Search results for: health team
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 10040

Search results for: health team

9890 Redefining Success Beyond Borders: A Deep Dive into Effective Methods to Boost Morale Among Virtual Workers for Exponential Project Performance

Authors: Florence Ibeh, David Oyewmi Oyekunle, David Boohene

Abstract:

The continuous advancement of information technology has completely transformed how businesses and organizations operate on a global scale. The widespread availability of virtual communication tools enables individuals to opt for remote work. While remote employment offers various benefits, such as facilitating corporate growth and enhancing customer support, it also presents distinct challenges. Therefore, investigating the intricacies of virtual team morale is crucial for ensuring the achievement of project objectives. For this study, content analysis of pre-existing secondary data was employed to examine the phenomenon. Essential elements vital for improving the success of projects within virtual teams were identified. These factors include technology adoption, creating a distraction-free work environment, effective leadership, trust-building, clear communication channels, well-defined task allocation, active team participation, and motivation. Furthermore, the study established a substantial correlation between morale levels and the participation and productivity of virtual team members. Higher levels of morale were associated with optimal performance among virtual teams. The study determined that the key factors for enhancing project performance in virtual teams are the adoption of technology, a focused environment, effective leadership, trust, communication, well-defined tasks, collaborative teamwork, and motivation. Additionally, the study discovered that modifying the optimal strategies employed by in-office teams can enhance the diminished morale prevalent in remote teams to sustain a high level of team morale for virtual teams. The findings of this study are highly significant in the dynamic field of project management. Currently, there is limited information regarding strategies that address challenges arising from external factors in virtual teams, such as ambient noise and disruptions caused by family members. The findings underscore the significance of selecting appropriate communication technologies, delineating distinct roles and responsibilities for virtual team members, and nurturing a culture of accountability and trust. Promoting seamless collaboration and instilling motivation among virtual team members are deemed highly effective in augmenting employee engagement and performance within virtual team setting.

Keywords: virtual teams, morale, project performance, distract-free environment, technology adaptation

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9889 A Continuous Real-Time Analytic for Predicting Instability in Acute Care Rapid Response Team Activations

Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

Abstract:

A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

Procedia PDF Downloads 142
9888 Disability Management and Occupational Health Enhancement Program in Hong Kong Hospital Settings

Authors: K. C. M. Wong, C. P. Y. Cheng, K. Y. Chan, G. S. C. Fung, T. F. O. Lau, K. F. C. Leung, J. P. C. Fok

Abstract:

Hospital Authority (HA) is the statutory body to manage all public hospitals in Hong Kong. Occupational Care Medicine Service (OMCS) is an in-house multi-disciplinary team responsible for injury management in HA. Hospital administrative services (AS) provides essential support in hospital daily operation to facilitate the provision of quality healthcare services. An occupational health enhancement program in Tai Po Hospital (TPH) domestic service supporting unit (DSSU) was piloted in 2013 with satisfactory outcome, the keys to success were staff engagement and management support. Riding on the success, the program was rolled out to another 5 AS departments of Alice Ho Miu Ling Nethersole Hospital (AHNH) and TPH in 2015. This paper highlights the indispensable components of disability management and occupational health enhancement program in hospital settings. Objectives: 1) Facilitate workplace to support staff with health affecting work problem, 2) Enhance staff’s occupational health. Methodology: Hospital Occupational Safety and Health (OSH) team and AS departments (catering, linen services, and DSSU) of AHNH and TPH worked closely with OMCS. Focus group meetings and worksite visits were conducted with frontline staff engagement. OSH hazards were identified with corresponding OSH improvement measures introduced, e.g., invention of high dusting device to minimize working at height; tailor-made linen cart to minimize back bending at work, etc. Specific MHO trainings were offered to each AS department. A disability management workshop was provided to supervisors in order to enhance their knowledge and skills in return-to-work (RTW) facilitation. Based on injured staff's health condition, OMCS would provide work recommendation, and RTW plan was formulated with engagement of staff and their supervisors. Genuine communication among stakeholders with expectation management paved the way for realistic goals setting and success in our program. Outcome: After implementation of the program, a significant drop of 26% in musculoskeletal disorders related sickness absence day was noted in 2016 as compared to the average of 2013-2015. The improvement was postulated by innovative OSH improvement measures, teamwork, staff engagement and management support. Staff and supervisors’ feedback were very encouraging that 90% respondents rated very satisfactory in program evaluation. This program exemplified good work sharing among departments to support staff in need.

Keywords: disability management, occupational health, return to work, occupational medicine

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9887 A Case Study: Social Network Analysis of Construction Design Teams

Authors: Elif D. Oguz Erkal, David Krackhardt, Erica Cochran-Hameen

Abstract:

Even though social network analysis (SNA) is an abundantly studied concept for many organizations and industries, a clear SNA approach to the project teams has not yet been adopted by the construction industry. The main challenges for performing SNA in construction and the apparent reason for this gap is the unique and complex structure of each construction project, the comparatively high circulation of project team members/contributing parties and the variety of authentic problems for each project. Additionally, there are stakeholders from a variety of professional backgrounds collaborating in a high-stress environment fueled by time and cost constraints. Within this case study on Project RE, a design & build project performed at the Urban Design Build Studio of Carnegie Mellon University, social network analysis of the project design team will be performed with the main goal of applying social network theory to construction project environments. The research objective is to determine a correlation between the network of how individuals relate to each other on one’s perception of their own professional strengths and weaknesses and the communication patterns within the team and the group dynamics. Data is collected through a survey performed over four rounds conducted monthly, detailed follow-up interviews and constant observations to assess the natural alteration in the network with the effect of time. The data collected is processed by the means of network analytics and in the light of the qualitative data collected with observations and individual interviews. This paper presents the full ethnography of this construction design team of fourteen architecture students based on an elaborate social network data analysis over time. This study is expected to be used as an initial step to perform a refined, targeted and large-scale social network data collection in construction projects in order to deduce the impacts of social networks on project performance and suggest better collaboration structures for construction project teams henceforth.

