Search results for: elderly care service model

Authors: Wei Zhang, Chye Kiang Heng, John Chye Fung

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Background: The world’s demographics is currently undergoing the largest wave of both rapid ageing and dramatic urbanisation in human history. As one of the most rapidly ageing countries, Singapore will see about one in four residents aged 65 years and above by 2030 in its high-rise and high-density urban environment. Research questions: To support urban seniors ageing in place and interdependence among senior residents and their informal caregivers, this study argues a community-based care model with bottom-up mutual help networks and asks how neighbourhood built-environment influences the formulation and facilitation of bottom-up mutual help networks in Singapore. Methods: Two public housing communities with different physical environment and rich age-friendly neighbourhood initiatives were chosen as the case studies. The categories, participants and places of bottom-up mutual help activities will be obtained via field observation, non-structural interviews of participants, service providers and managers of care facilities, and documents. Mapping and content analysis will be used to explore the influences of neighbourhood built-environment on the formulation and facilitation of bottom-up mutual help networks. Results and conclusions: The results showed that neighbourhood design, place programming, and place governance have a confluence on the bottom-up mutual help networks for senior residents. Significance: The outcomes of this study will provide fresh evidence for paradigm shifts of community-based care for the elderly and neighbourhood planning. In addition, the research findings will shed light on meaningful implications of urban planners and policy makers as they tackle with the issues arising from the ageing society.

Keywords: Built environment, Mutual help, Neighbourhood, Senior residents, Singapore

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Authors: Akankunda Veronicah Karuhanga

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Dementia is an age mental disorder that makes victims lose normal functionality that needs delicate attention. It has been technically defined as a clinical syndrome that presents a number of difficulties in speech and other cognitive functions that change someone’s behaviors and can also cause impairments in activities of daily living, not forgetting a range of neurological disorders that bring memory loss and cognitive impairment. Family members are the primary healthcare givers and therefore, the way how they handle the situation in its early stages determines future deterioration syndromes like total memory loss. Unfortunately, most family members are ignorant about this condition and in most cases, the patients are brought to our facilities when their condition was already mismanaged by family members and we thus cannot do much. For example, incontinence can be managed at early stages through potty training or toilet scheduling before resorting to 24/7 diapers which are also not good. Professional Elderly care should be understood and practiced as an extension of homes, not a dumping place for people considered “abnormal” on account of ignorance. Immediate relatives should therefore be sensitized concerning the normalcy of dementia in the context of old age so that they can be understanding and supportive of dementia patients rather than discriminating against them as present-day lepers. There is a need to skill home-based caregivers on how to handle dementia in its early stages. Unless this is done, many of our elderly homes shall be filled with patients who should have been treated and supported from their homes. This skilling of home-based caregivers is a vital intervention because until elderly care is appreciated as a human moral obligation, many transactional rehabilitation centers will crop up and this shall be one of the worst moral decadences of our times.

Keywords: dementia, family, Alzheimers, relevancy

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Authors: Leonardo Ramirez Lopez, Edward Guillen Pinto, Carlos Ramos Linares

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The controversy brought about by the increasing use of mHealth apps and their effectiveness for disease prevention and diagnosis calls for immediate control. Although a critical topic in research areas such as medicine, engineering, economics, among others, this issue lacks reliable implementation models. However, projects such as Open Web Application Security Project (OWASP) and various studies have helped to create useful and reliable apps. This research is conducted under a quality model to optimize two mHealth apps for older adults. Results analysis on the use of two physical activity monitoring apps - AcTiv (physical activity) and SMCa (energy expenditure) - is positive and ideal. Through a theoretical and practical analysis, precision calculations and personal information control of older adults for disease prevention and diagnosis were performed. Finally, apps are validated by a physician and, as a result, they may be used as health monitoring tools in physical performance centers or any other physical activity. The results obtained provide an effective validation model for this type of mobile apps, which, in turn, may be applied by other software developers that along with medical staff would offer digital healthcare tools for elderly people.

Keywords: model, validation, effective, healthcare, elderly people, mobile app

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Authors: Dongjae Kang, Sokho Son, Jinmee Kim

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Cloud service brokering is a new service paradigm that provides interoperability and portability of application across multiple Cloud providers. In this paper, we designed cloud service brokerage system, any broker, supporting integrated service provisioning and SLA based service life cycle management. For the system design, we introduce the system concept and whole architecture, details of main components and use cases of primary operations in the system. These features ease the Cloud service provider and customer’s concern and support new Cloud service open market to increase cloud service profit and prompt Cloud service echo system in cloud computing related area.

Keywords: cloud service brokerage, multiple Clouds, Integrated service provisioning, SLA, network service

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Authors: Raheel Shakoor Siddiqui, Sanjay Narayana Murthy, Manikandar Srinivas Cheruvu, Kash Akhtar

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Major trauma is a dynamic public health epidemic that is continuously evolving. Major trauma care services rely on multi-disciplinary team input involving highly trained pre and in-hospital critical care teams. Pre-hospital critical care teams (PHCCTs), major trauma centres (MTCs), trauma units, and rehabilitation facilities all form an efficient and organised trauma system. England comprises 27 MTCs funded by the National Health Service (NHS). Major trauma care entails enhanced resuscitation protocols coupled with the expertise of dedicated trauma teams and rapid radiological imaging to improve trauma outcomes. Literature reports a change in the demographic of major trauma as elderly patients (silver trauma) with injuries sustained from a fall of 2 metres or less commonly present to services. Evidence of an increasing population age with multiple comorbidities necessitates treatment within the first hour of injury (golden hour) to improve trauma survival outcomes. Staffing and funding pressures within the NHS have subsequently led to a shortfall of available physician-led PHCCTs. Thus, there is a strong emphasis on targeted research and funding to appropriately deploy resources to deprived areas. This review article will discuss the current English trauma system whilst critically appraising present challenges, identifying insufficiencies, and recommending aims for an improved future trauma system in England.

