Better Flow Of Information Research Articles

The dilemma of the split between theory and reality as experienced by primary healthcare professionals: a mixed methods study of evidence-based practice in a primary care context

BackgroundPrimary care depends upon a good information flow across professional and structural boundaries to provide the best care for patients. Previous research has mainly focused on Evidence-Based Practice (EBP) within specific professions. Mapping of pan-professional experiences of and attitudes to EBP in publicly funded clinical practice is necessary to deepen the understanding of EBP and its implementation. Thus, this study aimed to investigate healthcare professionals’ experiences of and attitudes towards working in accordance with EBP in primary care.MethodsThe study used a convergent mixed methods design divided into two strands: a quantitative enquiry tool (Evidence-Based Practice Attitude Scale, EBPAS) and a set of qualitative interviews analysed by means of qualitative content analysis. Both strands included all primary care employees with patient interaction in the studied county (n = 625), including doctors, nurses, physiotherapists, psychologists and assistant nurses. Out of the original 625 healthcare professionals, 191 finished the first strand and 8 volunteered for the second strand (2 nurses, 2 physiotherapists, 1 psychiatrist and 3 doctors).ResultsThe EBPAS value of 2.8 (max 4) indicated a generally positive attitude towards EBP amongst the population, which was also evident in the interviews. However, there were additional experiences of not having the ability or resources to engage in EBP. This was illustrated by the theme that emerged from the qualitative content analysis: “The dilemma of the split between theory and reality”. Due to the organisational and managerial focus on efficiency rather than quality of care, there were few or no incentives for promoting individual educational or research development.ConclusionsAlthough the general attitude towards EBP is positive, experiences of practising it differ. There is a need to increase knowledge of EBP concepts, requirements and implementation in the clinical setting. The absence of opportunities to do research and collegial debate about new ways of finding and implementing research-based evidence results might influence the quality of care.

Web-Based Multistate Disaster Rehearsal of Concepts Exercises

Introduction:The Mountain Plains Regional Disaster Health Response System (Mountain Plains RDHRS) works to build disaster capacity across US Federal Region VIII, a rural western six-state region. It conducts an annual rehearsal of concepts and exercises to identify gaps and inform policy development. In 2022, a multi-state exercise was conducted involving responders from individual hospitals coordinating with Healthcare Coalitions and State Public Health. These responses rolled up to a multi-state emergency operations center overseen by the Mountain Plains RDHRS.Method:A fictitious mass multi-state botulism incident generated a pediatric surge across the region. Individual patient cards with demographic information were given to a set of hospitals in participating states. The communication pathways within states were identified. Communication between local and regional pediatric transfer centers were assessed. Overall situational awareness was tracked.The exercise format was incident occurrence and notifications by normal channels and a Zoom conference call held on day one. Situational awareness and patient movement occurred in multiple Zoom rooms on day two. An after-exercise review occurred by Zoom on day three including all participants from the exercise.Results:There was generally good information flow within states, but minimal information exchange across states There was poor regional situational awareness with a lack of complete patient lists and transfers. The Mountain Plains RDHRS planned to exceed the hospital’s patient capacities with a large number of pediatric patients to practice patient movement across state lines. Instead the hospitals showed a surprising willingness to keep and manage critical pediatric patients instead of transferring to tertiary care pediatric centers. This was identified as a consequence of the COVID-19 experience.Conclusion:Web-based exercises vertically spanning responses from individual hospitals to multi-state regional entities are feasible. This exercise demonstrated multiple gaps in regional disaster response.