Keywords: construction design teams, construction project management, social network analysis, team collaboration, network analytics

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9886 Integration of Agile Philosophy and Scrum Framework to Missile System Design Processes

Authors: Misra Ayse Adsiz, Selim Selvi

Abstract:

In today's world, technology is competing with time. In order to catch up with the world's companies and adapt quickly to the changes, it is necessary to speed up the processes and keep pace with the rate of change of the technology. The missile system design processes, which are handled with classical methods, keep behind in this race. Because customer requirements are not clear, and demands are changing again and again in the design process. Therefore, in the system design process, a methodology suitable for the missile system design dynamics has been investigated and the processes used for catching up the era are examined. When commonly used design processes are analyzed, it is seen that any one of them is dynamic enough for today’s conditions. So a hybrid design process is established. After a detailed review of the existing processes, it is decided to focus on the Scrum Framework and Agile Philosophy. Scrum is a process framework. It is focused on to develop software and handling change management with rapid methods. In addition, agile philosophy is intended to respond quickly to changes. In this study, it is aimed to integrate Scrum framework and agile philosophy, which are the most appropriate ways for rapid production and change adaptation, into the missile system design process. With this approach, it is aimed that the design team, involved in the system design processes, is in communication with the customer and provide an iterative approach in change management. These methods, which are currently being used in the software industry, have been integrated with the product design process. A team is created for system design process. The roles of Scrum Team are realized with including the customer. A scrum team consists of the product owner, development team and scrum master. Scrum events, which are short, purposeful and time-limited, are organized to serve for coordination rather than long meetings. Instead of the classic system design methods used in product development studies, a missile design is made with this blended method. With the help of this design approach, it is become easier to anticipate changing customer demands, produce quick solutions to demands and combat uncertainties in the product development process. With the feedback of the customer who included in the process, it is worked towards marketing optimization, design and financial optimization.

Keywords: agile, design, missile, scrum

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9885 Strengthening Factors of Family Living with Disabilities

Authors: Supranee Sittikan, Darunee Jongudomkarn, Rutja Phuphaibul

Abstract:

Thai’s families with disabilities are diverse, poor economy, low education disproportionately characterized their living that includes stress and suffering. This article reports a preliminary study using a qualitative case study with six disabilities (five physical and one mental problem) Their six family caregivers who perceived they were managing well with their conditions as well. Data were collected by in-depth interviews during November-December 2017 in North-East of Thailand. Preliminary results were found factors of moving in comprised of three themes as followings Karma: the families believe that the disability happened because of bad-karma which attached to them. From the reason, the members of families have to deserve and accept it. Family attachment: the families believe in the importance of being the family so they have to take good care in one another whether happy or suffering Community support: the families can get more to received helping hands from local health care providers and community health volunteers. These activities are very important to be representative in taking the families through health accessibility, which help them face with disabling problems. Nevertheless, the study needs further exploring on other families’ and health care team's perspective in larger scales leading to develop an appropriate health care service system which can support and promote the well-being of the families living with disabilities in the future.

Keywords: families with disabilities, Karma, family attachment, community support

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9884 Development of an Aerosol Protection Capsule for Patients with COVID-19

Authors: Isomar Lima da Silva, Aristeu Jonatas Leite de Oliveira, Roberto Maia Augusto

Abstract:

Biological isolation capsules are equipment commonly used in the control and prevention of infectious diseases in the hospital environment. This type of equipment, combined with pre-established medical protocols, contributes significantly to the containment of highly transmissible pathogens such as COVID-19. Due to its hermetic isolation, it allows more excellent patient safety, protecting companions and the health team. In this context, this work presents the development, testing, and validation of a medical capsule to treat patients affected by COVID-19. To this end, requirements such as low cost and easy handling were considered to meet the demand of people infected with the virus in remote locations in the Amazon region and/or where there are no ICU beds and mechanical ventilators for orotracheal intubation. Conceived and developed in a partnership between SAMEL Planos de Saúde and Instituto Conecthus, the device entitled "Vanessa Capsule" was designed to be used together with the NIV protocol (non-invasive ventilation), has an automatic exhaust system and filters performing the CO2 exchange, in addition to having BiPaps ventilatory support equipment (mechanical fans) in the Cabin Kit. The results show that the degree of effectiveness in protecting against infection by aerosols, with the protection cabin, is satisfactory, implying the consideration of the Vanessa capsule as an auxiliary method to be evaluated by the health team. It should also be noted that the medical observation of the evaluated patients found that the treatment against the COVID-19 virus started earlier with non-invasive mechanical ventilation reduces the patient's suffering and contributes positively to their recovery, in association with isolation through the Vanessa capsule.

Keywords: COVID-19, mechanical ventilators, medical capsule, non-invasive ventilation

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9883 Unpacking the Summarising Event in Trauma Emergencies: The Case of Pre-briefings

Authors: Professor Jo Angouri, Polina Mesinioti, Chris Turner

Abstract:

In order for a group of ad-hoc professional to perform as a team, a shared understanding of the problem at hand and an agreed action plan are necessary components. This is particularly significant in complex, time sensitive professional settings such as in trauma emergencies. In this context, team briefings prior to the patient arrival (pre-briefings) constitute a critical event for the performance of the team; they provide the necessary space for co-constructing a shared understanding of the situation through summarising information available to the team: yet the act of summarising is widely assumed in medical practice but not systematically researched. In the vast teamwork literature, terms such as ‘shared mental model’, ‘mental space’ and ‘cognate labelling’ are used extensively, and loosely, to denote the outcome of the summarising process, but how exactly this is done interactionally remains under researched. This paper reports on the forms and functions of pre-briefings in a major trauma centre in the UK. Taking an interactional approach, we draw on 30 simulated and real-life trauma emergencies (15 from each dataset) and zoom in on the use of pre-briefings, which we consider focal points in the management of trauma emergencies. We show how ad hoc teams negotiate sharedness of future orientation through summarising, synthesising information, and establishing common understanding of the situation. We illustrate the role, characteristics, and structure of pre-briefing sequences that have been evaluated as ‘efficient’ in our data and the impact (in)effective pre-briefings have on teamwork. Our work shows that the key roles in the event own the act of summarising and we problematise the implications for leadership in trauma emergencies. We close the paper with a model for pre-briefing and provide recommendations for clinical practice, arguing that effective pre-briefing practice is teachable.

