Search results for: junior staff

Authors: Darawan Augsornwan, Artitaya Sabangbal, Maneewan Srijan, Kanokarn Kongpitee, Lalida Petphai, Palakorn Surakunprapha

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Background: Srinagarind Hospital, Ward 3C, has patients with head and neck cancer, congenital urology anomalies such as hypospadis, cleft lip and cleft palate and congenital megacolon who need surgery. Undergoing surgery is a difficult time for patients/ family; they feel fear and anxiety. Nurses work closely with patients and family for 24 hours in the process of patients care, so should have the good nursing ability, innovation and an efficient nursing care system to promote patients self-care ability reducing suffering and preventing complications. From previous nursing outcomes we found patients did not receive appropriate information, could not take care of their wound, not early ambulation after the operation and lost follow-up. Objective: to develop the nursing system for patients who were undergoing an operation. Method: this is a participation action research. The sample population was 11 nurses and 60 patients. This study was divided into 3 phase: Phase 1. Situation review In this phase we review the clinical outcomes, the process of care from documents such as nurses note and interview nurses, patients and family about the process of care by nurses. Phase 2: focus group with 11 nurses, searching guideline for specific care, nursing care system then establish the protocol. This phase we have the protocol for giving information, teaching protocol and teaching record, leaflet for all of top five diseases, make video media to convey information, ambulation package and protocol for patients with head and neck cancer, patients zoning, primary nurse, improved job description for each staff level. Program to record number of patients, kind of medical procedures for showing nurses activity each day. Phase 3 implementation and evaluation. Result: patients/family receive appropriate information about deep breathing exercise, cough, early ambulation after the operation, information during the stay in the hospital. Patients family satisfaction is 95.04 percent, appropriate job description for a practical nurse, nurse aid, and worker. Nurses satisfaction is 95 percent. The complications can be prevented. Conclusion: the nursing system is the dynamic process using evidence to develop nursing care. The appropriate system depends on context and needs to keep an eye on every event.

Keywords: development, nursing system, patients undergoing operation, 3C Ward

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Authors: Shir Daphna-Tekoah, Nurit Eitan-Gutman, Uri Balla

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Background: Systemic documentation is essential in social work practice. Collaboration between an institution of higher education and social work health care services enabled adaptation of the medical documentation model of SOAP in the field of social work, by creating the ISOAPS model (Introduction, Subjective, Objective, Assessment, Plan, Summary) model. Aims: The article describes the ISOAPS model and its implementation in the field of social work, as a tool for standardization of documentation and the enhancement of multidisciplinary collaboration. Methods: We examined the changes in standardization using a mixed methods study, both before and after implementation of the model. A review of social workers’ documentation was carried out by medical staff and social workers in the Clalit Healthcare Services, the largest provider of public and semi-private health services in Israel. After implementation of the model, semi-structured qualitative interviews were undertaken. Main findings: The percentage of reviewers who evaluated their documentation as correct increased from 46%, prior to implementation, to 61% after implementation. After implementation, 81% of the social workers noted that their documentation had become standardized. The training process prepared them for the change in documentation and most of them (83%) started using the model on a regular basis. The qualitative data indicate that the use of the ISOAPS model creates uniform documentation, improves standards and is important to teach social work students. Conclusions: The ISOAPS model standardizes documentation and promotes communication between social workers and medical staffs. Implications for practice: In the intricate realm of healthcare, efficient documentation systems are pivotal to ensuring coherent interdisciplinary communication and patient care. The ISOAPS model emerges as a quintessential instrument, meticulously tailored to the nuances of social work documentation. While it extends its utility across the broad spectrum of social work, its specificity is most pronounced in the medical domain. This model not only exemplifies rigorous academic and professional standards but also serves as a testament to the potential of contextualized documentation systems in elevating the overall stature of social work within healthcare. Such a strategic documentation tool can not only streamline the intricate processes inherent in medical social work but also underscore the indispensable role that social workers play in the broader healthcare ecosystem.

Keywords: ISOAPS, professional documentation, medial social-work, social work

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Authors: Yun Chan Lee

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Background: End-of-life care is a large area of all nursing practice and student nurses are likely to meet dying patients in many placement areas. It is therefore important to understand the emotional responses and coping strategies of student nurses in order for nursing education systems to have some appreciation of how nursing students might be supported in the future. Methodology: This research used a qualitative phenomenological approach. Six student nurses understanding a degree-level adult nursing course were interviewed. Their responses to questions were analyzed using interpretative phenomenological analysis. Finding: The findings identified 3 main themes. First, the common experience of ‘unpreparedness’. A very small number of participants felt that this was unavoidable and that ‘no preparation is possible’, the majority felt that they were unprepared because of ‘insufficient input’ from the university and as a result of wider ‘social taboos’ around death and dying. The second theme showed that emotions were affected by ‘the personal connection to the patient’ and the important sub-themes of ‘the evoking of memories’, ‘involvement in care’ and ‘sense of responsibility’. The third theme, the coping strategies used by students, seemed to fall into two broad areas those ‘internal’ with the student and those ‘external’. In terms of the internal coping strategies, ‘detachment’, ‘faith’, ‘rationalization’ and ‘reflective skills’ are the important components of this part. Regarding the external coping strategies, ‘clinical staff’ and ‘the importance of family and friends’ are the importance of accessing external forms of support. Implication: It is clear that student nurses are affected emotionally by caring for dying patients and many of them have apprehension even before they begin on their placements but very often this is unspoken. Those anxieties before the placement become more pronounced during and continue after the placements. This has implications for when support is offered and possibly its duration. Another significant point of the study is that participants often highlighted their wish to speak to qualified nurses after their experiences of being involved in end-of-life care and especially when they had been present at the time of death. Many of the students spoke that qualified nurses were not available to them. This seemed to be due to a number of reasons. Because the qualified nurses were not available, students had to make use of family members and friends to talk to. Consequently, the implication of this study is not only to educate student nurses but also to educate the qualified mentors on the importance of providing emotional support to students.

Keywords: nursing students, coping strategies, end-of-life care, emotional responses

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Authors: J. George, M. Al Mutairi, W. Aljuryyad, A. Alhussanan, A. Alkashan, T. Aldoghiri, Z. Alamari, A. Albakr

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Introduction: Students make plans for their career and are keen in exploring options of employment in those carriers. They make their employment choice based on their desires and preferences. This study aims to identify if students of King Saud Bin Abdulaziz for Health Sciences, College of Applied Medical Sciences after obtaining appropriate education prefer to work as clinicians, university faculty, or full-time researchers. There are limited studies in Saudi Arabia exploring the university student’s employment choices and preferences. This study would help employers to build the required job positions and prevent misleading employers from opening undesired positions in the job market. Methodology: The study included 394 students from third and fourth years both male and female among the eighth programs of college of applied medical sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus. A prospective quantitative cross-sectional study was conducted; data were collected by distributing a seven item questionnaire and analyzed using SPSS. Results: Among the participants, 358 (90.9%) of them chose one of the three listed career choices, 263 (66.8%) decided to work as hospital staff after their education, 75 students (19.0%) chose to work as a faculty member in a university after obtaining appropriate degree, 20 students (5.1%) preferred to work as full-time researcher after obtaining appropriate degree, the remaining 36 students (9.1%) had different career goals, such as obtaining a master degree after graduating, to obtain a bachelor of medicine and bachelor in surgery degree, and working in the private sector. The most recurrent reason behind the participants' choice was "career goal", where 276 (70.1%) chose it as a reason. Conclusion: The findings of the study showed that most student’s preferred to work in hospitals as clinicians, followed by choice of working as a faculty in a university, the least choice was to be working as full-time researchers.