Keywords: trauma, orthopaedics, major trauma, trauma system, trauma network

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Authors: Valmir Moratelli

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This paper discusses the construction of the narrative of television fiction from the point of view of the invisibility of the representation of elderly black characters. Through the appointment of social and contemporary elements, we analyze why the theme of old age of black people is practically non-existent in brazilian soap operas of TV Globo. By raising characteristic aspects of the leaflet narrative, we want to discuss how the cancellation of identity discourses about elderly blacks and their relationship with aspects of social life is constructed.

Keywords: audiovisual, black, erderly, television

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Authors: Ashoke Priyadarshana Premananda

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As per the suggestions of previously conducted research in Counseling Psychology, the necessity of forming culture- friendly approaches has been strongly emphasized by a number of scholars in the field. In response to that, Multicultural-model of Buddhist Based Cognitive Behavioral Therapy (MMBCBT) has been formed as a culture-friendly therapeutic approach to address psychological disturbances (depression) in late adulthood. Elderly population in the world is on the rise by leaps and bounds, and forming a culture-based therapeutic model which is blended with Buddhist teachings has been the major objective of the study. Buddhist teachings and cultural applications, which were mapped onto Cognitive Behavioral Therapy (CBT) in the West, ultimately resulted in MMBCBT. Therefore, MMBCBT is a blend of cultural therapeutic techniques and the essence of certain Buddhist teachings extracted from five crucial suttas, which include CBT principles. In the process of mapping, MeghiyaSutta, GirimānandaSutta, SallekhaSutta, DvedhāvitakkaSutta, and Vitakka- SaṇṭhānaSutta have been taken into consideration mainly because of their cognitive behavioral content. The practical components of Vitakka- Saṇṭhānasutta (Aññanimittapabbaṃ) and Sallekhasutta (SallekhaPariyāya and CittuppādaPariyāya) have been used in the model while mindfulness of breathing was also carried out with the participants. Basically, multi-cultural therapeutic approaches of MMBCBT aim at modifying behavior (behavioral modification), whereas the rest is centered to the cognitive restructuring process. Therefore, MMBCBT is endowed with Behavioral Therapy (BT) and Cognitive Therapy(CT). In order to find out the validation of MMBCBT as a newly formed approach, it was then followed by mixed research (quantitative and qualitative research) with a sample selected from the elderly population following the purposive sampling technique. 40 individuals were selected from three elderly homes as per the purposive sampling technique. Elderly people identified to be depressed via Geriatric Depression Scale underwent MMBCBT for two weeks continuously while action research was being conducted simultaneously. Additionally, a Focus Group interview was carried out to support the action research. As per the research findings, people who identified depressed prior to the exposure to MMBCBT were found to be showing positive changes after they were exposed to the model. “Paired Sample t test” showed that the Multicultural Model of Buddhist based Cognitive Behavioral Therapy reduced depression of elderly people (The mean value (x̄) of the sample (level of depression) before the model was 10.7 whereas the mean value after the model was 7.5.). Most importantly, MMBCBT has been found to be effectively used with people from all walks of life despite religious diversities.

Keywords: buddhist psychotherapy, cognitive behavioral therapy in buddhism, counseling in cultural context, gerontology, and buddhism

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Authors: L. Sudbury-Riley, P. Hunter-Jones, L. Menzies, M. Pyrah, H. Knight

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Just as manufacturing firms aim for zero defects, service providers strive to avoid service failures where customer expectations are not met. However, because services comprise unique human interactions, service failures are almost inevitable. Consequently, firms focus on service recovery strategies to fix problems and retain their customers for the future. Because a hospice offers care to terminally ill patients, it may not get the opportunity to correct a service failure. This situation makes the identification of what hospice users really need and want, and to ascertain perceptions of the hospice’s service delivery from the user’s perspective, even more important than for other service providers. A well-documented and fundamental barrier to improving end-of-life care is a lack of service quality measurement tools that capture the experiences of user’s from their own perspective. In palliative care, many quantitative measures are used and these focus on issues such as how quickly patients are assessed, whether they receive information leaflets, whether a discussion about their emotional needs is documented, and so on. Consequently, quality of service from the user’s perspective is overlooked. The current study was designed to overcome these limitations by adapting service blueprinting - never before used in the hospice sector - in order to undertake a ‘deep-dive’ to examine the impact of hospice services upon different users. Service blueprinting is a customer-focused approach for service innovation and improvement, where the ‘onstage’ visible service user and provider interactions must be supported by the ‘backstage’ employee actions and support processes. The study was conducted in conjunction with East Cheshire Hospice in England. The Hospice provides specialist palliative care for patients with progressive life-limiting illnesses, offering services to patients, carers and families via inpatient and outpatient units. Using service blueprinting to identify every service touchpoint, in-depth qualitative interviews with 38 in-patients, outpatients, visitors and bereaved families enabled a ‘deep-dive’ to uncover perceptions of the whole service experience among these diverse users. Interviews were recorded and transcribed, and thematic analysis of over 104,000 words of data revealed many excellent aspects of Hospice service. Staff frequently exceed people’s expectations. Striking gratifying comparisons to hospitals emerged. The Hospice makes people feel safe. Nevertheless, the technique uncovered many areas for improvement, including serendipity of referrals processes, the need for better communications with external agencies, improvements amid the daunting arrival and admissions process, a desperate need for more depression counselling, clarity of communication pertaining to actual end of life, and shortcomings in systems dealing with bereaved families. The study reveals that the adapted service blueprinting tool has major advantages of alternative quantitative evaluation techniques, including uncovering the complex nature of service user’s experiences in health-care service systems, highlighting more fully the interconnected configurations within the system and making greater sense of the impact of the service upon different service users. Unlike other tools, this in-depth examination reveals areas for improvement, many of which have already been implemented by the Hospice. The technique has potential to improve experiences of palliative and end-of-life care among patients and their families.

