Search results for: nurse leaders

Authors: Arif Budiman

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Any organization or company that wishes to achieve vision, mission, and goals of the organization is required to implement a performance management system or known as the Performance Management System (PMS) in every part of the whole organization. PMS is a tool to help visualize the direction and work program of the organization to achieve the goal. The challenge is PMS should not stop merely as a visualization tool to achieve the vision and mission of the organization, but PMS should also be able to create a high-performance culture that is inherent in each individual of the organization. Establishment of a culture within an organization requires the support of top leaders and also requires a system or governance that encourages every individual in the organization to be involved in any work program of the organization. Keywords of creating a high-performance culture are the formation of communication pattern involving the whole individual, either vertically or horizontally, and performed consistently and persistently by all individuals in each line of the organization. PT Pertamina (Persero) as the state-owned national energy company holds a system to internalize the culture of high performance through a system called Performance Management System Cycle (PMS Cycle). This system has 7 stages of the cycle, those are: (1) defining vision, mission and strategic plan of the company, (2) defining key performance indicator of each line and the individual (‘expectation setting conversation’), (3) defining performance target and performance agreement, (4) monitoring performance on a monthly regular basis (‘pulse check’), (5) implementing performance dialogue between leaders and staffs periodically every 3 months (‘performance dialogue’), (6) defining rewards and consequences based on the achievement of the performance of each line and the individual, and (7) calculating the final performance value achieved by each line and individual from one period of the current year. Perform PMS is a continual communication running throughout the year, that is why any three performance discussion that should be performed, include expectation setting conversations, pulse check and performance dialogue. In addition, another significant point and necessary undertaken to complete the assessment of individual performance assessment is soft competencies through 360-degree assessment by leaders, staffs, and peers.

Keywords: 360-degree assessment, expectation setting conversation, performance management system cycle, performance dialogue, pulse check

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Authors: Sharon Jackson White

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Purpose: Nurse practitioners (NPs) practicing within hospital medicine play a significant role in caring for patients who might benefit from palliative care (PC) services. Using the Theory of Planned Behavior, the purpose of this study was to examine the relationships among facilitators to referral, barriers to referral, self-efficacy with end-of-life discussions, history of referral, and referring to PC among NPs in hospital medicine. Hypotheses: 1) Perceived facilitators to referral will be associated with a higher history of referral and a higher number of referrals to PC. 2) Perceived barriers to referral will be associated with a lower history of referral and a lower number of referrals to PC. 3) Increased self-efficacy with end-of-life discussions will be associated with a higher history of referral and a higher number of referrals to PC. 4) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the history of referral to PC. 5) Perceived facilitators to referral, perceived barriers to referral, and self–efficacy with end-of-life discussions will contribute to a significant variance in the number of referrals to PC. Significance: Previous studies of referring patients to PC within the hospital setting care have focused on physician practices. Identifying factors that influence NPs referring hospitalized patients to PC is essential to ensure that patients have access to these important services. This study incorporates the SNRS mission of advancing nursing research through the dissemination of research findings and the promotion of nursing science. Methods: A cross-sectional, predictive correlational study was conducted. History of referral to PC, facilitators to referring to PC, barriers to referring to PC, self-efficacy in end-of-life discussions, and referral to PC were measured using the PC referral case study survey, facilitators and barriers to PC referral survey, and self-assessment with end-of-life discussions survey. Data were analyzed descriptively and with Pearson’s Correlation, Spearman’s Rho, point-biserial correlation, multiple regression, logistic regression, Chi-Square test, and the Mann-Whitney U test. Results: Only one facilitator (PC team being helpful with establishing goals of care) was significantly associated with referral to PC. Three variables were statistically significant in relation to the history of referring to PC: “Inclined to refer: PC can help decrease the length of stay in hospital”, “Most inclined to refer: Patients with serious illnesses and/or poor prognoses”, and “Giving bad news to a patient or family member”. No predictor variables contributed a significant variance in the number of referrals to PC for all three case studies. There were no statistically significant results showing a relationship between the history of referral and referral to PC. All five hypotheses were partially supported. Discussion: Findings from this study emphasize the need for further research on NPs who work in hospital settings and what factors influence their behaviors of referring to PC. Since there is an increase in NPs practicing within hospital settings, future studies should use a larger sample size and incorporate hospital medicine NPs and other types of NPs that work in hospitals.

Keywords: palliative care, nurse practitioners, hospital medicine, referral

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Authors: Hassan Barau Singhry

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Purpose: Leadership or the absence of it is an important behaviour affecting employees’ job satisfaction. Although, there are many models of leadership, one that stands out in a period of change is the transformational behaviour. The aim of this study is to investigate the role of an organizational justice on the relationship between transformational leadership and employee job satisfaction. The study is based on the assumption that change begins with leaders and leaders should be fair and just. Methodology: A cross-sectional survey through structured questionnaire was employed to collect the data of this study. The population is selected the three tiers of government such as the local, state, and federal governments in Nigeria. The sampling method used in this research is stratified random sampling. 418 middle managers of public organizations respondents to the questionnaire. Multiple regression aided by structural equation modeling was employed to test 4 hypothesized relationships. Finding: The regression results support for the mediating role of organizational justice such as distributive, procedural, interpersonal and informational justice in the link between transformational leadership and job satisfaction. Originality/value: This study adds to the literature of human resource management by empirically validating and integrating transformational leadership behaviour with the four dimensions of organizational justice theory. The study is expected to be beneficial to the top and middle-level administrators as well as theory building and testing.