Keywords: College of Applied Medical Sciences, employment ambitions, graduating students, King Saud bin Abdulaziz University for Health Sciences

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Authors: Sheillah Hlamalani Mboweni, Lufuno Makhado

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Background: The increasing number of people who tested HIV positive and who demand antiretroviral therapy (ART) prompted the National Department of Health to adopt WHO recommendations of task shifting where Professional Nurses(PNs) initiate ART rather than doctors in the hospital. This resulted in the decentralization of services to primary health care(PHC), generating a need to capacitate PNs on NIMART. After years of training, the impact of NIMART was assessed where it was established that even though there was an increased number who accessed ART, the quality of care is of serious concern. The study aims to answer the following question: What are the challenges influencing NIMART implementation in primary health care. Objectives: This study explores challenges influencing NIMART training and implementation and makes recommendations to improve patient and HIV program outcomes. Methods: A qualitative explorative program evaluation research design. The study was conducted in the rural districts of North West province. Purposive sampling was used to sample PNs trained on NIMART. FGDs were used to collect data with 6-9 participants and data was analysed using ATLAS ti. Results: Five FGDs, n=28 PNs and three program managers were interviewed. The study results revealed two themes: inadequacy in NIMART training and the health care system challenges. Conclusion: The deficiency in NIMART training and health care system challenges is a public health concern as it compromises the quality of HIV management resulting in poor patients’ outcomes and retard the goal of ending the HIV epidemic. These should be dealt with decisively by all stakeholders. Recommendations: The national department of health should improve NIMART training and HIV management: standardization of NIMART training curriculum through the involvement of all relevant stakeholders skilled facilitators, the introduction of pre-service NIMART training in institutions of higher learning, support of PNs by district and program managers, plan on how to deal with the shortage of staff, negative attitude to ensure compliance to guidelines. There is a need to develop a conceptual framework that provides guidance and strengthens NIMART implementation in PHC facilities.

Keywords: antiretroviral therapy, nurse initiated management of retroviral therapy, primary health care, professional nurses

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Authors: Arzu K. Harmanci Seren, Feride Eskin Bacaksiz

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The shortage of nursing personnel is considered one of the most important labour force issues in health sector of developed countries since early 1970s. International Labour Organization developed standards for working conditions of nurses in collaboration with World Health Organization with the aim of helping to solve nursing shortage problem all over the world. As a result of this collaboration, ILO Nursing Personnel Convention (C. 149), and the accompanying Recommendation (R. 157) were adopted in 1977. Turkey as a country that has a serious nurse shortage problem, has been a member of ILO since 1932, and has not signed this convention yet. This study was planned to compare some of the working standards in Convention with the present working conditions of nurses in Turkey. The data were collected by an on line survey between 19 January-16 February 2015 for this cross-sectional study. Participants were reached through social network accounts in collaboration with nursing associations. Totally 828 nurses from the 57 provinces of Turkey participated in the study. Survey was consisted of 14 open ended questions related to working conditions of nurses and 34 Likert statements related to nursing policies of the facilities they are working in. The data were analysed using the IBM SPSS 21.0 (licensed to Istanbul University) software. Descriptive and comparative statistics were performed. Most of the participants (81.5%) were staff and 18.5% of them were manager nurses. Most of them had baccalaureate (57.9%) or master (27.4%) degree in nursing. 18.5% of the participants were working in private hospitals, 34.9% of them in university hospitals and 46.6% of them were in Ministry of Health Hospitals. It was found that monthly working schedules were announced mostly 7 days ago (18%), working time of nurses was at least 8 hours (41.5%) and at most 24 hours (22.8%) in a day and had time for lunch or dinner 25.18 (SD=16.66), for resting 21.02 (SD=29.25) minutes. On the other hand, it was determined that 316 (43.2%) nurses did not have time for lunch and 61 (7.9%) of them could not find time for eating anything. It was also explored they were working 15-96 hours in a week (mean=48.28, SD=8.89 hours), 4-29 days in a month (mean=19.29, SD=5.03 days) and 597 (72%) nurses overworked changing form 1 hour to 150 hours (32.80, SD=23.42 hours) before the month in which surveys were filled. Most of the participants did not leave the job due to the sickness (47.5%) even if they felt sick. Also most of them did not leave the job due to any excuse (67.2%) or education (57.3%). This study has significance because of nurses from different provinces participated in and it provides brief information about the working conditions of nurses nationwide. It was explored that nurses in Turkey were working at worse conditions according the International Labour Organization’s recommendations.

Keywords: nurse, international labour organization, recommendations for nurses, working conditions

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Authors: Carolinda Douglass

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Institutional Effectiveness (IE) is the purposeful integration of functions that foster student success and support institutional performance. IE is growing rapidly within higher education as it is increasingly viewed by higher education administrators as a beneficial approach for promoting data-informed decision-making in campus-wide strategic planning and execution of strategic initiatives. Specific IE tools, including, but not limited to, project management; impactful collaboration and communication; commitment to continuous quality improvement; and accountability through rigorous evaluation; are gaining momentum under the auspices of IE. This research utilizes a case study approach to examine the use of these IE tools, highlight successes of this use, and identify areas for improvement in the implementation of IE tools within higher education. The research includes three case studies: (1) improving upon academic program review processes including the assessment of student learning outcomes as a core component of program quality; (2) revising an institutional vision, mission, and core values; and (3) successfully navigating an institution-wide re-accreditation process. Several methods of data collection are embedded within the case studies, including surveys, focus groups, interviews, and document analyses. Subjects of these methods include higher education administrators, faculty, and staff. Key findings from the research include areas of success and areas for improvement in the use of IE tools associated with specific case studies as well as aggregated results across case studies. For example, the use of case management proved useful in all of the case studies, while rigorous evaluation did not uniformly provide the value-added that was expected by higher education decision-makers. The use of multiple IE tools was shown to be consistently useful in decision-making when applied with appropriate awareness of and sensitivity to core institutional culture (for example, institutional mission, local environments and communities, disciplinary distinctions, and labor relations). As IE gains a stronger foothold in higher education, leaders in higher education can make judicious use of IE tools to promote better decision-making and secure improved outcomes of strategic planning and the execution of strategic initiatives.

Keywords: accreditation, data-informed decision-making, higher education management, institutional effectiveness tools, institutional mission, program review, strategic planning

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Authors: Zan Chen, D. Kwok

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The SkillsFuture Singapore’s mission to develop a responsive and forward-looking Training and Adult Education (TAE) and workforce development system is undergirded by how successful TAE providers are in their business performance and strategies that strengthen their operational efficiency and processes. Therefore, understanding the factors that drive the business performance of TAE providers is critical to the success of SkillsFuture Singapore’s initiatives. This study aims to investigate how business strategy, work autonomy, work intensity and professional development support impact the business performance of private TAE providers. Specifically, the three research questions are: (1) Are there significant relationships between the above-mentioned four factors and TAE providers’ business performance?; (2) Are there significant differences on the four factors between low and high TAE providers’ business performance groups?; and (3) To what extent and in what manner do the four factors predict TAE providers’ business performance? This was part of the first national study on organizations and professionals working in the Training and Adult Education (TAE) sector. Data from 265 private TAE providers where respondents were Chief Executive Officers representatives from the Senior Management were analyzed. The results showed that business strategy (the extent that the organization leads the way in terms of developing new products and services; uses up-to-date learning technologies; customizes its products and services to the client’s needs), work autonomy (the extent that the staff personally have an influence on how hard they work; deciding what tasks they are to do; deciding how they are to do the tasks, and deciding the quality standards to which they work) and professional development support (both monetary and non-monetary support and incentives) had positive and significant relationships with business performance. However, no significant relationship is found between work intensity and business performance. A business strategy, work autonomy and professional development support were significantly higher in the high business performance group compared to the low-performance group among the TAE providers. Results of hierarchical regression analyses controlling for the size of the TAE providers showed significant impacts of business strategy, work autonomy and professional development support on TAE providers’ business performance. Overall, the model accounted for 27% of the variance in TAE providers’ business performance. This study provides policymakers with insights into improving existing policies, designing new initiatives and implementing targeting interventions to support TAE providers. The findings also have implications on how the TAE providers could better formulate their organizational strategies and business models. Finally, limitations of study, along with directions for future research will be discussed in the paper.