Keywords: hospices, end-of-life-care, service blueprinting, service delivery

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Authors: Lovro Štefan

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The main purpose of the study was to explore if a higher level of Elderly Dietary index score was correlated with lower peak plantar pressures. One-hundred and twenty older adults aged ≥60 years participated in this cross-sectional study. To assess the level of adherence to nutritional recommendations for older adults, we used Elderly Dietary Index score. Plantar pressures beneath the forefoot, midfootandhindfootregions of the foot were determined by pressure platform. Pearson’s coefficient of correlations and partial correlations were used to calculate the relationships. In the unadjusted model, higher Elderly Dietary Index was significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.45, p<0.001) and hindfoot (r = -0.37, p<0.001) the region, while no significant correlation with peak plantar pressure beneath the (r = -0.15, p=0.113) was observed. When we adjusted for age, body-mass index and gait velocity, higher Elderly Dietary Index remained significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.41, p<0.001) and hintfoot (r = -0.32, p<0.001) region. This study shows that higher adherence to nutritional recommendations is significantly correlated with lower forefoot and hindfoot peak plantar pressures in older women.

Keywords: elderly, biomechanics, nutrition, associations, force

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Authors: Hyun-Ju Oh, Soon-Rim Suh, Mihan Kim

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The steady and rapid increase of the older population is a global phenomenon. Chronic diseases and disabilities are increased due to aging. In general, exercise has been known to be most effective in preventing and managing chronic back pain. However, it is hard for the older women to initiate and maintain the exercise. Transtheoretical model (TTM) is one of the theories explain behavioral changes such as exercise. The application of the program considering the stage of behavior change is effective for the elderly woman to start and maintain the exercise. The purpose of this study was to develop TTM based exercise program and to examine its effect for elderly women with chronic back-pain. For the program evaluation, the non-equivalent control pre-posttest design was applied. The independent variable of this study is exercise intervention program. The contents of the program were constructed considering the characteristics of the elderly women with chronic low back pain, focusing on the process of change, the stage of change by the previous studies. The developed exercise program was applied to the elderly women with chronic low back pain in the planning stage and the preparation stage. The subjects were 50 older women over 65 years of age with chronic back-pain who did not practice regular exercise. The experimental group (n=25) received the 8weeks TTM based exercise program. The control group received the book which named low back pain management. Data were collected at three times: before the exercise intervention, right after the intervention, and 4weeks after the intervention. The dependent variables were the processes of change, decisional balance, exercise self-efficacy, back-pain, depression and muscle strength. The results of this study were as follows. Processes of change (<.001), pros of decisional balance (<.001), exercise self-efficacy (<.001), back pain (<.001), depression (<.001), muscle strength (<.001) were higher in the experimental group than in the control group right after the program and 4weeks after the programs. The results of this study show that applying the TTM based exercise program increases the use of the change process, increases the exercise self-efficacy, increases the stage of changing the exercise behavior and strengthens the muscular strength by lowering the degree of pain and depression Respectively. The significance of the study was to confirm the effect of continuous exercise by maintaining regular exercise habits by applying exercise program of the transtheoretical model to the chronic low back pain elderly with exercise intention.

Keywords: chronic back pain, elderly, exercise, women

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Authors: Lou-Hon Sun, Yu-Ming Chiu, Chen-Wei Tao, Chia-Yun Tsai

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It is common practice for many companies to ask employees to provide heart-touching service for customers and to emphasize the attitude of 'customer first'. However, services may not necessarily gain praise, and may actually be considered excessive, if customers do not appreciate such behaviors. In reality, many restaurant businesses try to provide as much service as possible without taking into account whether over-provision may lead to negative customer reception. A survey of 894 people in Britain revealed that 49 percent of respondents consider over-attentive waiters the most annoying aspect of dining out. It can be seen that merely aiming to exceed customers’ expectations without actually addressing their needs, only further distances and dissociates the standard of services from the goals of customer satisfaction itself. Over-service is defined, as 'service provided that exceeds customer expectations, or simply that customers deemed redundant, resulting in negative perception'. It was found that customers’ reactions and complaints concerning over-service are not as intense as those against service failures caused by the inability to meet expectations; consequently, it is more difficult for managers to become aware of the existence of over-service. Thus the ability to manage over-service behaviors is a significant topic for consideration. The Kano model classifies customer preferences into five categories: attractive quality attribute, one-dimensional quality attribute, must-be quality attribute, indifferent quality attribute and reverse quality attributes. The model is still very popular for researchers to explore the quality aspects and customer satisfaction. Nevertheless, several studies indicated that Kano’s model could not fully capture the nature of service quality. The concept of over-service can be used to restructure the model and provide a better understanding of the service quality construct. In this research, the structure of Kano's two-dimensional questionnaire will be used to classify the factors into different dimensions. The same questions will be used in the second questionnaire for identifying the over-service experienced of the respondents. The finding of these two questionnaires will be used to analyze the relevance between service quality classification and over-service behaviors. The subjects of this research are customers of fine dining chain restaurants. Three hundred questionnaires will be issued based on the stratified random sampling method. Items for measurement will be derived from DINESERV scale. The tangible dimension of the questionnaire will be eliminated due to this research is focused on the employee behaviors. Quality attributes of the Kano model are often regarded as an instrument for improving customer satisfaction. The concept of over-service can be used to restructure the model and provide a better understanding of service quality construct. The extension of the Kano model will not only develop a better understanding of customer needs and expectations but also enhance the management of service quality.