Keywords: distributive justice, job satisfaction, organizational justice, procedural justice, transformational leadership

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Authors: Alexis Naranjo

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In the current global stage, a new sense and mix feelings against the globalization has started to take shape thanks to events such as Brexit and the 2016 US election. The perceptions towards the globalization have started to focus in a resistance movement called the 'anti-globalization movement'. This paper examines the current global stage vs. leadership decisions in a time when market integrations are not longer seeing as an opportunity for an economic growth buster. The biggest economy in the world the United States of America has started to face a new beginning of something called 'anti-globalization', in the current global stage starting with the United Kingdom to the United States a new strategy to help local economies has started to emerge. A new nationalist movement has started to focus on their local economies which now represents a direct threat to the globalization, trade agreements, wages and free markets. Business leaders of multinationals now in our days face a new dilemma, how to address the feeling that globalization and outsourcing destroy and take away jobs from local economies. The initial perception of the literature and data rebels that companies in Western countries like the US sees many risks associate with outsourcing, however, saving cost associated with outsourcing is greater than the firm’s local reputation. Starting with India as a good example of a supplier of IT developers, analysts and call centers we can start saying that India is an industrialized nation which has not yet secured its spot and title. India has emerged as a powerhouse in the outsource industry, which makes India hold the number one spot in the world to outsource IT services. Thanks to the globalization of economies and markets around the globe that new ideas to increase productivity at a lower cost has been existing for years and has started to offer new ideas and options to businesses in different industries. The economic growth of the information technology (IT) industry in India is an example of the power of the globalization which in the case of India has been tremendous and significant especially in the economic arena. This research paper concentrates in understand the behavior of business leaders: First, how multinational’s leaders will face the new challenges and what actions help them to lead in turbulent times. Second, if outsourcing or withdraw from a market is an option what are the consequences and how you communicate and negotiate from the business leader perspective. Finally, is the perception of leaders focusing on financial results or they have a different goal? To answer these questions, this study focuses on the most recent data available to outline and present the findings of the reason why outsourcing is and option and second, how and why those decisions are made. This research also explores the perception of the phenomenon of outsourcing in many ways and explores how the globalization has contributed to its own questioning.

Keywords: anti-globalization, globalization, leadership, outsourcing

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Authors: Wageeh A. Nafei

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This paper explores the role of Paradoxical Leadership (PL) in enhancing Organizational Success (OS) at private hospitals in Egypt. Based on the collected data from employees in private hospitals (doctors, nursing staff, and administrative staff). The researcher has adopted a sampling method to collect data for the study. The appropriate statistical methods, such as Alpha Correlation Coefficient (ACC), Confirmatory Factor Analysis (CFA), and Multiple Regression Analysis (MRA), are used to analyze the data and test the hypotheses. The research has reached a number of results, the most important of which are (1) there is a statistical relationship between the independent variable represented by PL and the dependent variable represented by Organizational Success (OS). The paradoxical leader encourages employees to express their opinions and builds a work environment characterized by flexibility and independence. Also, the paradoxical leader works to support specialized work teams, which leads to the creation of new ideas, on the one hand, and contributes to the achievement of outstanding performance on the other hand. (2) the mentality of the paradoxical leader is flexible and capable of absorbing all suggestions from all employees. Also, the paradoxical leader is interested in enhancing cooperation among them and provides an opportunity to transfer experience and increase knowledge-sharing. Also, the sharing of knowledge creates the necessary diversity that helps the organization to obtain rich external information and enables the organization to deal with a rapidly changing environment. (3) The PL approach helps in facing the paradoxical demands of employees. A paradoxical leader plays an important role in reducing the feeling of instability in the work environment and lack of job security, reducing negative feelings for employees, restoring balance in the work environment, improving the well-being of employees, and increasing the degree of job satisfaction of employees in the organization. The study referred to a number of recommendations, the most important of which are (1) the leaders of the organizations must listen to the views of employees and their needs and move away from the official method of control. The leader should give sufficient freedom to employees to participate in decision-making and maintain enough space among them. The treatment between the leaders and employees must be based on friendliness, (2) the need for organizational leaders to pay attention to sharing knowledge among employees through training courses. The leader should make sure that every information provided by the employee is valuable and useful, which can be used to solve a problem that may face his/her colleagues at work, (3) the need for organizational leaders to pay attention to sharing knowledge among employees through brainstorming sessions. The leader should ensure that employees obtain knowledge from their colleagues and share ideas and information among them. This is in addition to motivating employees to complete their work in a new creative way, which leads to employees’ not feeling bored of repeating the same routine procedures in the organization.