Keywords: adult education, business performance, business strategy, training, work autonomy

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Authors: Tarek K. Jalouta, Jolietta R. Holliman, Kathryn R. Burke, Kathleen M. Bewley-Thomas

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Background: Chronic hepatitis C virus (HCV) infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. In the United States, HCV screening awareness, treatment, and linkage to care are under continues ascending progress. However, still millions of people are asymptomatically infected and undiagnosed yet. Through this community mission, we sought to identify the best and the newest strategies to identify those infected people to educate them, link them to care and cure them. Methods: We have identified patients that did not have a prior HCV screening in our Electronic medical record (EMR) including all our different hospital locations (South Suburban Chicago, Northern, Western and Central Indiana). Providing education to all Primary care/Gastroenterology/Infectious diseases providers and staff in the clinic to increase awareness of the HCV screening. Health-related quality of life, chronic clinical complications, and demographics data were collected for each patient. All outcomes of HCV antibody-reactive and HCV RNA–positive results were identified and statistically analyzed. Results: From July 2016 to July 2018 we screened 35,720 individuals of birth cohort in our different Franciscan’s health medical centers. Of the screened population, 986 (2.7%) individuals were HCV AB-reactive. Of those, 319 (1%) patients were HCV RNA-positive, and 264 patients were counseled and linked to providers. 34 patients initiated anti-HCV therapy with successful treatment. Conclusions: Our HCV screening augmentation project considered the largest screening program in the Midwest. Augmenting the HCV screening process through creating a Best Practice Alert (BPA) in the EMR (Epic Sys.) and point of care testing could be helpful. Although continued work is required, our team is working on increase screening through adding HCV test to CBC-Panels in Emergency Department settings, phone calls to all birth cohort individuals through Robo-Calling System aimed to reach 75,000 individuals by 2019. However, a better linkage to care and referral monitoring system to all HCV RNA positive patients is still needed, and access to therapy, especially for uninsured patients, is challenging.

Keywords: chronic hepatitis C, chronic hepatitis C treatment, chronic hepatitis C screening, chronic hepatitis C prevention, liver cancer

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Authors: Subramanyam Devarakonda Hanumantharao, Udayendu Prakash Sharma, Mahesh Garg

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Introduction: Gomabai Netralaya a reputed eye hospital is located in Neemuch a small city of Madhya Pradesh, India. The hospital is established in 1992 by Late. G.D Agrawal a renowned educationist, freedom fighter and philanthropist. The eye hospital was established to serve all sections of the society in affordable manner. To provide comprehensive eye care services to the rural poor the hospital started organizing outreach camps since 1994. Purpose: To study the cost effectiveness of outreach eye camps for addressing the sustainability issues of the outreach program. Methods: One year statistics of outreach eye camps were collected from Hospital Management Information System software to analyze the productivity of camps. Income and expenses report was collected from outreach department records to analyze per camp expenses and per patient expenses against the income generated. All current year records were analyzed to have accuracy of information and results. Information was collected in two ways: 1)Actual camp performance records and expenses from book of accounts. 2)Cross verification was done through one to one discussion with outreach staff. Results: Total 17534 outpatients were examined through 52 outreach eye camps. Total 6042 (34% of total outpatients) patients were advised with cataracts and 4651 (77% of advice) operations were performed. The average OPD per camp was 337 and per camp 116 patients was advised for cataract surgery and 89 surgeries were performed per camp. Total 18200 US$ incurred on organizing 52 outreach camps in the radius of 100 k.ms. Considering the total outpatients screened through camps the screening cost per patient was 1.00 US$ and considering the surgical output the per surgery expenses was 4.00 US$. The cost recovery of the total expenses was through Government grant of US$ 16.00 per surgery (that includes surgical grant). All logistics cost of camps and patients transportation cost was taken care by local donors. Conclusion: The present study demonstrates that with people’s participation, successful high volume outreach eye camps can be organized. The cost effectiveness of the outreach camps is totally depended on volume of outpatient’s turn-up at camp site and per camp surgical output. The only solution to sustainability of outreach eye camps is sharing of cost with local donors and increasing productivity.

Keywords: camps, outreach, productivity, sustainable

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Authors: Adetona Abbassa, Aliyu Shakirat B.

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The study area is part of Bosso local Government, enclosed within Longitude 6.25’ to 6.31’ and Latitude 9.35’ to 9.45’, an area of 16x8 km², within the basement region of central Nigeria. The region is a host to Nigerian Airforce base 12 (NAF 12quick response) and its staff quarters, the headquarters of Bosso local government, the Independent National Electoral Commission’s two offices, four government secondary schools, six primary schools and Minna international airport. The area suffers an acute shortage of water from November when rains stop to June when rains commence within North Central Nigeria. A way of addressing this problem is a reconnaissance method to delineate possible fractures and fault lines that exists within the region by sampling the Aeromagnetic data and using an appropriate analytical algorithm to delineate these fractures. This is followed by an appropriate ground truthing method that will confirm if the fracture is connected to underground water movement. The first vertical derivative for structural analysis, reveals a set of lineaments labeled AA’, BB’, CC’, DD’, EE’ and FF’ all trending in the Northeast – Southwest directions. AA’ is just below latitude 9.45’ above Maikunkele village, cutting off the upper part of the field, it runs through Kangwo, Nini, Lawo and other communities. BB’ is at Latitude 9.43’ it truncated at about 2Km before Maikunkele and Kuyi. CC’ is around 9.40’ sitting below Maikunkele runs down through Nanaum. DD’ is from Latitude 9.38’; interestingly no community within this region where the fault passes through. A result from the three sites where Vertical Electrical Sounding was carried out reveals three layers comprised of topsoil, intermediate Clay formation and weathered/fractured or fresh basement. The depth to basement map was also produced, depth to the basement from the ground surface with VES A₂, B5, D₂ and E₁ to be relatively deeper with depth values range between 25 to 35 m while the shallower region of the area has a depth range value between 10 to 20 m. Hence, VES A₂, A₅, B₄, B₅, C₂, C₄, D₄, D₅, E₁, E₃, and F₄ are high conductivity zone that are prolific for groundwater potential. The depth range of the aquifer potential zones is between 22.7 m to 50.4 m. The result from site C is quite unique though the 3 layers were detected in the majority of the VES points, the maximum depth to the basement in 90% of the VES points is below 8 km, only three VES points shows considerably viability, which are C₆, E₂ and F₂ with depths of 35.2 m and 38 m respectively but lack of connectivity will be a big challenge of chargeability.

