the possible factors underlying English borrowing. The nature of the study entails the use of an online research method that includes ten online Facebook conversations in the form of private messages collected from Bachelor and Masters Algerian students recruited from the English department at the University of Oum El-Bouaghi. The analysis of data revealed that social media platform provided the users with opportunities to shift from one language to another. This practice was noticed in students’ online conversations. English borrowing was the most relevant language performance in accordance with Arabic which is the mother tongue of the chosen sample. The analysis has assumed that participants are skilled in more than one language.

Keywords: borrowing, language performance, linguistic background, social media

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3887 Role of Geomatics in Architectural and Cultural Conservation

Authors: Shweta Lall

Abstract:

The intent of this paper is to demonstrate the role of computerized auxiliary science in advancing the desired and necessary alliance of historians, surveyors, topographers, and analysts of architectural conservation and management. The digital era practice of recording architectural and cultural heritage in view of its preservation, dissemination, and planning developments are discussed in this paper. Geomatics include practices like remote sensing, photogrammetry, surveying, Geographic Information System (GIS), laser scanning technology, etc. These all resources help in architectural and conservation applications which will be identified through various case studies analysed in this paper. The standardised outcomes and the methodologies using relevant case studies are listed and described. The main component of geomatics methodology adapted in conservation is data acquisition, processing, and presentation. Geomatics is used in a wide range of activities involved in architectural and cultural heritage – damage and risk assessment analysis, documentation, 3-D model construction, virtual reconstruction, spatial and structural decision – making analysis and monitoring. This paper will project the summary answers of the capabilities and limitations of the geomatics field in architectural and cultural conservation. Policy-makers, urban planners, architects, and conservationist not only need answers to these questions but also need to practice them in a predictable, transparent, spatially explicit and inexpensive manner.

Keywords: architectural and cultural conservation, geomatics, GIS, remote sensing

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3886 Design Guidelines for URM Infills and Effect of Construction Sequence on Seismic Performance of Code Compliant RC Frame Buildings

Authors: Putul Haldar, Yogendra Singh, D. K. Paul

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Un-Reinforced Masonry (URM) infilled RC framed buildings are the most common construction practice for modern multi-storey buildings in India like many other parts of the world. Although the behavior and failure pattern of the global structure changes significantly due to infill-frame interaction, the general design practice is to treat them as non-structural elements and their stiffness, strength and interaction with frame is often ignored, as it is difficult to simulate. Indian Standard, like many other major national codes, does not provide any explicit guideline for modeling of infills. This paper takes a stock of controlling design provisions in some of the major national seismic design codes (BIS 2002; CEN 2004; NZS-4230 2004; ASCE-41 2007) to ensure the desired seismic performance of infilled frame. Most of the national codes on seismic design of buildings still lack in adequate guidelines on modeling and design of URM infilled frames results in variable assumption in analysis and design. This paper, using nonlinear pushover analysis, also presents the effect of one of such assumptions of conventional ‘simultaneous’ analysis procedure of infilled frame on the seismic performance of URM infilled RC frame buildings.

Keywords: URM infills, RC frame, seismic design codes, construction sequence of infilled frame

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3885 Child Marriages in Africa: Using a Rights-Based Approach to Protect the Girl-Child in Nigeria

Authors: Foluke Abimbola

Abstract:

The United Nations Convention on the rights of the child has been signed and ratified by several countries due to the concern about various abuses and crimes committed against children both locally and internationally. It is a shame that in view of the peculiar hardships being experienced by children today, the natural right to childhood has to be protected by a vast array of laws and international conventions. 194 countries have so far acceded to and ratified the convention on the Rights of a Child while some countries such as Nigeria have enacted the convention as a domestic law, yet child abuse is still rampant not only in Nigeria but all over the world. In Nigeria, the Child Rights Act was passed into law in 2003, with its provisions similar to the United Nations Convention on the Rights of a Child. Despite the age of marriage provided in the Nigerian Child’s Rights Act 2003, many communities still practice child marriages to the detriment of the girl-child. Cases where these children have to withdraw from school as a result of these unripe marriages abound. Unfortunately, the Constitution of the Federal Republic of Nigeria 1999 appears to indirectly support early marriages for girls in section 29 (4) where it states that a woman who is married is deemed to be of full age whereas ‘full age’ as a general term in the Constitution is from 18 years old and above. Section 29 (4) may thus be interpreted to mean that a girl of 12 years old, if married, is deemed to be of ‘full-age.’ In view of these discrepancies which continue to justify this unwholesome practice, this paper shall proffer solutions to this unlawful act and make recommendations to existing institutions, using a rights-based approach, on how to prevent and/or substantially reduce this practice. A comparative analysis with other African countries will be adopted in order to conduct a research for effective policies that may be implemented for the protection of these girls. Thus, this paper will further examine the issue of child marriage which is still quite rampant in African countries particularly in Nigeria which also affects the girl-child’s right to an education. Such children are in need of special protection and this paper will recommend ways in which state institutions, particularly in Nigeria, may be able to introduce policies to curb incidences of child marriage and child sexual abuse while proffering strategies for the prevention of these crimes.

Keywords: child abuse, child marriages, child rights, constitutions, child rights, the girl-child

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3884 Lean Implementation in a Nurse Practitioner Led Pediatric Primary Care Clinic: A Case Study

Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

Abstract:

Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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3883 Experience in Caring for a Patient with Terminal Aortic Dissection of Lung Cancer and Paralysis of the Lower Limbs after Surgery

Authors: Pei-Shan Liang

Abstract:

Objective: This article explores the care experience of a terminal lung cancer patient who developed lower limb paralysis after surgery for aortic dissection. The patient, diagnosed with aortic dissection during chemotherapy for lung cancer, faced post-surgical lower limb paralysis, leading to feelings of helplessness and hopelessness as they approached death with reduced mobility. Methods: The nursing period was from July 19 to July 27, during which the author, alongside the intensive care team and palliative care specialists, conducted a comprehensive assessment through observation, direct care, conversations, physical assessments, and medical record review. Gordon's eleven functional health patterns were used for a holistic evaluation, identifying four nursing health issues: "pain related to terminal lung cancer and invasive procedures," "decreased cardiac tissue perfusion due to hemodynamic instability," "impaired physical mobility related to lower limb paralysis," and "hopelessness due to the unpredictable prognosis of terminal lung cancer." Results: The medical team initially focused on symptom relief, administering Morphine 5mg in 0.9% N/S 50ml IVD q6h for pain management and continuing chemotherapy as prescribed. Open communication was employed to address the patient's physical, psychological, and spiritual concerns. Non-pharmacological interventions, including listening, caring, companionship, opioid medication, and distraction techniques like comfortable positioning and warm foot baths, were used to alleviate pain, reducing the pain score to 3 on the numeric rating scale and easing respiratory discomfort. The palliative care team was also involved, guiding the patient and family through the "Four Paths of Life," helping the patient achieve a good end-of-life experience and the family to experience a peaceful life. This process also served to promote the concept of palliative care, enabling more patients and families to receive high-quality and dignified care. The patient was encouraged to express inner anxiety through drawing or writing, which helped reduce the hopelessness caused by psychological distress and uncertainty about the disease's prognosis, as assessed by the Hospital Anxiety and Depression Scale, reaching a level of mild anxiety but acceptable without affecting sleep. Conclusion: What left a deep impression during the care process was the need for intensive care providers to consider the patient's psychological state, not just their physical condition, when the patient's situation changes. Family support and involvement often provide the greatest solace for the patient, emphasizing the importance of comfort and dignity. This includes oral care to maintain cleanliness and comfort, frequent repositioning to alleviate pressure and discomfort, and timely removal of invasive devices and unnecessary medications to avoid unnecessary suffering. The nursing process should also address the patient's psychological needs, offering comfort and support to ensure that they can face the end of life with peace and dignity.

Keywords: intensive care, lung cancer, aortic dissection, lower limb paralysis

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