Keywords: consumer satisfaction, DINESERV, kano model, over-service

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Authors: Tristance Kee

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With an unprecedented increase in elderly population around the world, the severe lack of quality housing and health-and-safety provisions to serve this cohort cannot be ignored any longer. Many elderly citizens, especially singletons, live in unsafe housing conditions with poorly executed planning and design. Some suffer from deteriorating mobility, sight and general alertness and their sub-standard living conditions further hinder their daily existence. This research explains how concepts such as Universal Design and Co-Design operate in a high density city such as Hong Kong, China where innovative design can become an alternative solution where government and the private sector fail to provide quality elderly friendly facilities to promote a sustainable urban development. Unlike other elderly research which focuses more on housing policies, nursing care and theories, this research takes a more progressive approach by providing an in-depth impact assessment on how innovative design can be practical solutions for creating a more sustainable built environment. The research objectives are to: 1) explain the relationship between innovative design for elderly and a healthier and sustainable environment; 2) evaluate the impact of human ergonomics with the use of universal design; and 3) explain how innovation can enhance the sustainability of a city in improving citizen’s sight, sound, walkability and safety within the ageing population. The research adopts both qualitative and quantitative methodologies to examine ways to improve elderly population’s relationship to our built environment. In particular, the research utilizes collected data from questionnaire survey and focus group discussions to obtain inputs from various stakeholders, including designers, operators and managers related to public housing, community facilities and overall urban development. In addition to feedbacks from end-users and stakeholders, a thorough analysis on existing elderly housing facilities and Universal Design provisions are examined to evaluate their adequacy. To echo the theme of this conference on Innovation and Sustainable Development, this research examines the effectiveness of innovative design in a risk-benefit factor assessment. To test the hypothesis that innovation can cater for a sustainable development, the research evaluated the health improvement of a sample size of 150 elderly in a period of eight months. Their health performances, including mobility, speech and memory are monitored and recorded on a regular basis to assess if the use of innovation does trigger impact on improving health and home safety for an elderly cohort. This study was supported by district community centers under the auspices of Home Affairs Bureau to provide respondents for questionnaire survey, a standardized evaluation mechanism, and professional health care staff for evaluating the performance impact. The research findings will be integrated to formulate design solutions such as innovative home products to improve elderly daily experience and safety with a particular focus on the enhancement on sight, sound and mobility safety. Some policy recommendations and architectural planning recommendations related to Universal Design will also be incorporated into the research output for future planning of elderly housing and amenity provisions.

Keywords: elderly population, innovative design, sustainable built environment, universal design

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Authors: Wei-Kuang Liu, Ya-Hsu Chiang

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In the coming of an aging society, the issues of living quality, health care, and social security for the elderly have been gradually taken seriously. In order to maintain favorable living condition, urban societies are also facing the challenge of disasters caused by extreme climate change. However, in the practice of disaster prevention, elderly people are always weak due to their physiological conditions. That is to say, in the planning of resilient urbanism, the aging society is relatively in need of more care. Thus, this research aims to map areas where have high-density elderly population and fragile environmental condition in Taiwan, and to understand the actual situation of disaster prevention management in these areas, so as to provide suggestions for the development of intellectual resilient urban management. The research takes the cities of Taoyuan and Taichung as examples for explorations. According to GIS mapping of areas with high aging index, high-density population and high flooding potential, the communities of Sihai and Fuyuan in Taoyuan and the communities of Taichang and Nanshih in Taichung are highlighted. In these communities, it can be found that there are more elderly population and less labor population with high-density living condition. In addition, they are located in the areas where they have experienced severe flooding in the recent past. Based on a series of interviews with community organizations, there is only one community out of the four using flood information mobile app and Line messages for the management of disaster prevention, and the others still rely on the traditional approaches that manage the works of disaster prevention by their community security patrol teams and community volunteers. The interview outcome shows that most elderly people are not interested in learning the use of intellectual devices. Therefore, this research suggests to keep doing the GIS mapping of areas with high aging index, high-density population and high flooding potential for grasping the high-risk communities and to help develop smart monitor and forecast systems for disaster prevention practice in these areas. Based on case-study explorations, the research also advises that it is important to develop easy-to-use bottom-up and two-way immediate communication mechanism for the management of aging society’s disaster prevention.

Keywords: aging society, disaster prevention, GIS, resilient, Taiwan

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Authors: Sandrine Andriantsimietry, Hantanirina Ravaosendrasoa

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Madagascar, in 2018, set up the first best available technology, autoclave, to treat the health care waste in public hospitals according the best environmental practices in health care waste management. Incineration of health care waste, frequently through open burning is the most common practice of treatment and elimination of health care waste across the country. Autoclave is a best available technology for non-incineration of health care waste that permits recycling of treated waste and prevents harm in environment through the reduction of unintended persistent organic pollutants from the health sector. A Global Environment Fund project supported the introduction of the non-incineration treatment of health care waste to help countries in Africa to move towards Stockholm Convention objectives in the health sector. Two teaching hospitals in Antananarivo and one district hospital in Manjakandriana were equipped respectively with 1300L, 250L and 80L autoclaves. The capacity of these model hospitals was strengthened by the donation of equipment and materials and the training of the health workers in best environmental practices in health care waste management. Proper segregation of waste in the wards to collect the infectious waste that was treated in the autoclave was the main step guaranteeing a cost-efficient non-incineration of health care waste. Therefore, the start-up of the switch of incineration into non-incineration treatment was carried out progressively in each ward with close supervision of hygienist. Emissions avoided of unintended persistent organic pollutants during these four months of autoclaves use is 9.4 g Toxic Equivalent per year. Public hospitals in low income countries can be model in best environmental practices in health care waste management but efforts must be made internally for sustainment.