Keywords: lithology, aeromagnetic, aquifer, geoelectric, iso-resistivity, basement, vertical electrical sounding(VES)

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Authors: Antoine Villa, Moustapha Mohamedou, Florence Pilliere, Catherine Verdun-Esquer, Mathieu Molimard, Mohamed Sidatt Cheikh El Moustaph, Mireille Canal-Raffin

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Context: In Mauritania, the activity of the National Center of Oncology (NCO) has steadily risen leading to an increase in the handling of antineoplastic drugs (AD) by healthcare professionals. In this context, the AD contamination of those professionals is a major concern for occupational physicians. It has been evaluated using biological monitoring of occupational exposure (BMOE). Methods: The intervention took place in 2015, in 2 care units, and evaluated nurses preparing and/or infusing AD and agents in charge of hygiene. Participants provided a single urine sample, at the end of the week, at the end of their shift. Five molecules were sought using specific high sensitivity methods (UHPLC-MS/MS) with very low limits of quantification (LOQ) (cyclophosphamide (CP), Ifosfamide (IF), methotrexate (MTX): 2.5ng/L; doxorubicin (Doxo): 10ng/L; α-fluoro-β-alanine (FBAL, 5-FU metabolite): 20ng/L). A healthcare worker was considered as 'contaminated' when an AD was detected at a urine concentration equal to or greater than the LOQ of the analytical method or at trace concentration. Results: Twelve persons participated (6 nurses, 6 agents in charge of hygiene). Twelve urine samples were collected and analyzed. The percentage of contamination was 66.6% for all participants (n=8/12), 100% for nurses (6/6) and 33% for agents in charge of hygiene (2/6). In 62.5% (n=5/8) of the contaminated workers, two to four of the AD were detected in the urine. CP was found in the urine of all contaminated workers. FBAL was found in four, MTX in three and Doxo in one. Only IF was not detected. Urinary concentrations (all drugs combined) ranged from 3 to 844 ng/L for nurses and from 3 to 44 ng/L for agents in charge of hygiene. The median urinary concentrations were 87 ng/L, 15.1 ng/L and 4.4 ng/L for FBAL, CP and MTX, respectively. The Doxo urinary concentration was found 218ng/L. Discussion: There is no current biological exposure index for the interpretation of AD contamination. The contamination of these healthcare professionals is therefore established by the detection of one or more AD in urine. These urinary contaminations are higher than the LOQ of the analytical methods, which must be as low as possible. Given the danger of AD, the implementation of corrective measures is essential for the staff. Biological monitoring of occupational exposure is the most reliable process to identify groups at risk, tracing insufficiently controlled exposures and as an alarm signal. These results show the necessity to educate professionals about the risks of handling AD and/or to care for treated patients.

Keywords: antineoplastic drugs, Mauritania, biological monitoring of occupational exposure, contamination

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Authors: Eda Üstünel, Seval Karacabey

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The students, who are enrolled in German Preparatory Language Programme at the School of Foreign Languages, Muğla Sıtkı Koçman University, Turkey, learn German as a foreign language for two semesters in an academic year. Although the language programme is a skills-based one, the students lack German speaking skills due to their fear of making language mistakes while speaking in German. This problem of incompetency in German speaking skills exists also in their four-year departmental study at the Faculty of Education. In order to address this problem we design German speaking activities, which are extra-curricular activities. With the help of these activities, we aim to lead Turkish students of German language to speak in the target language, to improve their speaking skills in the target language and to create a stress-free atmosphere and a meaningful learning environment to communicate in the target language. In order to achieve these aims, an ERASMUS+ exchange staff (a German trainee teacher of German as a foreign language), who is from Schwabisch Gmünd University, Germany, conducted out-of-class German speaking activities once a week for three weeks in total. Each speaking activity is lasted for one and a half hour per week. 7 volunteered students of German preparatory language programme attended the speaking activity for three weeks. The activity took place at a cafe in the university campus, that’s the reason, we call it as an out-of-class activity. The content of speaking activity is not related to the topics studied at the units of coursebook, that’s the reason, we call this activity as extra-curricular one. For data collection, three tools are used. A questionnaire, which is an adapted version of Sabo’s questionnaire, is applied to seven volunteers. An interview session is then held with each student on individual basis. The interview questions are developed so as to ask students to expand their answers that are given at the questionnaires. The German trainee teacher wrote fieldnotes, in which the teacher described the activity in the light of her thoughts about what went well and which areas were needed to be improved. The results of questionnaires show that six out of seven students note that such an acitivity must be conducted by a native speaker of German. Four out of seven students emphasize that they like the way that the activities are designed in a learner-centred fashion. All of the students point out that they feel motivated to talk to the trainee teacher in German. Six out of seven students note that the opportunity to communicate in German with the teacher and the peers enable them to improve their speaking skills, the use of grammatical rules and the use of vocabulary.

Keywords: Learning a Foreign Language, Speaking Skills, Teaching German as a Foreign Language, Turkish Learners of German Language

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Authors: Julie A. Carberry, Victor Maddalena

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Animal-Assisted Interventions (AAIs) have existed in various forms for centuries. In the past 30 years, there has been a dramatic increase in popularity. AAIs are now part of the lives of persons of all ages in many types of institutions. Anecdotal evidence of the benefits of AAIs have led to widespread adoption, yet there remains a lack of solid research base for support. The research question was, what are the lived experiences of AAI volunteer handlers are? An interpretive phenomenological methodology was used for this qualitative study. Data were collected from 1 - 2 hour-long semi-structured interviews and 1 observational field visit. All interviews were conducted, transcribed, and coded for themes by the principal investigator. Participants must have been an active St. John Ambulance Therapy Dog Program volunteer for a least one year. In total, 14 volunteer handlers, along with some of their dogs, were included. The St. John Ambulance is a not for profit organization that provides training and community services to Canadians. The Therapy Dog Program is 1 of the 4 nationally recognized core community service programs. The program incorporates dogs in the otherwise traditional therapeutic intervention of friendly visitation with clients. The lack of formal objectives and goals, and a trained therapist defines the program as an Animal-Assisted Activity (AAA), which is a type of AAI. Since the animals incorporated are dogs, the program is specifically a Canine-Assisted Activity (CAA), which is a type of Canine-Assisted Intervention (CAI). Six themes emerged from the analysis of the data: (a) a win-win-win situation for all parties involved – volunteer handlers, clients, and the dogs, (b) being on the other end of the leash: functions of the role of volunteer handler, (c) the importance of socialization: from spreading smiles to creating meaningful connections, (d) the role of the dog: initiating interaction and providing comfort, (e) an opportunity to feel good and destress, and (f) altruism versus personal rewards. Other insights were found regarding the program, clients, and staff. Possible implications from this research include increased organizational recruitment and retention of volunteer handlers and as well as increased support for CAAs and other CAIs that incorporate teams of volunteer handlers and their dogs. This support could, in turn, add overall support for the acceptance and broad implementation of AAIs as an alternative and or complementary non-pharmaceutical therapeutic intervention.