Keywords: paradoxical leadership, organizational success, human resourece, management

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Authors: Amal Mohammed Alqahatni

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This paper is a non-empirical analysis of existing literature on digital leadership competency, data-driven organizations, and dealing with AI technology (big data). This paper will provide insights into the importance of developing the leader’s analytical skills and style to be more effective for high-quality decision-making in a data-driven organization and achieve creativity during the organization's transformation to be digitalized. Despite the enormous potential that big data has, there are not enough experts in the field. Many organizations faced an issue with leadership style, which was considered an obstacle to organizational improvement. It investigates the obstacles to leadership style in this context and the challenges leaders face in coaching and development. The leader's lack of analytical skill with AI technology, such as big data tools, was noticed, as was the lack of understanding of the value of that data, resulting in poor communication with others, especially in meetings when the decision should be made. By acknowledging the different dynamics of work competency and organizational structure and culture, organizations can make the necessary adjustments to best support their leaders. This paper reviews prior research studies and applies what is known to assist with current obstacles. This paper addresses how analytical leadership will assist in overcoming challenges in a data-driven organization's work environment.

Keywords: digital leadership, big data, leadership style, digital leadership challenge

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Authors: Yousuf N. Al Khamisi, Eduardo M. Hernandez, Khurshid M. Khan

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Purpose: This paper presents a model of a Knowledge-Based (KB) using Lean Six Sigma (L6σ) principles to enhance the performance of healthcare leadership. Design/methodology/approach: Using L6σ principles to enhance healthcare leaders’ performance needs a pre-assessment of the healthcare organisation’s capabilities. The model will be developed using a rule-based approach of KB system. Thus, KB system embeds Gauging Absence of Pre-requisite (GAP) for benchmarking and Analytical Hierarchy Process (AHP) for prioritization. A comprehensive literature review will be covered for the main contents of the model with a typical output of GAP analysis and AHP. Findings: The proposed KB system benchmarks the current position of healthcare leadership with the ideal benchmark one (resulting from extensive evaluation by the KB/GAP/AHP system of international leadership concepts in healthcare environments). Research limitations/implications: Future work includes validating the implementation model in healthcare environments around the world. Originality/value: This paper presents a novel application of a hybrid KB combines of GAP and AHP methodology. It implements L6σ principles to enhance healthcare performance. This approach assists healthcare leaders’ decision making to reach performance improvement against a best practice benchmark.

Keywords: Lean Six Sigma (L6σ), Knowledge-Based System (KBS), healthcare leadership, Gauge Absence Prerequisites (GAP), Analytical Hierarchy Process (AHP)

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Authors: Livhuwani Muthelo

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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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Authors: Cuma Şimşek

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Nowadays our globalized world is in a very rapid and sophisticated change. In the information age, notion of ‘information’ has begun to spread faster than ever also in this age, changes and transformation has gained tremendous momentum with technology boom. This continuous change and transformation, increased the competition between existing organizations and corporations. Besides, the organizations which show resistance to change has been put out of action in this competitive environment. It is not possible to sustain the existence of organizations without adapting to change and transformation by isolating itself from developments. As a consequence of improved communication and dialog possibilities by means of increasing knowledge level, there has been made a change of scene in administrative mentality, style and activation, especially in 21th century. Leaders emerge as the most important factor in this process of perception and success. At the same time it is not enough to adapt the alteration with conventional leadership abilities and behaviors. In parallel with alteration, new types of leadership are coming up. The optimal leadership type for our era and a trending topic "Transformational Leadership" is in great demand now. In this research, current situation of the Air Forces which use high-technology weapons efficiently, operates in an environment full of threats and is analyzed. It is evaluated that in order to be ready for war continuously and adjusting itself to changing terms of warfare atmosphere , Air Forces need ‘transformational leaders’ who are innovative, foreseeing and having a vision so that they can develop new methods and strategies for complex problems. Because it is the Air Force which is responsible for being the deterrent force of its country.

Keywords: transformational, change, air force, leadership

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Authors: Richard W. Jelier

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This research examines the emergence of the knowledge-based economies in three world cities in a comparative context. The Australian, American and British approaches to (KBE) are analyzed through the study of three premier world cities of Sydney, New York and London. Long considered leaders in the KBE, London and New York’s pre-imminence in this race to the top is not surprising. Sydney, Australia however has seen a remarkable transformation from an old economy to an emerging success in the new economy. After an examination of national KBE indicators (GDP comparisons and Knowledge Economy indexes) the research turns to a detailed investigation of specific strategies advanced in greater Sydney, New York City and London to advance the creative sector and compete for a spot among the world leaders in the knowledge age. These intense efforts at restructuring national and local economies have led to increasingly intense competition between cities and nations and there are clear winners and losers. Overall the conclusion of this research suggests that as Australia is rising, America is struggling to keep its position as a global world leader in the new economy. London’s urban primacy has helped elevate it role in the UK new economy and recent transformations have led London to compete successfully with New York City for the top position as the premier global city.