Keywords: summarising, medical emergencies, interaction analysis, shared/mental models

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9882 Exploring Individual and Team Approaches in Crafting Workplace Inclusivity for Deaf and Hard of Hearing Employees in Malaysia

Authors: Nor Wahiza Abdul Wahat, Nor Haniza Abdul Wahat, Siti Noormi Alias, Mohamad Sazali Shaari

Abstract:

This study prepares the groundwork for the development of a strategic model and instrument for workplace inclusivity for deaf and hard-of-hearing employees in Malaysia. In the past, scholars have discussed inclusivity of workplaces to the extent to which employees feel they are significantly part of the organizational processes. Such processes include access to information, connectedness to colleagues and team members as well as their ability to participate in and influence decision-making processes. A qualitative study was conducted to explore on experiences of employed deaf and hard-of-hearing employees in a few Malaysian organizations. Data were collected from two focus group discussions involving male and female deaf and hard of hearing employees. Three in-depth interviews were also conducted with employer representatives. Generated themes highlighted individual, and team approaches towards crafting workplace inclusivity for deaf and hard of hearing employees in Malaysia. The adaptiveness of deaf and hard-of-hearing employees and social inclusion by colleagues were among the emerged sub-themes. This study allowed the researchers to further develop workplace inclusivity instruments and models for the benefit of deaf and hard of hearing Malaysian employees, as well as their employers.

Keywords: deaf, hard of hearing, workplace inclusivity, disabilities

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9881 Interdisciplinary Teaching for Nursing Students: A Key to Understanding Teamwork

Authors: Ilana Margalith, Yaron Niv

Abstract:

One of the most important factors of professional health treatment is teamwork, in which each discipline contributes its expert knowledge, thus ensuring quality and a high standard of care as well as efficient communication (one of the International Patient Safety Goals). However, in most countries, students are educated separately by each health discipline. They are exposed to teamwork only during their clinical experience, which in some cases is short and skill-oriented. In addition, health organizations in most countries are hierarchical and although changes have occurred in the hierarchy of the medical system, there are still disciplines that underrate the unique contributions of other health professionals, thus, young graduates of health professions develop and base their perception of their peers from other disciplines on insufficient knowledge. In order to establish a wide-ranging perception among nursing students as to the contribution of different health professionals to the health of their patients, students at the Clalit Nursing Academy, Rabin Campus (Dina), Israel, participated in an interdisciplinary clinical discussion with students from several different professions, other than nursing, who were completing their clinical experience at Rabin Medical Center in medicine, health psychology, social work, audiology, physiotherapy and occupational therapy. The discussion was led by a medical-surgical nursing instructor. Their tutors received in advance, a case report enabling them to prepare the students as to how to present their professional theories and interventions regarding the case. Mutual stimulation and acknowledgment of the unique contribution of each part of the team enriched the nursing students' understanding as to how their own nursing interventions could be integrated into the entire process towards a safe and speedy recovery of the patient.

Keywords: health professions' students, interdisciplinary clinical discussion, nursing education, patient safety

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9880 Creative Culture to Innovative Culture: Transformal Operation

Authors: Peer M. Sathikh

Abstract:

Creativity and innovation have become an important phenomenon today, whose potential is being realized through the success of Apple, Google/Android, Nike, Virgin, Dyson and other multinationals that are a household name today. Creativity and Innovation are, many times, used interchangeably, causing confusion as to what each represents and are capable of. Attempts to understand creativity and innovation clearly point to the difference, and at the same time, inter-dependency of one on the other. The assumption that having more creative personnel in a team will translate into innovation sooner or later seems generally counterproductive. What helps define the role of creativity and innovation in an organization and how can one build an innovative team? This paper points to the importance of understanding creative culture and innovation culture in order to bring about the desired innovation outcome and proposes a means to transform one to another as ideas move from mere ideas to useful innovation.

Keywords: creativity, innovation, creative culture, innovation culture, transformal operators

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9879 Ranking Theory-The Paradigm Shift in Statistical Approach to the Issue of Ranking in a Sports League

Authors: E. Gouya Bozorg

Abstract:

The issue of ranking of sports teams, in particular soccer teams is of primary importance in the professional sports. However, it is still based on classical statistics and models outside of area of mathematics. Rigorous mathematics and then statistics despite the expectation held of them have not been able to effectively engage in the issue of ranking. It is something that requires serious pathology. The purpose of this study is to change the approach to get closer to mathematics proper for using in the ranking. We recommend using theoretical mathematics as a good option because it can hermeneutically obtain the theoretical concepts and criteria needful for the ranking from everyday language of a League. We have proposed a framework that puts the issue of ranking into a new space that we have applied in soccer as a case study. This is an experimental and theoretical study on the issue of ranking in a professional soccer league based on theoretical mathematics, followed by theoretical statistics. First, we showed the theoretical definition of constant number Є = 1.33 or ‘golden number’ of a soccer league. Then, we have defined the ‘efficiency of a team’ by this number and formula of μ = (Pts / (k.Є)) – 1, in which Pts is a point obtained by a team in k number of games played. Moreover, K.Є index has been used to show the theoretical median line in the league table and to compare top teams and bottom teams. Theoretical coefficient of σ= 1 / (1+ (Ptx / Ptxn)) has also been defined that in every match between the teams x, xn, with respect to the ability of a team and the points of both of them Ptx, Ptxn, and it gives a performance point resulting in a special ranking for the League. And it has been useful particularly in evaluating the performance of weaker teams. The current theory has been examined for the statistical data of 4 major European Leagues during the period of 1998-2014. Results of this study showed that the issue of ranking is dependent on appropriate theoretical indicators of a League. These indicators allowed us to find different forms of ranking of teams in a league including the ‘special table’ of a league. Furthermore, on this basis the issue of a record of team has been revised and amended. In addition, the theory of ranking can be used to compare and classify the different leagues and tournaments. Experimental results obtained from archival statistics of major professional leagues in the world in the past two decades have confirmed the theory. This topic introduces a new theory for ranking of a soccer league. Moreover, this theory can be used to compare different leagues and tournaments.

Keywords: efficiency of a team, ranking, special table, theoretical mathematic

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9878 Nursing Care Experience for a Patient with Type2 Diabetes Mellitus and Hyperglycemic Hyperosmolar State

Authors: Yen-Hsia Lin, Ya-Fang Cheng, Hui-Zhu Chen, Chi-Hui Tiao

Abstract:

This is a case study of a 70-year-old man suffering from Type 2 diabetes mellitus and hyperglycemia hyperosmolarity state. He was admitted into the intensive care unit from the 20th to 26th of October, 2015. After receiving relevant information through open-ended conversations, observation, and physical assessment, as well as the psychological, social and spiritual holistic nursing assessment, several clinical health problems such as unstable blood sugar, impaired skin integrity and lack of self-care management knowledge were identified by the author. During the period of care, the patient was encouraged to share and express his feelings, an active listening and initiating approach from the nursing team had led to the understanding of why the patient refused to use insulin. This knowledge enabled the nursing team to manage patient care by educating the patient with self-care management skills, such as foot wound care and insulin injection skills to slow the deterioration of complications. Also, the implementation of appropriate diet and exercise routine to improve patients’ style. By enhancing self-care ability in diabetic patients, they are able to return home with the skill to improve better quality life style.