Keywords: animal-assisted activity, animal-assisted intervention, canine-assisted activity, canine-assisted intervention, perspective, qualitative, volunteer handler

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Authors: E. Njuguna, S. Ilovi, P. Muiruri, K. Mutai, J. Kinuthia, P. Njoroge

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Introduction: Cervical cancer is the commonest cause of cancer-related morbidity and mortality among women in developing countries in Sub Saharan Africa. Screening for cervical cancer in all women regardless of HIV status is crucial for the early detection of cancer of the cervix when treatment is most effective in curing the disease. It is particularly more important to screen HIV infected women as they are more at risk of developing the disease and progressing faster once infected with HPV (Human Papilloma Virus). We aimed to determine the factors affecting the utilization of cervical cancer screenings among HIV infected women above 18 years of age at Kenyatta National Hospital (KNH) Comprehensive Care Center (CCC). Materials and Methods: A cross-sectional mixed quantitative and qualitative study involving randomly and purposefully selected HIV positive female respectively was conducted. Qualitative data collection involved 4 focus group discussions of eligible female participants while quantitative data were acquired by one to one interviewer administered structured questionnaires. The outcome variable was the utilization of cervical cancer screening. Data were entered into Access data base and analyzed using Stata version 11.1. Qualitative data were analyzed after coding for significant clauses and transcribing to determine themes arising. Results: We enrolled a total of 387 patients, mean age (IQ range) 40 years (36-44). Cervical cancer screening utilization was 46% despite a health care provider recommendation of 85%. The screening results were reported as normal in 72 of 81 (88.9%) and abnormal 7 of 81(8.6%) of the cases. Those who did not know their result were 2 of 81(2.5%). Patients were less likely to utilize the service with increasing number of years attending the clinic (OR 0.9, 95% CI 0.86-0.99, p-value 0.02), but more likely to utilize the service if recommendation by a staff was made (OR 10, 95% CI 4.2-23.9, p<0.001), and if cervical screening had been done before joining KNH CCC (OR 2.9, 95% CI 1.7-4.9, p < 0.001). Similarly, they were more likely to rate the services on cervical cancer screening as good (OR 5.0, 95% CI 1.7-3.4, p <0.001) and very good (OR 8.1, 95% CI 2.5-6.1, p<0.001) if they had utilized the service. The main barrier themes emerging from qualitative data included fear of screening due to excessive pain or bleeding, lack of proper communication on screening procedures and increased waiting time. Conclusions: Utilization of cervical cancer screening services was low despite health care recommendation. Patient socio-demographic characteristics did not influence whether or not they utilized the services, indicating the important role of the health care provider in the referral and provision of the service.

Keywords: cervical, cancer, HIV, women, comprehensive care center

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Authors: Annette Cosgrove

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The objectives of this research study is to examine the impact of professional development in Technology Enhanced Learning (TEL) and the digitisation of learning in teaching communities across multiple higher education sites in the ATU (Atlantic Technological University *) ( 2020-2025), including the proposal of an evidence based digital teaching model for use in a future pandemic. The research strategy undertaken for this PhD Study is a multi-site study using mixed methods. Qualitative & quantitative methods are being used in the study to collect data. A pilot study was carried out initially , feedback collected and the research instrument was edited to reflect this feedback, before being administered. The purpose of the staff questionnaire is to evaluate the impact of professional development in the area of TEL, and to capture the practitioners views on the perceived impact on their teaching practice in the higher education sector across ATU (West of Ireland – 5 Higher education locations ). The phenomenon being explored is ‘ the impact of professional development in the area of technology enhanced learning and on teaching practice in a higher education institution.’ The research methodology chosen for this study is an Action based Research Study. The researcher has chosen this approach as it is a prime strategy for developing educational theory and enhancing educational practice . This study includes quantitative and qualitative methods to elicit data which will quantify the impact that continuous professional development in the area of digital teaching practice and technologies has on the practitioner’s teaching practice in higher education. The research instruments / data collection tools for this study include a lecturer survey with a targeted TEL Practice group ( Pre and post covid experience) and semi-structured interviews with lecturers.. This research is currently being conducted across the ATU multisite campus and targeting Higher education lecturers that have completed formal CPD in the area of digital teaching. ATU, a west of Ireland university is the focus of the study , The research questionnaire has been deployed, with 75 respondents to date across the ATU - the primary questionnaire and semi- formal interviews are ongoing currently – the purpose being to evaluate the impact of formal professional development in the area of TEL and its perceived impact on the practitioners teaching practice in the area of digital teaching and learning . This paper will present initial findings, reflections and data from this ongoing research study.

Keywords: TEL, DTL, digital teaching, digital assessment

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Authors: Babatope David Omoniyi, Fiona Lalor, Sinead Furey

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This ongoing project investigates the impact of Brexit on consumer perceptions of trust in the food industry. Brexit has significantly impacted the food industry, triggering a paradigm shift in the movement of food/agricultural produce, regulations, and cross-border collaborations between Great Britain, Northern Ireland, and the Republic of Ireland. In a world where the dynamics have shifted because of regulatory changes that impact trade and the free movement of foods and agricultural produce between these three countries, monitoring and controlling every stage of the food supply chain have become challenging, increasing the potential for food fraud and food safety incidents. As consumers play a pivotal role in shaping the market, understanding any shifts in trust post-Brexit enables them to navigate the market with confidence and awareness. This study aims to explore the complexities of consumer perceptions, focusing on trust as a cornerstone of consumer confidence in the post-Brexit food landscape. The objectives include comparing trust in official controls pre- and post-Brexit, determining consumer awareness of food fraud, and devising recommendations that reflect the evidence from this primary research regarding consumer trust in food authenticity post-Brexit. The research design follows an exploratory sequential mixed methods approach, incorporating qualitative methods such as focus groups and structured interviews, along with quantitative research through a large-scale survey. Participants from UCD and Ulster University campuses, comprising academic and non-academic staff, students, and researchers, will provide insights into the impact of Brexit on consumer trust. Preliminary findings from focus groups and interviews highlight changes in labelling, reduced quantity and quality of foods in both Northern Ireland and the Republic of Ireland, fewer food choices, and increased food prices since Brexit. The study aims to further investigate and quantify these impacts through a comprehensive large-scale survey involving participants from Northern Ireland and the Republic of Ireland. The results will inform official controls and consumer-facing messaging contributing valuable insights to navigate the evolving post-Brexit food landscape.

Keywords: Brexit, consumer trust, food fraud, food authenticity, food safety, food industry

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Authors: Susumu Fukita, Hiromi Kawasaki, Satoko Yamasaki, Kotomi Yamashita, Tomoko Iki

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The increase in the number of workers with mental health problems has become an issue. Many workers work in small- and medium-sized enterprises, which often support local employment and economy, especially in underpopulated mountainous areas. It is important for managers to take mental health measures for employees since there is no budget to hire health staff in small- and medium-sized enterprises. It is necessary to understand the manager's attitude toward the mental health of employees and to publicly support the manager in promoting mental health measures for employees. The purpose of this study was to study the awareness of managers of small- and medium-sized enterprises regarding the mental health of employees and to consider support for managers to take measures for the mental health of employees. Semi-structured interviews were conducted with six managers of small- and medium-sized enterprises in underpopulated mountainous areas in November 2019. Managers were asked about their awareness of the mental health of their employees. Qualitative descriptive analysis was used, and subcategories and categories were extracted. Four categories emerged. Regarding the mental health of employees, the managers acknowledged that if the appearance and behavior of the employees do not interfere with their lives, the manager judges that the employees’ mental health is normal. It was also found that the managers acknowledged that there is a comfortable working environment due to the characteristics of the underpopulated mountainous area. On the other hand, the managers acknowledged that employees are dissatisfied with salaries and management systems. In addition, it was found the manager acknowledged that some employees retire due to mental health problems. Although managers recognized that employees may be dissatisfied with salaries, they also recognized that there was a comfortable working environment due to the characteristics of the areas, with good interpersonal relationships. Economic challenges are difficult to solve in underpopulated mountainous areas. It is useful to consider measures that take advantage of the characteristics of the areas where it is easy to work because of good relations with each other, for example, to create a family-like workplace culture where managers and employees can engage in daily conversation. The managers judged that the employees were in good health if there was no interference with their lives. However, it is too late to take measures at the stage when it becomes an obstacle to life. Therefore, it is necessary to provide training for managers to learn observation techniques by which they quickly notice changes in the situation of employees and give appropriate responses; and to set up a contact point for managers to consult. Local governments should actively provide public support such as training for managers and establishing consultation desks to maintain valuable employment and local economics in underpopulated mountainous areas.