Keywords: knowledge-based economy, knowledge economy indexes, sustainable transformation, creative economies, New York, London and Sydney

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Authors: Anyia Nduka, Aslan Bin Amad Senin

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Organizational culture, strategic leadership and organizational resilience have gained significant attention in recent years. This study aims to examine the relationship between these factors and their combined influence on an organization's ability to adapt and thrive in the face of challenges and disruptions. A mixed-methods approach, combining quantitative survey data and qualitative interviews with leaders and employees from cohort organizations within the industry. The quantitative phase involves measuring organizational culture, strategic leadership behaviours, and organizational resilience using standardized scales. This study highlighted the significance of organizational culture and strategic leadership in building and sustaining organizational resilience. Preliminary findings suggest a strong positive relationship between a resilient organizational culture and strategic leadership practices. Secondly, Organizations can enhance their capacity to respond to disruptions, exploit opportunities, and achieve long-term success in a rapidly changing business environment. Furthermore, the qualitative analysis reveals several key themes that elucidate the link between organizational culture, strategic leadership, and resilience. This study contributes to the growing body of knowledge on organizational resilience and strategic leadership, providing insights and practical implications for leaders and practitioners seeking to strengthen their organizations' resilience capabilities. Further research is needed to explore the specific mechanisms and contextual factors that influence the relationship between these variables in different organizational contexts and industries.

Keywords: organizational culture, strategic leadership, organizational resilience, leadership

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Authors: Odeh Ibn Iganga

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The issue of foreign debt, debt crisis or the concept of Third World debt burden generally gained prominence after the end of the cold war which pitched the United States and the former Soviet Union against each other in an ideological supremacy tussle. Before then however, Third World Countries (TWCs) enjoyed a relative economic resilience and stability and ostensibly friendly relations with the leaders of the polarized blocks in a way to garner supports for, and as an instrument of strengthening and expanding influence and power of the leaders of the two blocs, and achieve their goals. Consequently, the Third World concept lost its political relevance and usage perhaps, too, its economic comportment, and eventually became phraseology synonymous with developing countries bedeviled with debt crisis and struggling to emerge from debt burden, economic underdevelopment and poverty. Since then, also, particularly during the last two decades, the issue of Third World debt burden, which is currently posing significant problems, has a considerable attracted public policy and academic scrutiny. Third World debt burden thus is not a recent phenomenon but is a result of, and due to, pursuance of foreign aid from countries of the North which had, from the start, created the condition of economic subservience and master-servant relationship that could generate persistent seeking and lobbing for foreign aids through borrowing, thus tying down in a perpetual manner, most of the Third World Countries to underdevelopment, dependency and poverty. The interest of this paper, therefore, is to examine the causes, costs and or the implications of the debt burden on the economies of the Third World Countries, review some general solutions to the debt burden as well as offering suggestions as a way out of the doldrums.

Keywords: third world, debt burden, debt crisis, economic development and underdevelopment

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Authors: Patrick Nurse, Professor Neil Sebire, Polly Livermore

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The use of digital systems in healthcare is now highly prevalent. With further advancement of technology, these systems will become increasingly utilised within the healthcare sector. Therefore understanding how clinicians (for example, doctors, nurses) interact with technology and digital systems is critical to making care safer. Seven members from the Parent/Carers’ Research Advisory Group and the Young-Persons’ Research Group at a healthcare Trust in London and three staff members contributed to an engagement workshop to assess the impact of digital systems on the practice of nurses. The group also advised on the viability of a research study to investigate this further. A wide range of issues within digital system implementation in healthcare were raised, such as ‘workarounds’, system’s training, and upkeep and regulation of usage, which all emerged as early themes during the discussion. Further discussion focused on the subject of escalation of issues, ‘workarounds’, and problem solving. While challenging to implement, digital systems are hugely beneficial to healthcare providers. The workshop indicated that there is scope for investigation of the prevalence, nature, and escalation of ‘workarounds’, this was of key interest to the advisory group. An interesting concern of the group was their worry from a patient and parental perspective regarding how nurses might feel when needing to complete a ‘workaround’ during a busy shift. This is especially relevant if the reasons to complete the ‘workaround’ were outside the nurse’s control, driven by clinical need and urgency of care. This showed the level of insight that those using healthcare services have into the reality of workflows of those providing care. Additionally, it reflects the desire for patients and families to understand more about the administration and methodology of their care. Future study should be dedicated to understanding why nurses deploy ‘workarounds’, as well as their perspective and experience of them and subsequent escalation through leadership hierarchies

Keywords: patient engagement/involvement, workarounds, medication-administration, digital systems