Keywords: autoclave, health care waste management, model hospitals, non-incineration

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Authors: Taru Hakanen, Mervi Murtonen

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This study aims to increase understanding of the transition of business models in servitization. The significance of service in all business has increased dramatically during the past decades. Service-dominant logic (SDL) describes this change in the economy and questions the goods-dominant logic on which business has primarily been based in the past. A business model canvas is one of the most cited and used tools in defining end developing business models. The starting point of this paper lies in the notion that the traditional business model canvas is inherently goods-oriented and best suits for product-based business. However, the basic differences between goods and services necessitate changes in business model representations when proceeding in servitization. Therefore, new knowledge is needed on how the conception of business model and the business model canvas as its representation should be altered in servitized firms in order to better serve business developers and inter-firm co-creation. That is to say, compared to products, services are intangible and they are co-produced between the supplier and the customer. Value is always co-created in interaction between a supplier and a customer, and customer experience primarily depends on how well the interaction succeeds between the actors. The role of service experience is even stronger in service business compared to product business, as services are co-produced with the customer. This paper provides business model developers with a service business model canvas, which takes into account the intangible, interactive, and relational nature of service. The study employs a design science approach that contributes to theory development via design artifacts. This study utilizes qualitative data gathered in workshops with ten companies from various industries. In particular, key differences between Goods-dominant logic (GDL) and SDL-based business models are identified when an industrial firm proceeds in servitization. As the result of the study, an updated version of the business model canvas is provided based on service-dominant logic. The service business model canvas ensures a stronger customer focus and includes aspects salient for services, such as interaction between companies, service co-production, and customer experience. It can be used for the analysis and development of a current service business model of a company or for designing a new business model. It facilitates customer-focused new service design and service development. It aids in the identification of development needs, and facilitates the creation of a common view of the business model. Therefore, the service business model canvas can be regarded as a boundary object, which facilitates the creation of a common understanding of the business model between several actors involved. The study contributes to the business model and service business development disciplines by providing a managerial tool for practitioners in service development. It also provides research insight into how servitization challenges companies’ business models.

Keywords: boundary object, business model canvas, managerial tool, service-dominant logic

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Authors: Suhathai Tosangwarn, Philip Clissett, Holly Blake

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Background: High prevalence of depression has been reported among older adults living in care homes in Thailand, associated with physical impairment, low social support, low self-esteem and particularly stigma associated with living in a care home. However, little is understood about how such stigma is experienced among Thai care home residents. This study examines residents’ perceptions of stigma and their strategies for coping with stigma. Method/Design: Case study research was used to gain an in-depth view about the stigma of residents’ perspectives and experiences from two care homes in the northeast of Thailand by conducting an in-depth interview and non-participant observation. Qualitative interviews were conducted with 30 older residents (aged >60 years), purposively sampled from both care homes. Non-participant observation was conducted in various public spaces of the care homes, including the dining room, corridors, and activities areas for approximately one to two hours per day at different times; morning and afternoon including weekdays and weekend in both care homes for one month. Thematic analysis was used to analyse the data. Results: The study identified three major themes related to the causes of stigma, the reactions towards stigma and the mitigating factors. Negative beliefs about care homes, negative attitudes, and stereotypes toward the elderly and perceptions of unequal power relations between staff and residents were the main factors precipitating stigma. Consequently, residents exhibited negative emotions and behaviours, including depressive symptoms, while living in care homes. Residents reported the use of particular coping strategies, including accessing support from the public and staff and engaging in care home activities which these helped them to cope with their perception of stigma. Conclusion: Improved understanding of the underlying factors behind perceived stigma in care home residents may help to prevent depression and reduce perceptions of stigma associated with living in a care home, by informing strategy, supportive intervention and guidelines for appropriate care for older Thai residents.

Keywords: care home, depression, older adult, stigma, Thailand

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Authors: Cornelius Ehlers, Lisa Harmatiuk, Sharon Rowland, Michelle Shafers

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The objective of the Street Connect program is to provide client-centered care for the homeless population within the City of Red Deer. The program aims to provide an extended continuum of care (addiction, mental health, and physical health) for high acuity homeless individuals who are not connected to a service provider and/or community service agency. Street Connect includes both primary and secondary streams of service: Overall, Street Connect has demonstrated its ability to support vulnerable populations within the City of Red Deer, specifically those who are homeless and seeking addiction, mental health, and medical assistance. The results from the data extract and chart audit reflect the complexity and vulnerability of the clients enrolled in the Street Connect program. The clients were predominantly male, with an average age of 41 years. The majority did not have a permanent address, and 65% did not have employment. Substance abuse/addiction issues were common, combined with a history of psychiatric diagnoses and previous mental health hospitalizations. The most utilized drugs were street drugs such as methamphetamine, fentanyl, and other opioids.