Keywords: hyperglycemia hyperosmolar state, type2 diabetes Mellitu, diabetes Mellitu foot care, intensive care

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9877 Distributed Leadership and Emergency Response: A Study on Seafarers

Authors: Delna Shroff

Abstract:

Merchant shipping is an occupation with a high rate of fatal injuries caused by organizational accidents and maritime disasters. In most accident investigations, the leader’s actions are under scrutiny and point out the necessity to investigate the leader’s decisions in critical conditions. While several leadership studies have been carried out in the past, there is a tendency for most research to focus on holders of formal positions. The unit of analysis in most studies has been the ‘individual.’ A need is, therefore, felt to adopt a practice-based perspective of leadership, understand how leadership emerges to affect maritime safety. This paper explores the phenomenon of distributed leadership among seafarers more holistically. It further examines the role of one form of distributed leadership, that is, planfully aligned leadership in the emergency response of the team. A mixed design will be applied. In the first phase, the data gathered by way of semi-structured interviews will be used to explore the seafarer’s implicit understanding of leadership. The data will be used to develop a conceptual framework of distributed leadership, specific to the maritime context. This framework will be used to develop a simulation. Experimental design will be used to examine the relationship between planfully aligned leadership and emergency response of the team members during navigation. Findings show that planfully aligned leadership significantly and positively predicts the emergency response of team members. Planfully aligned leadership leads to a better emergency response of the team members as compared to authoritarian leadership. In the third qualitative phase, additional data will be gathered through semi-structured interviews to further validate the findings to gain a more complete understanding of distributed leadership and its relation to emergency response. Above are the predictive results; the study expects to be a cornerstone of safety leadership research and has important implications for leadership development and training within the maritime industry.

Keywords: authoritarian leadership, distributed leadership, emergency response , planfully aligned leadership

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9876 A Development of Practice Guidelines for Surgical Safety Management to Reduce Undesirable Incidents from Surgical Services in the Operating Room of Songkhla Hospital, Thailand

Authors: Thitima Plejai

Abstract:

The practice in the operating room has been continually performed according to standards of services; however, undesirable incidents from surgical services are found such as surgical complications in the operating room. This participation action research aimed to develop practice guidelines for surgical safety management to reduce undesirable incidents from surgical services in the operating room of Songkhla Hospital. The target population was all 84 members of the multidisciplinary team who were involved in surgical services in the operating room consisting of 28 surgeons from five branches of surgery, 27 anesthetists and nurse anesthetists, and 29 surgical nurses. The data were collected through in-depth interviews, and non-participatory observations. The research instrument was tested by three experts, and the steps of the development consisted of four cycles, each consisting of assessment, planning, practice, practice reflection, and improvement until every step is practicable. The data were validated through triangulation research method, analyzed through content analysis and statistical analysis with number and percentage. The results of the development of practice guidelines surgical safety management to reduce undesirable incidents from surgical services could be concluded as follows. 1) The multidisciplinary team in surgery participated in the needs assessment for development of practice guidelines for surgical patient safety, and agreed on adapting the WHO Surgical Safety Checklists for use. 2) The WHO Surgical Safety Checklists was implemented, and meetings were held for the multidisciplinary team in surgery and the organizational risk committee to improve the practice guidelines to make them more practicable. 3) The multidisciplinary team consisting of surgeons from five branches of surgery, anesthetists, nurse anesthetists, surgical nurses, and the organizational risk committee announced policy on safety for surgical patients; the organizational risk committee designated the Surgical Safety Checklist as an instrument for surgical patient safety. The results of the safety management found that the surgical team members who could follow 100 percent of the guidelines were: professional nurses who checked patient identity and information before taking the patient to the operating room and kept complete records of data on the patients; surgical nurses who checked readiness of the patient before surgery; nurse anesthetists who assessed readiness before administering anesthetic drugs, and confirmed correctness of the patient; and circulating perioperative nurses who gave confirmation to the surgical team after completion of the surgery. The rates of undesirable incidents (surgical complications rates) before and after the implementation of the surgical safety management were 1.60 percent and 0.66 percent, respectively. The satisfaction of the surgery-related teams towards the use of the guidelines was 89 percent. The practice guidelines for surgical safety management to reduce undesirable incidents were taken as guidelines for surgical safety that the multidisciplinary team involved in the surgical process implemented correctly and in the same direction and clearly reduced undesirable incidents in surgical patients.

Keywords: practice guidelines, surgical safety management, reduce undesirable incidents, operating Room

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9875 Implementation of Inference Fuzzy System as a Valuation Subsidiary is Based Particle Swarm Optimization for Solves the Issue of Decision Making in Middle Size Soccer Robot League

Authors: Zahra Abdolkarimi, Naser Zouri

Abstract:

Nowadays, there is unbelievable growing of Robots created a collection of complex and motivate subject in robotic and intellectual ornate, also it made a mechatronics style base of theoretical and technical way in Robocop. Additionally, robotics system recommended RoboCup factor as a provider of some standardization and testing method in case of computer discussion widely. The actual purpose of RoboCup is creating independent team of robots in 2050 based of FiFa roles to bring the victory in compare of world star team. In addition, decision making of robots depends to environment reaction, self-player and rival player with using inductive Fuzzy system valuation subsidiary to solve issue of robots in land game. The measure of selection in compare with other methods depends to amount of victories percentage in the same team that plays accidently. Consequences, shows method of our discussion is the best way for Particle Swarm Optimization and Fuzzy system compare to other decision of robotics algorithmic.