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Authors: Fusun Akdag

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Today, as business becomes increasingly global, managers/leaders of multinational companies or local companies work with employees or customers from a variety of cultural backgrounds. To do this effectively, they need to develop cultural competence. Therefore, cultural intelligence (CQ) becomes a vitally important aptitude and skill, especially for leaders. The organizational success or failure depends upon the way, the kind of leadership which has been provided to its members. The culture we are born into deeply effects our values, beliefs, and behavior. Cultural intelligence (CQ) focuses on how well individuals can relate and work across cultures. CQ helps minimize conflict and maximize performance of a diverse workforce. The term 'decision,' refers to a commitment to a course of action that is intended to serve the interests and values of particular people. One dimension of culture that has received attention is individualism-collectivism or, independence-interdependence. These dimensions are associated with different conceptualizations of the 'self.' Individualistic cultures tend to value personal goal pursuit as opposed to pursuit of others’ goals. Collectivistic cultures, by contrast, view the 'self' as part of a whole. Each person is expected to work with his or her in-group toward goals, generally pursue group harmony. These differences underlie cross-cultural variation in decision-making, such as the decision modes people use, their preferences, negotiation styles, creativity, and more. The aim of this study is determining the effect of CQ on decision making styles of male and female managers in Turkey, an emergent economy framework. The survey is distributed to gather data from managers at various companies. The questionnaire consists of three parts: demographics, The Cultural Intelligence Scale (CQS) to measure the four dimensions of cultural intelligence and General Decision Making Style (GMDS) Inventory to measure the five subscales of decision making. The results will indicate the Turkish managers’ score at metacognitive, cognitive, motivational and behavioral aspects of cultural intelligence and to what extent these scores affect their rational, avoidant, dependent, intuitive and spontaneous decision making styles since business leaders make dozens of decisions every day that influence the success of the company and also having an impact on employees, customers, shareholders and the market.

Keywords: cultural intelligence, decision making, gender differences, management styles,

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Authors: Meaghan Bowman

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Soldiers are taught about the importance of effective communication with repetition of the phrase, “Communication is key.” They receive training in preparing for, and carrying out, interactions between foreign and domestic leaders to gain crucial information about a mission. These interactions are known as Key Leader Engagements (KLEs). For the training of KLEs, doctrine mandates the skills needed to conduct these “engagements” such as how to: behave appropriately, identify key leaders, and employ effective strategies. Army officers in training learn how to confront leaders, what information to gain, and how to ask questions respectfully. Unfortunately, soldiers rarely learn how to formulate questions optimally. Since less complex questions are easier to understand, we hypothesize that semantic complexity affects content understanding, and that age and education levels may have an effect on one’s ability to form paraphrases and judge their quality. In this study, we looked at paraphrases of queries as well as judgments of both the paraphrases’ naturalness and their semantic similarity to the query. Queries were divided into three complexity categories based on the number of relations (the first number) and the number of knowledge graph edges (the second number). Two crowd-sourced tasks were completed by Amazon volunteer participants, also known as turkers, to answer the research questions: (i) Are more complex queries harder to paraphrase and judge and (ii) Do age and education level affect the ability to understand complex queries. We ran statistical tests as follows: MANOVA for query understanding and two-way ANOVA to understand the relationship between query complexity and education and age. A probe of the number of given-level queries selected for paraphrasing by crowd-sourced workers in seven age ranges yielded promising results. We found significant evidence that age plays a role and marginally significant evidence that education level plays a role. These preliminary tests, with output p-values of 0.0002 and 0.068, respectively, suggest the importance of content understanding in a communication skill set. This basic ability to communicate, which may differ by age and education, permits reproduction and quality assessment and is crucial in training soldiers for effective participation in KLEs.

Keywords: engagement, key leader, paraphrasing, query complexity, understanding

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Randy D. Colon

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Through a freedom of information request, data pertaining to Housing Choice Voucher (HCV) households has been obtained from the Chicago Housing Authority, including rent price and number of bedrooms per HCV household, community area, and zip code from 2013 to the first quarter of 2018. Similar data pertaining to the private rental market will be obtained through public records found through the United States Department of Housing and Urban Development. The datasets will be analyzed through statistical and mapping software to investigate the potential link between HCV households and distorted rent prices. Quantitative data will be supplemented by qualitative data to investigate the lived experience of Chicago residents. Qualitative data will be collected at community meetings in the Chicago Englewood neighborhood through participation in neighborhood meetings and informal interviews with residents and community leaders. The qualitative data will be used to gain insight on the lived experience of community leaders and residents of the Englewood neighborhood in relation to housing, the rental market, and HCV. While there is an abundance of quantitative data on this subject, this qualitative data is necessary to capture the lived experience of local residents effected by a changing rental market. This topic reflects concerns voiced by members of the Englewood community, and this study aims to keep the community relevant in its findings.

Keywords: Chicago, housing, housing choice voucher program, housing subsidies, rental market

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Authors: Elissar Mansour, Emily Chen, Tracee Fernandez, Mariam Basheti, Christopher Gordon, Bandana Saini

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Sleep is an essential process for the maintenance of several neurobiological processes such as memory consolidation, mood, and metabolic processes. It is known that sleep patterns vary with age and is affected by multiple factors. While non-pharmacological strategies are generally considered first-line, sedatives are excessively used in the older population. This study aimed to explore the management of sleep in residential aged care facilities (RACFs) by nurse professionals and to identify the key factors that impact provision of optimal sleep health care. An inductive thematic qualitative research method was employed to analyse the data collected from semi-structured interviews with registered nurses working in RACF. Seventeen interviews were conducted, and the data yielded three themes: 1) the nurses’ observations and knowledge of sleep health, 2) the strategies employed in RACF for the management of sleep disturbances, 3) the organizational barriers to evidence-based sleep health management. Nurse participants reported the use of both non-pharmacological and pharmacological interventions. Sedatives were commonly prescribed due to their fast action and accessibility despite the guidelines indicating their use in later stages. Although benzodiazepines are known for their many side effects, such as drowsiness and oversedation, temazepam was the most commonly administered drug. Sleep in RACF was affected by several factors such as aging and comorbidities (e.g., dementia, pain, anxiety). However, the were also many modifiable factors that negatively impacted sleep management in RACF. These include staffing ratios, nursing duties, medication side effects, and lack of training and involvement of allied health professionals. This study highlighted the importance of involving a multidisciplinary team and the urge to develop guidelines and training programs for healthcare professionals to improve sleep health management in RACF.