Keywords: client-centred care, homelessness, mental health, rural

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Authors: Amit Zriker, Anat Freund

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The aim of the study was to conduct a thorough examination into the multiple complexities of bringing a foreign caregiver into the home to care for older adults in the Haredi society, by relating to the perspectives of the older adult and his family members. Research questions were: What is the meaning of bringing a foreign caregiver into the home in Haredi society, from the point of view of the older adult’s family members, and what are the implications of these meanings in the context of developing social policies and interventions? The current study was a qualitative-phenomenological study, which relates to “the lived experience” of those involved in the studied phenomenon. In the framework of the study, the participants included 15 adult Haredi sons and daughters of elderly impaired parents who receive homecare from a foreign caregiver. Data collection was carried out using in-depth, semi-structured interviews; the interview guidelines are comprised of the following content worlds: the meanings of aging in Haredi families; the decision-making process in relation to providing home care assistance for elderly impaired parents; making decisions regarding bringing a foreign caregiver into the home to care for an elderly parent; the daily routine after bringing in a foreign caregiver; bringing in a foreign caregiver vs. the society and vs. the Haredi establishment; and more. The issue of bringing a foreign caregiver into the home in the context of a faith-based society has received only scant and partial research attention to date. Nevertheless, in light of the growing elderly population in the Haredi society in Israel, and in closed, faith-based societies, in general; there is a growing need to bring foreign caregivers into the home as a possible solution to the “aging-in-place” problem in these societies. The separatist nature, and the collectivist and faith-based lifestyle of the Haredi society present unique challenges and needs in the process of employing a foreign caregiver. Moreover, the foreign caregiver also brings his/her own cultural world to the encounter, meaning, this process involves the elderly impaired individual, his/her family members, as well as the foreign caregiver. Therefore, it is important to understand their attitudes, perceptions and interactions, in order to create a good fit among all involved parties. The innovation and uniqueness of the current study is in its in-depth exploration of a phenomenon through an emotional-cultural lens. The study findings also contribute to the creation of social policy in the field of nursing, which will be adapted and culturally sensitive to Haredi society, and other faith-based societies.

Keywords: culturally-sensitive intervention, faith-based society, foreign caregiver, Haredi society

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Authors: L. Paulino Ferreira, M. Gomes Neto, M. Duarte, S. Serra

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Objectives: COVID-19 pandemic has caused older adults to experience a degree of social isolation and loneliness that is unprecedented. Our aim is to review state of the art regarding the consequences of social isolation due to COVID-19 in elderly people. Methods: The authors conducted a search on Medscape and PubMed with the keywords mentioned below, and the most relevant articles were selected. Results: Social isolation leads many elderlies to experience loneliness, anxiety, depression, alcohol abuse, and feelings of abandonment with a perception of being a burden on society. Thus, social isolation has increased the risk for suicide in older people. It is also noteworthy that the exacerbation of psychiatric disorders (such as depression, anxiety, and post-traumatic stress disorder) without correct treatment and follow-up also increases suicide risk. Loneliness is also associated with accelerated cognitive deterioration and dementia. Besides that, during social isolation, it could be more difficult for older people to get medication as well as proper health care. It is also noticed an increase in the risk of falls, poor nutrition, and lack of exercise. All this contributes to weakening elderlies’ immune systems leading to a higher risk of developing infections, cardiovascular events, and cancer, increasing hospitalization and morbimortality. Conclusion: Social isolation in the elderly has a significant impact on physical and mental health, as well as morbimortality and hospitalizations due to non-COVID causes. Nevertheless, further studies will be needed to assess the real dimension of the effects of social isolation due to COVID-19.

Keywords: social isolation, COVID-19, elderly, mental health

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Authors: Amir Mohammad Fathollahi Fard, Mostafa Hajiaghaei-Keshteli, Mohammad Mahdi Paydar

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With increasing life expectancy in developed countries, the role of home care services is highlighted by both academia and industrial contributors in Home Health Care Supply Chain (HHCSC) companies. The main decisions in such supply chain systems are the location of pharmacies, the allocation of patients to these pharmacies and also the routing and scheduling decisions of nurses to visit their patients. In this study, for the first time, an integrated model is proposed to consist of all preliminary and necessary decisions in these companies, namely, location-allocation-routing model. This model is a type of NP-hard one. Therefore, an Imperialist Competitive Algorithm (ICA) is utilized to solve the model, especially in large sizes. Results confirm the efficiency of the developed model for HHCSC companies as well as the performance of employed ICA.

Keywords: home health care supply chain, location-allocation-routing problem, imperialist competitive algorithm, optimization

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Authors: Prof. Ragea Alqahtani

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The purpose of the study was to measure the effectiveness of the Goldstein’s social skill streaming model based on the special and general pre-service teachers’ knowledge about controlling their emotions in conflict situations. A review of previous pieces of literature guided the design and measurement of the effectiveness of the approach to the control of emotions. The teachers were assessed using the coping strategy, adult anger, and Goldstein’s skill streaming inventories. Lastly, the paper provides various recommendations on the sensitization of the Goldstein’s Social Skill streaming model to both the special and pre-service teachers to promote their knowledge about controlling emotions in conflicts.

Keywords: emotional control, goldstein social skillstreaming model, modeling technique, self-as-a-model, self-efficacy, self-regulation

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Authors: M. A. Brown, K. Hugill, D. Meredith

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Since the establishment of midwifery, as a professional identity in its own right, in the early years of the 20th century, midwifery-led models of childbirth have prevailed in many parts of the world. However, in many locations midwives’ scope of practice remains underdeveloped or absent. In Qatar, all births take place in hospital and are under the professional jurisdiction of obstetricians, predominately supported by internationally trained nurse-midwives and obstetric nurses. The strategic vision for health services in Qatar endorsed a desire to provide women with the ‘Best Care Always’ and the introduction of midwifery was seen as a way to achieve this. In 2015 the process of recruiting postgraduate educated Clinical Midwife Specialists from international sources began. The midwives were brought together to initiate an in hospital and community service transformation plan. This plan set out a series of wide-ranging actions to transform maternity and neonatal services to make care safer and give women more health choices. Change in any organization is a complex and dynamic process. This is made even more complex when multifaceted professional and cross cultural factors are involved. This presentation reports upon the motivations and challenges that exist and the progress around introducing a multicultural midwifery model of childbirth care in the state of Qatar. The paper examines and reflects upon the drivers and unique features of childbirth in the country. Despite accomplishments, progress still needs to be made in order to fully implement sustainable changes to further improve care and ensure women and neonates get the ‘Best Care Always’. The progress within the transformation plan highlights how midwifery may coexist with competing models of maternity care to create an innovative, eclectic and culturally sensitive paradigm that can best serve women and neonatal health needs.