Keywords: employer, mental health, small- and medium- sized enterprises, underpopulated areas

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Authors: Amelia Faotusia

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The blue economy concept was coined by Pacific nations in recognition of the importance of sustainably managing their extensive marine territories. This is especially important for major ocean-based economic sectors of Pacific economies, such as coastal tourism. There is an absence of research, however, on the key ways in which the blue economy concept has emerged in discourse and public policy in Pacific countries, as well as how it articulates with coastal tourism. This research helps to fill such a gap with a specific focus on Tonga through the application of a post-positivist research approach to conduct a desktop study of relevant national documents and qualitative interviews with relevant government staff, civil society organizations, and tourism operators. The findings of the research reflect the importance of institutional integration and partnerships for a successful blue economy transition and are presented in the form of two case studies corresponding to two sub-sectors of Tonga’s coastal tourism sector: (i) the whale-watching and swimming industry, and (ii) beach resorts and restaurants. A thematic analysis applied to the interview data of both cases then enabled the identification of key areas and issues for socio-economic policy intervention and recommendations in support of blue economy transitions in Tonga’s coastal tourism sector. Examples of the relevant areas and issues that emerged included the importance of foreign direct investment, local market access, community-based special management areas, as well as the need to address the anthropogenic impacts of tropical cyclones, whale tourism, plastic litter on coastal assets, and ecosystems. Policy and practical interventions in support of addressing such issues include a proposed restructuring of the whale-watching and swimming licensing system; integration of climate resilience, adaptation, and capacity building as priorities of local blue economy interventions; as well as strengthening of the economic sustainability dimension of blue economy policies. Finally, this research also revealed the need for further specificity and research on the influence and value of local Tongan culture and traditional knowledge, particularly within existing customary marine tenure systems, on Tonga’s national and sectoral blue economy policies and transitions.

Keywords: blue economy, coastal tourism, integrated ocean management, ecosystem resilience

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Authors: Louise Bunce, Jill Childs, Adam J. Lonsdale, Naomi King

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A major concern for the Social Work profession concerns the frequency of burn-out and high turnover of staff. The characteristic of resilience has been identified as playing a crucial role in social workers’ ability to have a satisfying and successful career. Thus a critical role for social work education is to develop resilience in social work students. We currently need to know more about how to train resilient social workers who will also increase the academic standing of the profession. The specific aim of this research was to quantify characteristics that may contribute towards resilience and academic success among student social workers in order to mitigate against the problems of burn-out and low academic standing. These three characteristics were competence (effectiveness at mastering the environment), autonomy (sense of control and free will), and relatedness (interacting and connecting with others), as specified in Self-Determination Theory (SDT). When these three needs are satisfied, we experience higher degrees of motivation to succeed and wellbeing. Thus when these three needs are met in social work students, they have the potential to raise academic standards and promote wellbeing characteristics that contribute to the development of resilience. The current study tested the hypothesis that higher levels of autonomy, competence, and relatedness, as defined by SDT, will predict levels of academic success and resilience in social work students. Two hundred and ten social work students studying at a number of universities completed well-established questionnaires to assess autonomy, competence, and relatedness, level of academic performance and resilience (The Brief Resilience Scale). In this scale, students rated their agreement with items e.g., ‘I bounce back quickly after hard times’ and ‘I usually come through difficult times with little struggle’. After controlling for various factors, including age, gender, ethnicity, and course (undergraduate or postgraduate) preliminary analysis revealed that the components of SDT provided useful predictive value for academic success and resilience. In particular, autonomy and competence provided a useful predictor of academic success while relatedness was a particularly useful predictor of resilience. This study demonstrated that SDT provides a valuable framework for helping to understand what predicts academic success and resilience among social work students. This is relevant because the psychological needs for autonomy, competence and relatedness can be affected by external social and cultural pressures, thus they can be improved by the right type of supportive teaching practices and educational environments. These findings contribute to the growing evidence-base to help build an academic and resilient social worker student body and workforce.

Keywords: education, resilience, self-determination theory, student social workers

Procedia PDF Downloads 300

Authors: K. C. Wong, K. L. Siu, S. N. Ng, K. N. Yip, Y. Y. Yuen, K. W. Lee, K. W. Wong, C. C. Li, H. P. Lam

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Background: Occupational injuries among nursing profession were found related to repeated bedside nursing care, such as transfer, lifting and manual handling patients from previous studies. Likewise, undergraduate nursing students are also exposed to potential safety hazard due to their similar work nature of registered nurses. Especially, those students who worked as Temporary undergraduate nursing students (TUNS) which is a part-time clinical job in hospitals in Hong Kong who mainly assisted in providing bedside cares appeared to at high risk of work-related injuries. Several studies suggested the level of compliance with safe work behaviors was highly associated with work-related injuries. Yet, it had been limitedly studied among nursing students. This study was conducted to assess and compare the compliance with safe work behaviors and the levels of awareness of different workplace safety issues between undergraduate nursing students with or without TUNS experiences. Methods: This is a quantitative descriptive study using convenience sampling. 362 undergraduate nursing students in Hong Kong were recruited. The Safe Work Behavior relating to Patient Handling (SWB-PH) was used to assess their compliance of safe-work behaviors and the level of awareness of different workplace safety issues. Results: The results showed that most of the participants (n=250, 69.1%) who were working as TUNS. However, students who worked as TUNS had significantly lower safe-work behaviors compliance (mean SWB-PH score = 3.64±0.54) than those did not worked as TUNS (SWB-PH score=4.21±0.54) (p<0.001). Particularly, these students had higher awareness to seek help and use assistive devices but lower awareness of workplace safety issues and awareness of proper work posture than students without TUNS experiences. The students with TUNS experiences had higher engagement in help-seeking behaviors might be possibly explained by their richer clinical experiences which served as a facilitator to seek help from clinical staff whenever necessary. Besides, these experienced students were more likely to bear risks for occupational injuries and worked alone when no available aid which might be related to the busy working environment, heightened work pressures and high expectations of TUNS. Eventually, students who worked as TUNS might target on completing the assigned tasks and gradually neglecting the occupational safety. Conclusion: The findings contributed to an understanding of the level of compliance with safe work behaviors among nursing students with different clinical experiences. The results might guide the modification of current safety protocols and the introduction of multiple clinical training courses to improve nursing student’s engagement in safe work behaviors.