Keywords: registered nurses, residential aged care facilities, sedative use, sleep

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Authors: Crispin Rakibu Mbamba

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Twenty-two years after the adoption of the United Nation Trafficking Protocol, evidence suggest that child trafficking continues to rise. Community level factors, like poverty which creates the conditions for children’s vulnerability is key to the rise in trafficking cases in Ghana. Albeit, growing evidence suggestthat despite the vulnerabilities, communities have the capacity to prevent and address child trafficking issues. This study contributes to this positive agenda by exploring the ways in which communities (and the key actors) in Ghana contribute to child trafficking interventions.The study objective is explored through in-depth interviews with practitioners (including social workers) from an organization working in trafficking hotspots in Ghana. Interviews wereanalyzed thematically with the help of HyperRESEARCH software. From the in-depth interviews, three themes were identified as the ways in which communities are involved in child trafficking interventions: 1) engagement of community leaders, 2) community-led anti-trafficking committees and 3) knowledge about trafficking. Albeit the cultural differences, evidence on the instrumental role of community chiefs and leaders provide important learning on how to harness trafficking intervention measures and ensure better child protection practices. Based on the findings, we recommend the need to intensify trafficking awareness campaigns in rural communities where education is lacking to contribute to United Nations (UN) promoting Just, Peaceful and Inclusive societies’ mandate.

Keywords: child trafficking, community interventions, knowledge on trafficking, human trafficking intervention

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Authors: Chia-Ying Lin

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This paper explains how to enhance doctor-patient communication and nurse-patient communication through multiple intelligence signing methods and user-centered. It is hoped that through the implementation of the "electronic consent", the problems faced by the paper consent can be solved: storage methods, resource utilization, convenience, correctness of information, integrated management, statistical analysis and other related issues. Make better use and allocation of resources to provide better medical quality. First, invite the ｍedical records department to assist in the inventory of paper consent in the hospital: organising, classifying, merging, coding, and setting. Second, plan the electronic consent configuration file: set the form number, consent form group, fields and templates, and the corresponding doctor's order code. Next, Summarize four types of rapid methods of electronic consent: according to the doctor's order, according to the medical behavior, according to the schedule, and manually generate the consent form. Finally, system promotion and adjustment: form an "electronic consent promotion team" to improve, follow five major processes: planning, development, testing, release, and feedback, and invite clinical units to raise the difficulties faced in the promotion, and make improvements to the problems. The electronic signature rate of the whole hospital will increase from 4% in January 2022 to 79% in November 2022. Use the saved resources more effectively, including: reduce paper usage (reduce carbon footprint), reduce the cost of ink cartridges, re-plan and use the space for paper medical records, and save human resources to provide better services. Through the introduction of information technology and technology, the main spirit of "lean management" is implemented. Transforming and reengineering the process to eliminate unnecessary waste is also the highest purpose of this project.

Keywords: smart signature, electronic consent, electronic medical records, user-centered, doctor-patient communication, nurse-patient communication

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Aminu Alhaji Bala

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The Jama’atu Izalatil Bid’ah Wa-Iqamatis Sunnah is a Da’wah organization and reform movement launched in Jos - Nigeria in 1978 as a purely reform movement under the leadership of late Shaykh Ismai’la Idris. The organization started a full fledge preaching sessions at National, State and Local Government levels immediately after its formation. The contributions of this organization to da'wah activities in Nigeria are paramount. The organization conducted its preaching under the council of preaching with the help of the executives, elders and patrons of the movement. Teaching and preaching have been recognized as the major programs of the society. Its preaching activities are conducted from ward, local, state and national levels throughout the states of Nigeria and beyond. It also engaged itself in establishing Mosques, schools and offers sermons during Friday congregation and Eid days throughout its mosques where its sermon is translated into vernacular language, this attracted many Muslims who don’t understand Arabic to patronize the its activities. The organization however split into two faction due to different approaches to Da’wah methodology and some seemingly selfish interests among its leaders. It is upon this background that this research was conducted using analytical method to compare and contrast the da’wah methodology applied by the two factions of the organization. The research discussed about the formation, Da’wah activities of the organization. It also compared and contrast the Da’wah approach and methodology of the two factions. The research finding reveals that different approach and methods applied by these factions is one of the main reason of their split in addition to other selfish interest among its leaders.