Keywords: culture, managing change, midwifery, neonatal, service transformation plan

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Authors: Rhay-Hung Weng, Ching-Yuan Huang, Wan-Ping Chen

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Recently, many hospitals have put much emphasis upon the development of nurse innovation. The present study aimed to clarify how nurse innovation is related to medical service quality and medical service experience. This study adopted questionnaire-survey method with nurses and customers of the inpatient wards from three Taiwanese hospitals as the research subjects. After pairing, there were 294 valid questionnaires. Hierarchical regression analysis was utilized to test the possible impact of nurse innovation on medical service quality and experience. In terms of the dimensions of nurse innovation, “innovation behavior” ranked the highest (3.24), followed by knowledge creation and innovation diffusion; in terms of the degree of the medical service quality, 'reliability' ranked the highest (4.35). As for the degree of the medical service experience, 'feel experience' ranked the highest (4.44). All dimensions of nurse innovation have no significant effects on medical service quality and medical service experience. Of these three dimensions of nurse innovation, the level of innovation behavior was perceived by the nurses as the highest. The study found that nurse innovation has no significant effects on medical service quality and medical service experience. Managers shall provide sufficient resources and budget for fostering innovation development and encourage their nurses to develop nursing innovation for patents. The education and training courses on “patient-centered ” shall be enhanced among hospital nurses. Health care managers shall also explore the difficulties about innovation diffusion and find the solutions for nurses.

Keywords: innovation, employee innovative behavior, service quality, service experience

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Authors: M. Mohemmed Sha Mohamed Kunju, Abdalla A. Al-Ameen Abdurahman, T. Manesh Thankappan, A. Mohamed Mustaq Ahmed Hameed

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Web service composition is an effective approach to complete the web based tasks with desired quality. A single web service with limited functionality is inadequate to execute a specific task with series of action. So, it is very much required to combine multiple web services with different functionalities to reach the target. Also, it will become more and more challenging, when these services are from different providers with identical functionalities and varying QoS, so while composing the web services, the overall QoS is considered to be the major factor. Also, it is not true that the expected QoS is always attained when the task is completed. A single web service in the composed chain may affect the overall performance of the task. So care should be taken in different aspects such as functionality of the service, while composition. Dynamic and automatic service composition is one of the main option available. But to achieve the actual functionality of the task, quality of the individual web services are also important. Normally the QoS of the individual service can be evaluated by using the non-functional parameters such as response time, throughput, reliability, availability, etc. At the same time, the QoS is not needed to be at the same level for all the composed services. So this paper proposes a framework that allows composing the services in terms of QoS by setting the appropriate weight to the non-functional parameters of each individual web service involved in the task. Experimental results show that the importance given to the non-functional parameter while composition will definitely improve the performance of the web services.

Keywords: composition, non-functional parameters, quality of service, web service

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Authors: M. H. Fazel Zarandi, N. Moshahedi

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The hub location problem appears in a variety of applications such as medical centers, firefighting facilities, cargo delivery systems and telecommunication network design. The location of service centers has a strong influence on the congestion at each of them, and, consequently, on the quality of service. This paper presents a fuzzy maximal hub covering location problem (FMCHLP) in which travel costs between any pair of nodes is considered as a fuzzy variable. In order to consider the quality of service, we model each hub as a queue. Arrival rate follows Poisson distribution and service rate follows Erlang distribution. In this paper, at first, a nonlinear mathematical programming model is presented. Then, we convert it to the linear one. We solved the linear model using GAMS software up to 25 nodes and for large sizes due to the complexity of hub covering location problems, and simulated annealing algorithm is developed to solve and test the model. Also, we used possibilistic c-means clustering method in order to find an initial solution.

Keywords: fuzzy modeling, location, possibilistic clustering, queuing

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Authors: Yangrae Cho, Jinseok Kim, Yongtae Park

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Mobile app service ecosystem has been abruptly emerged, explosively grown, and dynamically transformed. In contrast with product markets in which product sales directly cause increment in firm’s income, customer’s usage is less visible but more valuable in service market. Especially, the market situation with cutthroat competition in mobile app store makes securing and keeping of users as vital. Although a few service firms try to manage their apps’ usage patterns by fitting on S-curve or applying other forecasting techniques, the time series approaches based on past sequential data are subject to fundamental limitation in the market where customer’s attention is being moved unpredictably and dynamically. We therefore propose a new conceptual approach for detecting usage pattern of mobile app service with Hidden Markov Model (HMM) which is based on the dual stochastic structure and mainly used to clarify unpredictable and dynamic sequential patterns in voice recognition or stock forecasting. Our approach could be practically utilized for app service firms to manage their services’ lifecycles and academically expanded to other markets.