Keywords: PSO algorithm, inference fuzzy system, chaos theory, soccer robot league

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9874 An Assessment of Airport Collaborative Decision-Making System Using Predictive Maintenance

Authors: Faruk Aras, Melih Inal, Tansel Cinar

Abstract:

The coordination of airport staff especially in the operations and maintenance departments is important for the airport operation. As a result, this coordination will increase the efficiency in all operation. Therefore, a Collaborative Decision-Making (CDM) system targets on improving the overall productivity of all operations by optimizing the use of resources and improving the predictability of actions. Enlarged productivity can be of major benefit for all airport operations. It also increases cost-efficiency. This study explains how predictive maintenance using IoT (Internet of Things), predictive operations and the statistical data such as Mean Time To Failure (MTTF) improves airport terminal operations and utilize airport terminal equipment in collaboration with collaborative decision making system/Airport Operation Control Center (AOCC). Data generated by the predictive maintenance methods is retrieved and analyzed by maintenance managers to predict when a problem is about to occur. With that information, maintenance can be scheduled when needed. As an example, AOCC operator would have chance to assign a new gate that towards to this gate all the equipment such as travellator, elevator, escalator etc. are operational if the maintenance team is in collaboration with AOCC since maintenance team is aware of the health of the equipment because of predictive maintenance methods. Applying predictive maintenance methods based on analyzing the health of airport terminal equipment dramatically reduces the risk of downtime by on time repairs. We can classify the categories as high priority calls for urgent repair action, as medium priority requires repair at the earliest opportunity, and low priority allows maintenance to be scheduled when convenient. In all cases, identifying potential problems early resulted in better allocation airport terminal resources by AOCC.

Keywords: airport, predictive maintenance, collaborative decision-making system, Airport Operation Control Center (AOCC)

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9873 Virtual Team Performance: A Transactive Memory System Perspective

Authors: Belbaly Nassim

Abstract:

Virtual teams (VT) initiatives, in which teams are geographically dispersed and communicate via modern computer-driven technologies, have attracted increasing attention from researchers and professionals. The growing need to examine how to balance and optimize VT is particularly important given the exposure experienced by companies when their employees encounter globalization and decentralization pressures to monitor VT performance. Hence, organization is regularly limited due to misalignment between the behavioral capabilities of the team’s dispersed competences and knowledge capabilities and how trust issues interplay and influence these VT dimensions and the effects of such exchanges. In fact, the future success of business depends on the extent to which VTs are managing efficiently their dispersed expertise, skills and knowledge to stimulate VT creativity. Transactive memory system (TMS) may enhance VT creativity using its three dimensons: knowledge specialization, credibility and knowledge coordination. TMS can be understood as a composition of both a structural component residing of individual knowledge and a set of communication processes among individuals. The individual knowledge is shared while being retrieved, applied and the learning is coordinated. TMS is driven by the central concept that the system is built on the distinction between internal and external memory encoding. A VT learns something new and catalogs it in memory for future retrieval and use. TMS uses the role of information technology to explain VT behaviors by offering VT members the possibility to encode, store, and retrieve information. TMS considers the members of a team as a processing system in which the location of expertise both enhances knowledge coordination and builds trust among members over time. We build on TMS dimensions to hypothesize the effects of specialization, coordination, and credibility on VT creativity. In fact, VTs consist of dispersed expertise, skills and knowledge that can positively enhance coordination and collaboration. Ultimately, this team composition may lead to recognition of both who has expertise and where that expertise is located; over time, the team composition may also build trust among VT members over time developing the ability to coordinate their knowledge which can stimulate creativity. We also assess the reciprocal relationship between TMS dimensions and VT creativity. We wish to use TMS to provide researchers with a theoretically driven model that is empirically validated through survey evidence. We propose that TMS provides a new way to enhance and balance VT creativity. This study also provides researchers insight into the use of TMS to influence positively VT creativity. In addition to our research contributions, we provide several managerial insights into how TMS components can be used to increase performance within dispersed VTs.

Keywords: virtual team creativity, transactive memory systems, specialization, credibility, coordination

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9872 Idea Expropriation, Incentives, and Governance within Organizations

Authors: Gulseren Mutlu, Gurupdesh Pandher

Abstract:

This paper studies the strategic interplay between innovation, incentives, expropriation threat and disputes arising from expropriation from an intra-organization perspective. We present a simple principal-agent model with hidden actions and hidden information in which two employees can choose how much (innovative) effort to exert, whether to expropriate the innovation of the other employee and whether to dispute if innovation is expropriated. The organization maximizes its expected payoff by choosing the optimal reward scheme for both employees as well as whether to encourage or discourage disputes. We analyze two mechanisms under which innovative ideas are not expropriated. First, we show that under a non-contestable mechanism (in which the organization discourages disputes among employees), the organization has to offer a “rent” to the potential expropriator. However, under a contestable mechanism (in which the organization encourages disputes), there is no need for such rent. If the cost of resolving the dispute is negligible, the organization’s expected payoff is higher under a contestable mechanism. Second, we develop a comparable team mechanism in which innovation takes place as a result of the joint efforts of employees and innovation payments are made based on the team outcome. We show that if the innovation value is low and employees have similar productivity, then the organization is better off under a contestable mechanism. On the other hand, if the innovation value is high, the organization is better off under a team mechanism. Our results have important practical implications for the design of innovation reward system for employees, hiring policy and governance for different companies.

Keywords: innovation, incentives, expropriation threat, dispute resolution

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9871 Antecedents to Leaders’ Empowering Behavior: A Study of Team Leaders and Their Subordinates

Authors: Manjari Srivastsva, Ruta Vyas

Abstract:

The research in the area of self leadership advocates employee/team empowerment. It is well understood that empowered employees would contribute more and better to their organizational outcomes. This research is a part of an ongoing larger research in the area of empowering leadership behavior. The present research aims to understand some of the antecedents to empowering behavior of leaders such that the organizations can focus on the right elements and invest in the appropriate areas during their leadership development activities. The research is exploratory field study. Sampling is purposive, employing triadic design i.e. a manager and two of his/her subordinates are selected for data collection. The total no. of respondents is 240, with 80 managers and 160 of their direct reports. Initially focus group interview was done and based on the inputs from focus group, quantitative data was collected personally by the researchers using questionnaire. The sample is drawn from seven professionally run organization including those of Indian origin as well as multi-national companies. This study proposes to explore the constituents of empowering behavior both from leaders’ and their subordinates’ perspective and also see the relationship between some of the personal variables of leaders as an antecedent to empowering behavior. Similarly, the study aims to explore the subordinates’ perspectives as an antecedent to empowering behavior. The relationship between antecedent variables and empowering behavior is tested for moderation employing organization culture. Exploratory and confirmatory factor analysis was done to establish the validity of the questionnaires. Further hierarchical regression analysis results revealed that organization based self-esteem and global self-esteem impact leaders’ empowering behavior and this relationship is further moderated by organization culture. Team members’ perspective showed higher importance for task characteristics and members' readiness from the point of view of empowerment. The relation between task characteristics and members’ readiness was not moderated by culture. The finding from this research may be utilized by professionals to guide organizations desiring rapid and sustainable growth, to develop leaders who empower their teams such that they act as leaders themselves and become stimulants for the growth of organizations.