Keywords: activities, Da’wah, methodology, organization

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

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Authors: L. Laurs, A. Blazeviciene, D. Milonas

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Introduction: Nursing as a profession is grounded in moral obligation. Nursing practice is grounded in ethical standards: to not harm, to promote justice, to be accountable, and to provide safe and competent care. The nature of the nurse-patient therapeutic relationship requires acting on the patient's behalf. Moral distress consists of negative stress symptoms that occur in situations that involve ethical situations that the nurse perceives as discordant with their professional values. Aim of the Study: The purpose of this study was to assess links between moral distress of registered nurses and factors related to patient care at the end of their life. Methods and Sample: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from seven municipal multi-profile hospitals providing both general and specialized healthcare services in Lithuania (N=1055). Research instruments included two questionnaires: Obstacles and Facilitating at the End of Life Care and Moral Distress Scale (revised). Results: Spearman’s correlation analysis was performed to assess the relationship between nurses' attitudes towards patient care at the end of life and the experienced moral distress. A statistically significant correlation between moral distress and the following factors related to patient end-of-life care has been identified: conversations with physicians on patient end-of-life problems have a positive impact on job satisfaction; some patients may be excluded from decisions about their treatment and nursing because they are questioned about their ability to assess the situation. These situations increased moral distress. Patient consciousness should not be permanently suppressed by calming medications, and the patient should be provided with all nursing care services and moral distress. Conclusions: The moral distress of nurses is significantly related to the end-of-life care of patients and their determinants: moral distress increased due to lack of discussion with doctors about problem-solving and exclusion of patients from decision-making. And it diminished by refusing calming medications to permanently suppress a patient's consciousness and providing good care for patients.

Keywords: moral distress, registered nurses, end of life, care

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Authors: M. Yaqoob, C. S. O’Neill, S. Faraj, C. L. O’Neill

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This paper presents the preliminary findings from a study exploring nurse’s contributions to end of life decisions and to the care of dying patients in ICU units in the Kingdom of Bahrain. The process of dying is complex as medical clinicians are frequently unable to say with certainty when death will occur. It is generally accepted that end of life care begins when it is possible to know that death is imminent. Nurses do not make medical treatment decisions when caring for a dying patient. There are, however, many other types of decisions made when a patient is approaching the end of life and nurses are either formally or informally part of these decision making processes. This study explored nurses care practices at the end of life, in two ICU units in large hospitals in the Kingdom of Bahrain. The research design was a grounded theory approach. Ten nurses participated, six of whom were Bahraini nationals and four were Indian. A core category death avoidance talk was supported by three major subcategories, degrees of involvement in decision making; signalling and creating an awareness of death; care shifting from dying patients to family. Despite nurses asserting that they carried out the orders of doctors and had no role in decision making processes at end of life this study showed that there were degrees of nurse involvement. Doctors frequently discussed the patient’s clinical condition with nurses and also sought information regarding the family. Information about the family was of particular relevance if the doctor was considering a DNR order, which the nurses equated with dying. Families were not always informed when a DNR decision was made. When families were not informed the nurses engaged in sophisticated rituals signalling and creating awareness to family members that the death of their loved one was near. This process also involved a subtle shifting of care from the dying patient to the family. This seminar paper will focus particularly on how nurses signal and create an awareness of death in an ICU setting. The findings suggest that despite the avoidance of death talk in the ICU nurses indirectly convey and create an awareness that death is near to family members.

Keywords: decision making, dying patients, end of life, intensive care unit

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Authors: Emni Omar Daw Hussin, Pathmawathi Subramanian, Wong Li Ping

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Background: To provide quality care at the end of life, nurses should possess knowledge and skills to provide effective end-of-life care, as well as develop the attitudes and interpersonal competence to provide compassionate care. Aim: This study aimed to assess nurses’ knowledge and attitude towards end of life care and caring for terminal ill patients and to examine relationships among demographic variables and nurse’s knowledge and attitudes toward end of life care and caring for terminal ill patients. Method: a cross-sectional study was conducted at 1 tertiary hospital located in Kuala Lumpur, Malaysia. Self-administrative questionnaire was used to collect data from 553 nurses from over all departments except emergency department, operation theater and outpatient clinic. Two tools were used in this study, the Frommelt’s Attitude Toward Care of the Dying (FATCOD) Scale to assess the nurses’ attitude and End of Life Knowledge Assessment to assess the nurses’ knowledge. Result: the result of this study yielded that, the majority of participants (54.8%) and (54.4%) have less positive attitude and knowledge towards end of life care and caring for terminal ill patients respectively. As well as there is no significant relationship were found between nurses’ ethnicity, religion, and the total score of FATCOD scale; End of Life Knowledge Assessment score. On other hand there is significant relationship among nurses’ age, working experience, level of education, attending any post basic courses and the total score of both FATCOD scale and End of Life Knowledge Assessment. Conclusion: A lack of education and experience and post basic course about end of life care and palliative care may contribute to the negative attitudes and poor knowledge regarding end of life care. Providing sufficient courses about end of life care could enhance the nurses’ knowledge towards end of life care, as well as providing a reflective narrative environment in which nurses can express their personal feelings about death and dying could be a potentially effective approach. Implication for Practice: This study elaborates the need for further research to develop an effective educational programs to enhance nurses’ knowledge and to promote positive attitude towards death and dying, as well as enhance communication skills, and coping strategies.