Keywords: Occupational safety, Safety compliance, Safe-work behavior, Nursing students

Procedia PDF Downloads 117

Authors: Athena Pedro, Zandile Batweni, Laura Bradfield, Michael Dare, Ashley Nyman

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The rapid growth and development of an infant in the first 1000 days of life means that this time period provides the greatest opportunity for a positive developmental impact on a child’s life socially, emotionally, cognitively and physically. Current research is being focused on children in the first 1000 days, but there is a lack of research and understanding of mothers and their experiences during this crucial time period. Thus, it is imperative that more research is done to help better understand the experiences of mothers during the first 1000 days of their child’s life, as well as gain more insight into mothers’ knowledge regarding this time period. The first 1000 days of life, from conception to two years, is a critical period, and the child’s attachment to his or her mother or primary caregiver during this period is crucial for a multitude of future outcomes. The aim of this study was to explore mothers’ understanding and experience of the first 1000 days of their child’s life, specifically looking at attachment in the context of Bowlby and Ainsworths’ attachment theory. Using a qualitative methodological framework, data were collected through semi-structured individual interviews with 12 first-time mothers from low-income communities in Cape Town. Thematic analysis of the data revealed that mothers articulated the importance of attachment within the first 1000 days of life and shared experiences of how they bond and form attachment with their babies. Furthermore, these mothers expressed their belief in the long-term effects of early attachment of responsive positive parenting as well as the lasting effects of poor attachment and non-responsive parenting. This study has implications for new mothers and healthcare staff working with mothers of new-born babies, as well as for future contextual research. By gaining insight into the mothers’ experiences, policies and intervention efforts can be formulated in order to assist mothers during this time, which ultimately promote the healthy development of the nation’s children and future adult generation. If researchers are also able to understand the extent of mothers’ general knowledge regarding the first 1000 days and attachment, then there will be a better understanding of where there may be gaps in knowledge and thus, recommendations for effective and relevant intervention efforts may be provided. These interventions may increase knowledge and awareness of new mothers and health care workers at clinics and other service providers, creating a high impact on positive outcome. Thus, improving the developmental trajectory for many young babies allows them the opportunity to pursue optimal development by reaching their full potential.

Keywords: attachment, experience, first 1000 days, knowledge, mothers

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Authors: Kirsty Biggs, Peter Larsen-Disney

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Background: The UK cervical screening programme significantly reduces cancer mortality through the early detection of abnormal cells. Despite this, over a quarter of eligible women choose not to attend their appointment. Objective: To qualitatively explore patients’ barriers to attending cervical smear appointments and identify key trends of cervical screening behaviour, knowledge, and attitudes in primary and secondary care. Methods: A cross-sectional study was conducted to evaluate smear services in Brighton and Hove using questionnaires in general practice and colposcopy. 226 patients participated in the voluntary questionnaire between 10/11/2017 and 02/02/2018. 118 patients were recruited from general practice surgeries and 108 from the colposcopy department. Women were asked about their smear knowledge, self-perceived risks factors, prior experiences and reasons for non-attendance. Demographic data was also collected. Results: Approximately a third of women did not engage in smear testing services. This was consistent across primary and secondary care groups. Over 90% were aware of the role of the screening process in relation to cervical cancer; however, over two thirds believed the smear was also a tool to screen for other pathologies. The most commonly cited reasons for non-attendance were negative emotions or previous experiences. Inconvenient appointment times were also commonly described. In a comparison of attenders versus non-attenders previous negative experiences (p < 0.01) and number of identified risk factors (p = 0.02) were statistically significant with non-attenders describing more prior negative smears and identifying more risk factors. Smear knowledge, risk perception and perceived importance of screening were not significant. Negative previous experiences were described in relation to poor bedside manner, pain, embarrassment and staff competency. Conclusions: In contrary to the literature, our white Caucasian cohort experienced significant barriers to accessing smear services. Women’s prior negative experiences are overriding their perceived importance to attend the screening programme; therefore, efforts need to focus on improving clinical experiences through auditing tools, training and providing a supportive appointment setting. Positive changes can also be expected by improving appointment availabilities with extended hours and self-booking systems.

Keywords: barriers, cervical, Papanicolaou, screening, smear

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Authors: Madeline Tagg, Choihoong Mui, Elizabeth Lek, Jide Menakaya

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Introduction: Simulation technology is used by neonatal teams to learn and refresh skills and gain the knowledge and confidence to care for sick neonates. In-situ simulation is considered superior to laboratory-based programmes as it closely mirrors real life situations. This study reports our experience of running regular laboratory-based simulation sessions for senior clinicians and nurses and its impact on their knowledge, skills and confidence. Methods: A before and after questionnaire survey was carried out on senior clinicians and nurses that attended a scheduled laboratory-based simulation session. Participants were asked to document their expectations before a 3-hour monthly laboratory programme started and invited to feedback their reflections at the end of the session. The session included discussion of relevant clinical guidelines, immersion in a scenario and video led debrief. The results of the survey were analysed in three skills based categories - improved, no change or a worsened experience. Results: 45 questionnaires were completed and analysed. Of these 25 (55%) were completed by consultants seven and six by nurses and trainee doctors respectively, and seven respondents were unknown. 40 (88%) rated the session overall and guideline review as good/excellent, 39 respondents (86%) rated the scenario session good/excellent and 40/45 fed back a good/excellent debrief session. 33 (73%) respondents completed the before and after questionnaire. 21/33 (63%) reflected an improved knowledge, skill or confidence in caring for sick new-bon babies, eight respondents reported no change and four fed back a worse experience after the session. Discussion: Most respondents found the laboratory based structured simulation session beneficial for their professional development. They valued equally the whole content of the programme such as guideline review and equipment training as well as the simulation and debrief sessions. Two out three participants stated their knowledge of caring for sick new-born babies had been transformed positively by the session. Sessions where simulation equipment failed or relevant staff were absent contributed to a poor educational experience. Summary: A regular structured laboratory-based simulation programme with a rich content is a credible educational resource for improving the knowledge, skills and confidence of senior clinicians caring for sick new born babies.

Keywords: knowledge, laboratory based, neonates, simulation

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Authors: Karen Eastman

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More youths and young adults with autism spectrum disorder (ASD) have been entering the workforce in recent years. Historically, students with ASD struggle after leaving high school and experience lower rates of employment, with social skills continuing to be the most problematic area of concern. Special education teachers may find it challenging to identify effective combinations of evidence-based practices (EBPs) and supports to best guide these students. One EBP, Peer Mediated Instruction and Intervention (PMII) has been well documented in the literature as being effective for younger students with autism but not researched as much with older students and adults, particularly in work settings. A need to combine PMII with other EBPs has been identified as a way to achieve a greater positive impact rather than any practice alone. A multiple baseline across skills design was used in this research project with two participants in different settings. PMII was combined with Visual Supports, with typical peers being trained in both practices. PMII is an evidence-based practice used to address social concerns by training peers without disabilities as to how they can provide feedback to and support, the student with ASD with social interactions in structured settings. The peers without disabilities were the instructors, while the adults facilitated the social situations and provided support to both the peers and students with ASD when needed. Because many individuals with ASD learn best with visual input, rather than using only the spoken word (verbal directions and feedback), Visual Supports were used in conjunction with PMII. Visual Supports can include written words, pictures, symbols, videos, or objects. In this project, the Visual Supports used were written social scripts, videos, Stop and Think signs, written reminder cards, a school map, and a pictorial task analysis of work tasks. Variables that may affect intervention outcomes in this project included attendance at school and school-based work settings for both the students with ASD and the peers without disabilities and behaviors and responses from others in the settings. Qualitative data was also collected from observations and surveys with peers about the process and their role. Data indicated that the students with ASD responded more positively to redirection and support from their peers than to teachers and staff and showed an increase in positive interactions with others. Those surveyed indicated a positive attitude toward and response to the use of peer interventions with visual supports.