Keywords: empowering behavior, team leaders, subordinates, self-esteem, organization culture, task characteristics, team members readiness

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9870 Community Participation in Health Related Activities in Ignié-Ngabé-Mayama Health District, Brazzaville, Republic of Congo

Authors: Tebeu Pierre Marie

Abstract:

Introduction: WHO defines community participation as a process in which the local population, take responsibility in planning for their health, participates in the strategy’s development for implementation and accessibility to physical, moral and social well-being. For the purpose of dealing with health, the community participation is made through the organization called health Centre committee leader (HCCL/COSA) for Integrated health Center and District hospital committee leaser (HDCL/COGES) for District Hospital. Little is known about the effective participation of the community in health related activities in Ignié-Ngabé-Mayama health district. Objective: This study aimed at assessing the involvement of community in the health system running at the Ignié-Ngabé-Mayama health district. Methods: This was a qualitative cross-sectional study conducted in the Ignié-Ngabé-Mayama health district from 15 December 2020 to 30 April 2021. The study population consisted of 10 HCCL and one District hospital committee leaser (DHCL). Data were collected using a pretested questionnaire and validated by the investigating team. The variables of interest were; effective existence of HCCL/DHCL, their involvement HCCL/DHCL in health related activities, their financing management, planning of activities and leadership. Results: A total of 11 participants were interviewed, including 10 HCCL and 1 DHCL. The Sex-Ratio was 9/11; with primary level 6/11 and were mostly farmers 6/11. Analyzing the involvement of the HDCL/DHCL in health promotion and preventive activities; this was effective only for two of them (2/11). Analyzing the barriers for their involvement, the leaders reported the lack of financial support by the state, lack NGO support. Additionally, they reported to have been very active when there was Performance Based Founding Project in the District. Conclusion: Only two of the (HDCL/HCCL) out of 11 were really functioning. Reported barriers to their running were: lack of state/NGOs support and ending of PBF Project. There is a need to organize a tripartite forum including stats, NGOs and Community for boosting the community participation in health related activities in Ignié-Ngabé-Mayama health district.

Keywords: health district committee, health Centre committee, community participation, Brazzaville, Congo

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9869 Impact Analysis of a School-Based Oral Health Program in Brazil

Authors: Fabio L. Vieira, Micaelle F. C. Lemos, Luciano C. Lemos, Rafaela S. Oliveira, Ian A. Cunha

Abstract:

Brazil has some challenges ahead related to population oral health, most of them associated with the need of expanding into the local level its promotion and prevention activities, offer equal access to services and promote changes in the lifestyle of the population. The program implemented an oral health initiative in public schools in the city of Salvador, Bahia. The mission was to improve oral health among students on primary and secondary education, from 2 to 15 years old, using the school as a pathway to increase access to healthcare. The main actions consisted of a team's visit to the schools with educational sessions for dental cavity prevention and individual assessment. The program incorporated a clinical surveillance component through a dental evaluation of every student searching for dental disease and caries, standardization of the dentists’ team to reach uniform classification on the assessments, and the use of an online platform to register data directly from the schools. Sequentially, the students with caries were referred for free clinical treatment on the program’s Health Centre. The primary purpose of this study was to analyze the effects and outcomes of this school-based oral health program. The study sample was composed by data of a period of 3 years - 2015 to 2017 - from 13 public schools on the suburb of the city of Salvador with a total number of assessments of 9,278 on this period. From the data collected the prevalence of children with decay on permanent teeth was chosen as the most reliable indicator. The prevalence was calculated for each one of the 13 schools using the number of children with 1 or more dental caries on permanent teeth divided by the total number of students assessed for school each year. Then the percentage change per year was calculated for each school. Some schools presented a higher variation on the total number of assessments in one of the three years, so for these, the percentage change calculation was done using the two years with less variation. The results show that 10 of the 13 schools presented significative improvements for the indicator of caries in permanent teeth. The mean for the number of students with caries percentage reduction on the 13 schools was 26.8%, and the median was 32.2% caries in permanent teeth institution. The highest percentage of improvement reached a decrease of 65.6% on the indicator. Three schools presented a rise in caries prevalence (8.9, 18.9 and 37.2% increase) that, on an initial analysis, seems to be explained with the students’ cohort rotation among other schools, as well as absenteeism on the treatment. In conclusion, the program shows a relevant impact on the reduction of caries in permanent teeth among students and the need for the continuity and expansion of this integrated healthcare approach. It has also been evident the significative of the articulation between health and educational systems representing a fundamental approach to improve healthcare access for children especially in scenarios such as presented in Brazil.

Keywords: primary care, public health, oral health, school-based oral health, data management

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9868 Creating Systems Change: Implementing Cross-Sector Initiatives within the Justice System to Support Ontarians with Mental Health and Addictions Needs

Authors: Tania Breton, Dorina Simeonov, Shauna MacEachern

Abstract:

Ontario’s 10 Year Mental Health and Addictions Strategy has included the establishment of 18 Service Collaborative across the province; cross-sector tables in a specific region coming together to explore mental health and addiction system needs and adopting an intervention to address that need. The process is community led and supported by implementation teams from the Centre for Addiction and Mental Health (CAMH), using the framework of implementation science (IS) to enable evidence-based and sustained change. These justice initiatives are focused on the intersection of the justice system and the mental health and addiction systems. In this presentation, we will share the learnings, achievements and challenges of implementing innovative practices to the mental health and addictions needs of Ontarians within the justice system. Specifically, we will focus on the key points across the justice system - from early intervention and trauma-informed, culturally appropriate services to post-sentence support and community reintegration. Our approach to this work involves external implementation support from the CAMH team including coaching, knowledge exchange, evaluation, Aboriginal engagement and health equity expertise. Agencies supported the implementation of tools and processes which changed practice at the local level. These practices are being scaled up across Ontario and community agencies have come together in an unprecedented collaboration and there is a shared vision of the issues overlapping between the mental health, addictions and justice systems. Working with ministry partners has allowed space for innovation and created an environment where better approaches can be nurtured and spread.