Keywords: knowledge, attitude, nurse, end of life care

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Authors: Fantahun Ibrahim

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The Ethiopian army was one of the largest and most heavily armed ground forces in Africa between 1974 and 1991. It scored a decisive victory over Somalia’s armed forces in March 1978. It, however, failed to withstand the combined onslaught of the northern insurgents from Tigray and Eritrea and finally collapsed in 1991. At the heart of the problem was the army’s huge intelligence failure. The northern insurgents, on the other hand, had a cutting edge in intelligence gathering. Among other things they infiltrated the army high command and managed to get top secrets about the army. Commanders who had fallen into the hands of the insurgents in several battles were told to send letters to their colleagues in the command structure and persuade them to work secretly for the insurgents. Some commanders did work for the insurgents and played a great role in the undoing of military operations. Insurgent commanders were able to warn their fighters about air strikes before jet fighters took off from airfields in the northern theatre. It was not uncommon for leaders of insurgents to get the full details of military operations days before their implementation. Such intelligence failures led to major military disasters like the fall of Afabet (March, 1988), Enda Sellase (February, 1989), Massawa and Debre Tabor (February, 1990), Karra Mishig, Meragna and Alem Ketema (June, 1990). This paper, therefore, seeks to investigate the army’s intelligence failures using untapped archival documents kept at the Ministry of National Defence in Addis Ababa and interviewing key former commanders of the army and ex-leaders of the insurgents.

Keywords: Ethiopian army, intelligence, infiltration, insurgents

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Authors: Isaac Alonge Olusola

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One of the major peculiarities of man is the ability to communicate and interact with language. The original Yoruba society, before the advent of the Europeans, was purely oral. That is the major means of inter- personal communication was through speaking. The abolition of slave trade by Britain marked the beginning of development of Yoruba alphabet and introduction of writing around 1800. However, most of the writing was Christian religion-focused. Later, the introduction of British colonial rule led to the introduction of writing that dwelt on political and economic emancipation. On October 1, 1960, Nigeria was granted independence by the British colonial masters and self-rule started in Nigeria. Unfortunately, the military and civilian administrations brought about political and economic oppression instead of comfort. The discomfort brought about by Nigerian political and military rulers turned the Yoruba poets to activists, reactionaries and critics. This paper will give a brief preamble on the history of Nigeria and how she got her political independence from the British in 1960. It will thereafter go further to mention some political and economic hardship brought about by Nigerian leaders. Using literary theories called semiotics and structuralism, the reactions and criticisms of some Yoruba poets will be mentioned and analyzed vis-à-vis the counter reactions of the governments in power. Moreover, the paper will bring about a conclusion on how to create a conducive atmosphere for the Yoruba poets to operate in Nigeria. Finally, suggestions will be offered on how the Nigerian government and Yoruba poets can co-exist positively to bring about a better standard of living to Nigerians and also promote good governance

Keywords: Yoruba, Yoruba language, Yoruba poets, political leaders

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Authors: Godaye Gobena Gomiole

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The purpose of this study was to investigate school context-related factors that affect principals' instructional leadership competence in primary schools in Tarcha Town, Ethiopia. A qualitative case study research design was used. The data were collected through semi-structured interviews and document analysis. Twelve senior principals were included in the study through purposive sampling. Interviews were used to collect in-depth data. The data was analyzed thematically. The findings of the study indicated that primary school principals face both internal and external challenges. Internally, they face limited knowledge and skills, a lack of courage and commitment, and administrative work overload. Their external challenges included negative attitudes from parents and teachers, a lack of instructional materials, and little support from local education authorities. Consequently, they can't serve effectively as instructional leaders or resource people. Based on the findings, it is recommended that the Ministry of Education, South West Regional Education Bureau, Dawuro Zone Education Department, and Tarcha Town Administration Education Officers and Cluster Supervisors regularly monitor and support school leaders and prepare and provide pertinent teaching materials and training so that the principals can lead in the capacity that is appropriate for the position.

Keywords: instructional leadership, primary school, principals, school context related factors

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Authors: Amber Brittain-Hale

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This research investigates the evolving role of social media in crisis situations by employing discourse analysis methodology and honing in on the Russo-Ukrainian War, particularly Ukraine's use of LinkedIn. The study posits that social media platforms, such as LinkedIn, play a crucial role in shaping communication, disseminating information, and influencing geopolitical strategies during conflicts. Focusing on Ukraine's official state account on LinkedIn and analyzing its posts and interactions, the research aims to unveil discourse dynamics in high-stakes scenarios and provide valuable insights for leaders navigating complex global challenges. A comprehensive analysis of the data will contribute to a deeper understanding of the tactics adopted by political leaders in managing communication, the bidirectional nature of discourse provided by online social networks, and the rapid advancement of technology that has led to the growing significance of social media platforms in crisis situations. Through this approach, the geopolitical factors that influenced the country's social media strategy during the Russo-Ukrainian War will be illuminated, offering a broader perspective on the role of social media in such challenging times. Ultimately, the study seeks to uncover lessons that can be drawn from Ukraine's LinkedIn approach, informing future strategies for utilizing social media during crises and advancing the understanding of how social media can be harnessed to address intricate global issues.

Keywords: russo-ukrainian war, social media, crisis, discourse analysis

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