Keywords: autism, social skills, vocational training, peer interventions

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Authors: Francesco Lubrano, Fabrizio Bertone, Federico Stirano

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Modern societies strongly depend on Critical Infrastructures (CI). Hospitals, power supplies, water supplies, telecommunications are just few examples of CIs that provide vital functions to societies. CIs like hospitals are very complex environments, characterized by a huge number of cyber and physical systems that are becoming increasingly integrated. Ensuring a high level of security within such critical infrastructure requires a deep knowledge of vulnerabilities, threats, and potential attacks that may occur, as well as defence and prevention or mitigation strategies. The possibility to remotely monitor and control almost everything is pushing the adoption of network-connected devices. This implicitly introduces new threats and potential vulnerabilities, posing a risk, especially to those devices connected to the Internet. Modern medical devices used in hospitals are not an exception and are more and more being connected to enhance their functionalities and easing the management. Moreover, hospitals are environments with high flows of people, that are difficult to monitor and can somehow easily have access to the same places used by the staff, potentially creating damages. It is therefore clear that physical and cyber threats should be considered, analysed, and treated together as cyber-physical threats. This means that an integrated approach is required. SAFECARE, an integrated cyber-physical security solution, tries to respond to the presented issues within healthcare infrastructures. The challenge is to bring together the most advanced technologies from the physical and cyber security spheres, to achieve a global optimum for systemic security and for the management of combined cyber and physical threats and incidents and their interconnections. Moreover, potential impacts and cascading effects are evaluated through impact propagation models that rely on modular ontologies and a rule-based engine. Indeed, SAFECARE architecture foresees i) a macroblock related to cyber security field, where innovative tools are deployed to monitor network traffic, systems and medical devices; ii) a physical security macroblock, where video management systems are coupled with access control management, building management systems and innovative AI algorithms to detect behavior anomalies; iii) an integration system that collects all the incoming incidents, simulating their potential cascading effects, providing alerts and updated information regarding assets availability.

Keywords: cyber security, defence strategies, impact propagation, integrated security, physical security

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Authors: Inger Eriksson, Lisbeth Ohlsson, Jeremias Rosenqvist

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Ingress: Focus in the study is directed towards phenomena and concepts of segregation, integration, and inclusion of students attending a special school form in Sweden, namely compulsory school for pupils with learning disabilities (in Swedish 'särskola') as an alternative to mainstream compulsory school. Aim: The aim of the study is to examine the school situation for students attending särskola from a historical perspective focussing the 1980s, 1990s and the 21st century, from an integration perspective, and from a perspective of power. Procedure: Five sub-studies are reported, where integration and inclusion are looked into by observation studies and interviews with school leaders, teachers, special and remedial teachers, psychologists, coordinators, and parents in the special schools/särskola. In brief, the study about special school students attending mainstream classes from 1998 takes its point of departure in the idea that all knowledge development takes place in a social context. A special interest is taken in the school’s role for integration generally, and the role of special education particularly and on whose conditions the integration is taking place – the special school students' or the other students,' or may be equally, in the class. Pedagogical and social conditions for so called individually integrated special school students in elementary school classes were studied in eleven classes. Results: The findings are interpreted in a power perspective supported by Foucault and relationally by Vygotsky. The main part of the data consists of extensive descriptions of the eleven cases, here called integration situations. Conclusions: In summary, this study suggests that the possibilities for a special school student to get into the class community and fellowship and thereby be integrated with the class are to a high degree dependant on to what extent the student can take part in the pedagogical processes. The pedagogical situation for the special school student is affected not only by the class teacher and the support and measures undertaken but also by the other students in the class as they, in turn, are affected by how the special school student is acting. This mutual impact, which constitutes the integration process in itself, might result in a true integration if the special school student attains the status of being accepted on his/her own terms not only being cared for or cherished by some classmates. A special school student who is not accepted even on the terms of the class will often experience severe problems in the contacts with classmates and the school situation might thus be a mere placement.

Keywords: integration/inclusion, mainstream school, power, special school students

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Authors: Bi Xiao Fang, Tan Bao Zhen

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Soft skills, core competencies, and generic competencies are exchangeable terminologies often used to represent a similar concept. In the Singapore context, such skills are currently being referred to as Critical Core Skills (CCS). In 2019, SkillsFuture Singapore (SSG) reviewed the Generic Skills and Competencies (GSC) framework that was first introduced in 2016, culminating in the development of the Critical Core Skills (CCS) framework comprising 16 soft skills classified into three clusters. The CCS framework is part of the Skills Framework, and whose stated purpose is to create a common skills language for individuals, employers and training providers. It is also developed with the objectives of building deep skills for a lean workforce, enhance business competitiveness and support employment and employability. This further helps to facilitate skills recognition and support the design of training programs for skills and career development. According to SSG, every job role requires a set of technical skills and a set of Critical Core Skills to perform well at work, whereby technical skills refer to skills required to perform key tasks of the job. There has been an increasing emphasis on soft skills for the future of work. A recent study involving approximately 80 organizations across 28 sectors in Singapore revealed that more enterprises are beginning to recognize that soft skills support their employees’ performance and business competitiveness. Though CCS is of high importance for the development of the workforce’s employability, there is little attention paid to the CCS use and profiling across occupations. A better understanding of how CCS is distributed across the economy will thus significantly enhance SSG’s career guidance services as well as training providers’ services to graduates and workers and guide organizations in their hiring for soft skills. This CCS profiling study sought to understand how CCS is demanded in different occupations. To achieve its research objectives, this study adopted a quantitative method to measure CCS use across different occupations in the Singaporean workforce. Based on the CCS framework developed by SSG, the research team adopted a formative approach to developing the CCS profiling tool to measure the importance of and self-efficacy in the use of CCS among the Singaporean workforce. Drawing on the survey results from 2500 participants, this study managed to profile them into seven occupation groups based on the different patterns of importance and confidence levels of the use of CCS. Each occupation group is labeled according to the most salient and demanded CCS. In the meantime, the CCS in each occupation group, which may need some further strengthening, were also identified. The profiling of CCS use has significant implications for different stakeholders, e.g., employers could leverage the profiling results to hire the staff with the soft skills demanded by the job.

Keywords: employability, skills profiling, skills measurement, soft skills

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Authors: Rehan Mohammad

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Background: Improved Water, Sanitation and Hygiene (WASH) practices in schools ensure children’s health, well-being and cognitive performance. In India under various WASH interventions in schools, teachers, and other staff make every possible effort to educate children about personal hygiene, sanitation practices and harms of open defecation. However, once children get back to their families, they see other practicing inappropriate WASH behaviors, and they consequently start following them. This show disconnect between school behavior and family behavior, which needs to be bridged to achieve desired WASH outcomes. Aims and Objectives: The aim of this study is to assess the factors causing disconnect of WASH-related behaviors between school and the family of children. It also suggests behavior change interventions to bridge the gap. Methodology: The present study has chosen a mixed- method approach. Both quantitative and qualitative methods of data collection have been used in the present study. The purposive sampling for data collection has been chosen. The data have been collected from 20% children in each age group of 04-08 years and 09-12 years spread over three primary schools and 20% of households to which they belong to which is spread over three slum communities in south district of Delhi. Results: The present study shows that despite of several behavior change interventions at school level, children still practice inappropriate WASH behaviors due to disconnect between school and family behaviors. These behaviors show variation from one age group to another. The inappropriate WASH behaviors being practiced by children include open defecation, wrong disposal of garbage, not keeping personal hygiene, not practicing hand washing practices during critical junctures and not washing fruits and vegetables before eating. The present study has highlighted that 80% of children in the age group of 04-08 years still practice inappropriate WASH behaviors when they go back to their families after school whereas, this percentage has reduced to 40% in case of children in the age group 09-12 years. Present study uncovers association between school and family teaching which creates a huge gap between WASH-related behavioral practices. The study has established that children learn and de-learn the WASH behaviors due to the evident disconnect between behavior change interventions at schools and household level. The study has also made it clear that children understand the significance of appropriate WASH practices but owing to the disconnect the behaviors remain unsettled. The study proposes several behavior change interventions to sync the behaviors of children at school and family level to ensure children’s health, well-being and cognitive performance.

Keywords: behavioral interventions, child health, family behavior, school behavior, WASH

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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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