Keywords: implementation, innovation, early identification, mental health and addictions, prevention, systems

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9867 Strategies to Enhance Compliance of Health and Safety Standards at the Selected Mining Industries in Limpopo Province, South Africa: Occupational Health Nurse’s Perspective

Authors: Livhuwani Muthelo

Abstract:

The health and safety of the miners in the South African mining industry are guided by the regulations and standards which are anticipated to promote a healthy work environment and fatalities. It is of utmost importance for the miners to comply with these regulations/standards to protect themselves from potential occupational health and safety risks, accidents, and fatalities. The purpose of this study was to develop and validate strategies to enhance compliance with the Health and safety standards within the mining industries of Limpopo province in South Africa. A mixed-method exploratory sequential research design was adopted. The population consisted of 5350 miners. Purposive sampling was used to select the participants in the qualitative strand and stratified random sampling in the quantitative strand. Semi-structured interviews were conducted among the occupational health nurse practitioners and the health and safety team. Thematic analysis was used to generate an understanding of the interviews. In the quantitative strand, a survey was conducted using a self-administered questionnaire. Data were analysed using SPSS version 26.0. A descriptive statistical test was used in the analysis of data including frequencies, means, and standard deviation. Cronbach's alpha test was used to measure internal consistency. The integrated results revealed that there are diverse experiences related to health and safety standards compliance among the mineworkers. The main findings were challenges related to leadership compliance and also related to the cost of maintaining safety, Miner's behavior-related challenges; the impact of non-compliance on the overall health of the miners was also described, the conflict between production and safety. Health and safety compliance is not just mere compliance with regulations and standards but a culture that warrants the miners and organization to take responsibility for their behavior and actions towards health and safety. Thus taking responsibility for your well-being and other miners.

Keywords: perceptions, compliance, health and safety, legislation, standards, miners

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9866 Development of Nursing Service System Integrated Case Manager Concept for the Patients with Epilepsy at the Tertiary Epilepsy Clinic of Thailand

Authors: C. Puangsawat, C. Limotai, P. Srikhachin

Abstract:

Bio-psycho-social caring was required for promoting the quality of life of the patients with epilepsy (PWE), despite controlled seizures. Multifaceted issues emerge at the epilepsy clinic. Unpredicted seizures, antiepileptic drug compliance problems/adverse effects, psychiatric, and social problems are all needed to be explored and managed. The Nursing Service System (NSS) at the tertiary epilepsy clinic (TEC) was consequently developed for improving the clinical care for PWE. Case manager concept was integrated as the framework guiding the processes and strategies used for developing the NSS as well as the roles of the multidisciplinary team at the clinic. This study aimed to report the outcomes of the developed NSS integrated case manager concept. The processes of our developed NSS program included 1) screening for patient’s problems using questionnaire prior to seeing epileptologists i.e., assessing the patient’s risk to develop acute seizures at the clinic, issues related to medication use, and uncovered psychiatric and social problems; and 2) assigning the patients at risk to be evaluated and managed by appropriate team. Nurses specializing in epilepsy in coordination with the multidisciplinary team implemented the NSS to promote coordinated work among the team which consists of epileptologists, nurses, pharmacists, psychologists, and social workers. Determination of the role of each person and their responsibilities along with joint care plan were clearly established. One year after implementation, the rate of acute seizure occurrence at the clinic was decreased, and satisfactory feedback from the patients was received. In order to achieve an optimal goal to promote self-management behaviors in PWE, continuing the NSS and systematic assessment of its effectiveness is required.

Keywords: case manager concept, nursing service system, patients with epilepsy, quality of life

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9865 Navigating Complex Communication Dynamics in Qualitative Research

Authors: Kimberly M. Cacciato, Steven J. Singer, Allison R. Shapiro, Julianna F. Kamenakis

Abstract:

This study examines the dynamics of communication among researchers and participants who have various levels of hearing, use multiple languages, have various disabilities, and who come from different social strata. This qualitative methodological study focuses on the strategies employed in an ethnographic research study examining the communication choices of six sets of parents who have Deaf-Disabled children. The participating families varied in their communication strategies and preferences including the use of American Sign Language (ASL), visual-gestural communication, multiple spoken languages, and pidgin forms of each of these. The research team consisted of two undergraduate students proficient in ASL and a Deaf principal investigator (PI) who uses ASL and speech as his main modes of communication. A third Hard-of-Hearing undergraduate student fluent in ASL served as an objective facilitator of the data analysis. The team created reflexive journals by audio recording, free writing, and responding to team-generated prompts. They discussed interactions between the members of the research team, their evolving relationships, and various social and linguistic power differentials. The researchers reflected on communication during data collection, their experiences with one another, and their experiences with the participating families. Reflexive journals totaled over 150 pages. The outside research assistant reviewed the journals and developed follow up open-ended questions and prods to further enrich the data. The PI and outside research assistant used NVivo qualitative research software to conduct open inductive coding of the data. They chunked the data individually into broad categories through multiple readings and recognized recurring concepts. They compared their categories, discussed them, and decided which they would develop. The researchers continued to read, reduce, and define the categories until they were able to develop themes from the data. The research team found that the various communication backgrounds and skills present greatly influenced the dynamics between the members of the research team and with the participants of the study. Specifically, the following themes emerged: (1) students as communication facilitators and interpreters as barriers to natural interaction, (2) varied language use simultaneously complicated and enriched data collection, and (3) ASL proficiency and professional position resulted in a social hierarchy among researchers and participants. In the discussion, the researchers reflected on their backgrounds and internal biases of analyzing the data found and how social norms or expectations affected the perceptions of the researchers in writing their journals. Through this study, the research team found that communication and language skills require significant consideration when working with multiple and complex communication modes. The researchers had to continually assess and adjust their data collection methods to meet the communication needs of the team members and participants. In doing so, the researchers aimed to create an accessible research setting that yielded rich data but learned that this often required compromises from one or more of the research constituents.