Keywords: mobile app service, usage pattern, Hidden Markov Model, pattern detection

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Authors: Harvard Najoan, Sarwono Sutikno, Yusep Rosmansyah

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Most enterprises are now using information technology services as their assets to support business objectives. These kinds of services are provided by the internal service provider (inside the enterprise) or external service provider (outside enterprise). To deliver quality information technology services, the service provider (which from now on will be called ‘organization’) either internal or external, must have a standard for service management system. At present, the standard that is recognized as best practice for service management system for the organization is international standard ISO/IEC 20000:2011. The most important part of this international standard is the first part or ISO/IEC 20000-1:2011-Service Management System Requirement, because it contains 22 for organization processes as a requirement to be implemented in an organizational environment in order to build, manage and deliver quality service to the customer. Assessing organization management processes is the first step to implementing ISO/IEC 20000:2011 into the organization management processes. This assessment needs Process Assessment Model (PAM) as an assessment instrument. PAM comprises two parts: Process Reference Model (PRM) and Measurement Framework (MF). PRM is built by transforming the 22 process of ISO/IEC 20000-1:2011 and MF is based on ISO/IEC 33020. This assessment instrument was designed to assess the capability of service management process in Divisi Teknologi dan Sistem Informasi (Information Systems and Technology Division) as an internal organization of PT Pos Indonesia. The result of this assessment model can be proposed to improve the capability of service management system.

Keywords: ISO/IEC 20000-1:2011, ISO/IEC 33020:2015, process assessment, process capability, service management system

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Authors: Papai Barman, Harihar Sahoo

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With increasing life expectancy, urbanization, and adult out migration, elder people live without adult child and most of time responsible for grandchild caring while the care is needed for them. On this line, the current study examined the association between grandchild caring (GCC) with different household structures and depression among elderly (60+) grandparents (GP) living in India using Longitudinal Aging Study in India (LASI), 2017-18. HH structure was defined as the skipped-generation household (SGH) where GP and GC lived together without middle generation and the multi-generation household (MGH) where more than two generations lived together. GCC was defined by two categories, compulsive and non-compulsive caring. CES-D depression scale was utilized to measure GP’s mental health. Socio-economic characteristics, chronic diseases, and health behavior were controlled to get the effect of HH structure and GCC considered key explanatory variables. Bivariate analyses showed that the prevalence of elderly lived in SGH in India (2.5%). Prevalence of compulsive caring was found 16.3% in MGH and 51.1% in SGH. Prevalence of depressions was found nearly 37.1 and 49.5% among the GPs responsible for GCC in MGH and SGH, respectively. Using Biprobit and margins results, GPs lived in SGH were 0.40 times (dy/dx=0.40, p<0.001) more likely to report depression than GPs lived in MGH, given the condition on compulsive caring. Ensuring SDG goal-3, health aging, and giving more social security to the elder people responsible for caring while they are needed care at later life, the current study may improve the existing knowledge and help policy makers to make an intervention on this most vulnerable people, especially for the elderly people living in SGH and responsible for caring.

Keywords: household structure, grandchild caring, skipped-generation household, multi-generation household, depression, mental health, India

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Authors: Frederic Fovet

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Inclusive provisions have been statutorily mandated in North America for now over two decades. Despite a growing body of literature around inclusive practices, many in-service teachers continue to express difficulties when it comes to tangible implementation of inclusion in the everyday classroom. While there is debate around the various forms inclusion can take (UDL, differentiation, personalization, etc.), there appears to be a more significant hurdle in getting in-service teachers to fully embrace inclusion both as a goal and a practice. This paper investigates teachers’ degree of awareness around the Social Model of Disability. It argues that teachers often lack basic awareness of disability studies, more particularly of the Social Model of Disability, and that this has a direct impact on their capacity to conceptualize and embrace inclusion. The paper draws from the researcher’s experience as a graduate instructor with in-service teachers, as well as from his experience as a consultant working with schools and school boards. The methodology chosen here is phenomenology, and it draws on tools such as auto-ethnography. The paper opens a discussion around the reform and transformation of pre-service teacher training. It argues that disability studies should be integrated into teacher training as it plays a key role in having teachers develop a theoretical understanding of disability as a social construct.

Keywords: disability, K-12, inclusion, social model, in-service teachers

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Authors: Sophia Cyril Vincent

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Background: As per the Indian Census 2011, there is nearly 104 million elderly population aged above 60 years (53 million females and 51 males), and the count is expected to be 173 million by the end of 2026. Nearly 5.5% of women and 1.5% of men are living alone.1 In India, even though it is the moral duty of the children to take care of aged parents, many elders are landing in old age homes due to the social transformation factors like mushrooming of nuclear families, migration of children, cultural echoes, differences in mindset and values. Nearly 728 old age homes are seen across the country, out of which 78 old age homes with approximately 3000 inmates are seen only in Bangalore2. The existing literature shows that elderly women residing in old age homes experience the challenges like- loneliness, health issues, rejection from children, grief, death anxiety, etc, which leads to mental and physical wellbeing in numerous and tangible ways3. Hence the best and cost-effective way to improve the meaning and quality of life among elderly females is logotherapy, a type of psychotherapeutic analysis and treatment, motivating and driving force4 within the human experience to lead a decent life. Aim: The current research is aimed at studying the effectiveness of a logotherapy intervention on meaning and quality of life among elderly women of old age homes. Samples:200 women aged < 60 years and staying in the old age home for more than 1 year were randomly allocated to the control group and experimental group. Methodology: Using the Meaning in life questionnaire (MLQ)and the World health organization quality of life (WHOQOL) questionnaire, meaning and quality of life were assessed among both groups' women. Intensive Logotherapy and meaning in life program for five days were provided for the experimental group and the control group, with no treatment. Result: Under analysis. Conclusion: It is the right of the elderly woman to lead a happy and peaceful life till her death irrespective of the residing place. Hence, continuous monitoring and effective management are necessary for elderly women.

Keywords: quality of life, meaning of life, logo therapy, old age home

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