Keywords: American Sign Language, complex communication, deaf-disabled, methodology

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9864 The Impact of Hybrid Working Models on Employee Engagement

Authors: Sibylle Tellenbach, Julie Haddock-Millar, Francis Bidault

Abstract:

The aim of this research is to understand the extent to which hybrid working models have influenced employee engagement in the Swiss financial sector. The context for this research is the transition out of the pandemic and the changes that have occurred between 2020 and 2023. Since the pandemic, many financial services companies have had to rethink their working model for office-based employees, as this group of employees has been able to experience a new way of working and, thus, greater freedom and flexibility. For a large number of companies, it was a huge change to shift from the traditional office-based to a new hybrid working model. A heightened focus on employee engagement has become a necessity in order to understand and respond to the challenges presented by the shift in a working model. This new way of working, partly office-based and partly virtual, has led to ambiguities about the impact on the engagement of hybrid teams. Therefore, the research question is: How hybrid working models have influenced employee engagement to what extent? The methodological approach is a narrative inquiry with four similar functional teams within four Swiss financial companies. Semi-structured interviews will be conducted with managers from middle management and their individual team members. The findings will demonstrate whether this shift in the working model influenced individual team members’ engagement and to what extent. The contribution of this research is two-fold. First, the research makes a theoretical contribution, presenting evidence of the impact of hybrid working on individual team members’ engagement in a specific sector and context, enhancing current knowledge on the challenges in working model transition. Second, this research will make a practice-based contribution, recommending ways to enhance the engagement of hybrid teams in a specific context. These recommendations may be applied in wider sectors and teams.

Keywords: employee engagement, hybrid teams, hybrid working models, Swiss financial sector, team engagement

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9863 A Lung Cancer Patient Grief Counseling Nursing Experience

Authors: Syue-Wen Lin

Abstract:

Objective: This article explores the nursing experience of a 64-year-old female lung cancer patient who underwent a thoracoscopic left lower lobectomy and treatment. The patient has a history of diabetes. The nursing process included cancer treatment, postoperative pain management, wound care and healing, and family grief counseling. Methods: The nursing period is from March 11 to March 15, 2024. During this time, strict aseptic wound dressing procedures and advanced wound care techniques are employed to promote wound healing and prevent infection. Postoperatively, due to the development of aspiration pneumonia and worsening symptoms, re-intubation was necessary. Given the patient's advanced cancer and deteriorating condition, the nursing team provided comprehensive grief counseling and care tailored to both the patient's physical and psychological needs, as well as the emotional needs of the family. Considering the complexity of the patient's condition, including advanced cancer, palliative care was also integrated into the overall nursing process to alleviate discomfort and provide psychological support. Results: Using Gordon's Functional Health Patterns for assessment, including evaluating the patient's medical history, physical assessment, and interviews, to provide individualized nursing care, it is important to collect data that will help understand the patient's physical, psychological, social, and spiritual dimensions. The interprofessional critical care team collaborates with the hospice team to help understand the psychological state of the patient's family and develop a comprehensive approach to care. Family meetings should be convened, and support should be provided to patients during the final stages of their lives. Additionally, the combination of cancer care, pain management, wound care, and palliative care ensures comprehensive support for the patient throughout her recovery, thereby improving her quality of life. Conclusion: Lung cancer and aspiration pneumonia present significant challenges to patients, and the nursing team not only provides critical care but also addresses individual patient needs through cancer care, pain management, wound care, and palliative care interventions. These measures have effectively improved the quality of life of patients, provided compassionate palliative care to terminally ill patients, and allowed them to spend the last mile of their lives with their families. Nursing staff work closely with families to develop comprehensive care plans to ensure patients receive high-quality medical care as well as psychological support and a comfortable recovery environment.

Keywords: grief counseling, lung cancer, palliative care, nursing experience

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9862 Experience Report about the Inclusion of People with Disabilities in the Process of Testing an Accessible System for Learning Management

Authors: Marcos Devaner, Marcela Alves, Cledson Braga, Fabiano Alves, Wilton Bezerra

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This article discusses the inclusion of people with disabilities in the process of testing an accessible system solution for distance education. The accessible system, team profile, methodologies and techniques covered in the testing process are presented. The testing process shown in this paper was designed from the experience with user. The testing process emerged from lessons learned from past experiences and the end user is present at all stages of the tests. Also, lessons learned are reported and how it was possible the maturing of the team and the methods resulting in a simple, productive and effective process.

Keywords: experience report, accessible systems, software testing, testing process, systems, e-learning

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9861 Comparing the ‘Urgent Community Care Team’ Clinical Referrals in the Community with Suggestions from the Clinical Decision Support Software Dem DX

Authors: R. Tariq, R. Lee

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Background: Additional demands placed on senior clinical teams with ongoing COVID-19 management has accelerated the need to harness the wider healthcare professional resources and upskill them to take on greater clinical responsibility safely. The UK NHS Long Term Plan (2019)¹ emphasises the importance of expanding Advanced Practitioners’ (APs) roles to take on more clinical diagnostic responsibilities to cope with increased demand. In acute settings, APs are often the first point of care for patients and require training to take on initial triage responsibilities efficiently and safely. Critically, their roles include determining which onward services the patients may require, and assessing whether they can be treated at home, avoiding unnecessary admissions to the hospital. Dem Dx is a Clinical Reasoning Platform (CRP) that claims to help frontline healthcare professionals independently assess and triage patients. It guides the clinician from presenting complaints through associated symptoms to a running list of differential diagnoses, media, national and institutional guidelines. The objective of this study was to compare the clinical referral rates and guidelines adherence registered by the HMR Urgent Community Care Team (UCCT)² and Dem Dx recommendations using retrospective cases. Methodology: 192 cases seen by the UCCT were anonymised and reassessed using Dem Dx clinical pathways. We compared the UCCT’s performance with Dem Dx regarding the appropriateness of onward referrals. We also compared the clinical assessment regarding adherence to NICE guidelines recorded on the clinical notes and the presence of suitable guidance in each case. The cases were audited by two medical doctors. Results: Dem Dx demonstrated appropriate referrals in 85% of cases, compared to 47% in the UCCT team (p<0.001). Of particular note, Dem Dx demonstrated an almost 65% (p<0.001) improvement in the efficacy and appropriateness of referrals in a highly experienced clinical team. The effectiveness of Dem Dx is in part attributable to the relevant NICE and local guidelines found within the platform's pathways and was found to be suitable in 86% of cases. Conclusion: This study highlights the potential of clinical decision support, as Dem Dx, to improve the quality of onward clinical referrals delivered by a multidisciplinary team in primary care. It demonstrated that it could support healthcare professionals in making appropriate referrals, especially those that may be overlooked by providing suitable clinical guidelines directly embedded into cases and clear referral pathways. Further evaluation in the clinical setting has been planned to confirm those assumptions in a prospective study.

Keywords: advanced practitioner, clinical reasoning, clinical decision-making, management, multidisciplinary team, referrals, triage

Procedia PDF Downloads 147