Situational Awareness in Construction Using a Serious Game

Production planners in construction face several problems related to the lack of information regarding construction project status, changes to resource availability, instability in production rates, design changes, and limited situational awareness (SA). Poor SA leads to uninformed and suboptimal resource allocation decisions. As a result, the construction workflow is negatively affected, degrading project performance. This study focuses specifically on possible relationships between production planners’ SA and the resulting workflow quality. Such understanding can lead to the development of measures to improve production management in construction. Interviews with diverse production planners highlighted the nature of the information needed, issues related to the lack of SA, and the effect on workflow. A serious roleplaying game was devised to measure the correlation between production planners’ SA and workflow, and 14 live simulation experiments were conducted with two teams of nine players each. Finally, a qualitative analysis of the information flow configurations applied in the experiments evaluated the expected effects of information flows in the live experiment. The study found a positive correlation between the quality of information flow and workflow in construction, indicating causation in line with theoretical expectations. Specifically, free communication among planners together with management tools such as formal weekly work planning and a digital planning tool reduced the assembly time, working time, and non-value-added time of the subcontractors in the experiments. Good information flows among production planners and an up-to-date jobsite status diminish uncertainty and increase SA, which lead to improved workflow and productivity.

Identifying the Barriers and Opportunities in the Provision and Use of Weather and Climate Information for Flood Risk Preparedness: The Case of Katakwi District, Uganda

The provision of weather and climate information (WCI) can help the most at-risk communities cope and adapt to the impacts of extreme events. While significant progress has been made in ensuring improved availability of WCI, there remain obstacles that hinder the accessibility and use of this information for adaptation planning. Attention has now focused on the “usability gap” to ensure useful and usable WCI informs practise. Less attention has however been directed on barriers to the active production and use of WCI. In this study, we combine two frameworks through a bottom-up approach to present a more coordinated institutional response that would be required to ensure a better flow of information from information providers to users at community level and vice versa. The bottom-up approach was designed in form of Farmers Agri-Met Village Advisory Clinics (FAMVACs) and Listening Groups (LG) and was initiated by Uganda Meteorological Authority (UNMA) as a way of ensuring connections between the information providers, the disseminators, and the communities to specifically give voice to the communities to provide feedback on the use of WCI in coping with flood risks. This approach is used to identify the barriers and opportunities in the production/provision and use of WCI for flood risk preparedness for a case study in Eastern Uganda. First, a use-case is developed for Katakwi District where smallholder farming communities have recorded their coping practises and barriers to the use of WCI in practise. Second, online interviews with practitioners from disaster management institutions are used to identify barriers to the production and provision of WCI to local farming communities. Findings show that for providers, barriers such as accessibility and completeness of data hinder the production of useful WCI. In situations where useful information is available, technical language used in the format and timeliness in dissemination hinder usability by local farmers. Useful and usable WCI may not be acted on in practise due to factors such as costs or market availability e.g., lack of access to improved seeds. Further, the study highlights possible solutions to bridge the identified gaps and they include capacity building, fostering data collaborations across sectors, data translation to simple advisories, among others. The study also presents the FAMVACs approach which shows the importance of a more coordinated response with a shift of focus from the users of information only, to a more inclusive understanding of the data and information gaps across the wider provider-user landscapes. We argue that this would contribute to more effective disaster management at both the national and local levels.

Perceived Impact on Alzheimer's Disease Clinical Trial Participants After Study Termination

<h3>Introduction</h3> Many pharmaceutical companies are working to identify novel treatments to slow or stop the progression of Alzheimer's Disease (AD), which they test through use of multi-site clinical trials. The Geriatric Psychiatry Research Program at McLean Hospital has been a study site in 8 clinical trials over the past 10 years, enrolling over 30 participants and their caregivers, or study partners. During the monthly, multi-hour study visits, McLean study staff accompanied participants and study partners and thus became familiar with the patient's clinical care. Two of the disease-modifying clinical trials conducted at McLean between 2012 and 2019 were terminated by the sponsors after interim analyses revealed study endpoints were not being met. Participants at McLean were immediately discontinued and required to stop infusions of study drug (or placebo) in both placebo-controlled and long-term extension phases of the trials. This abrupt discontinuation broke the pattern of regular study visits and consistent care the participants and study partners had come to expect, especially for those who had been involved in the same study for over 6 years. This observational, qualitative study seeks to examine the effects of study termination on participants and study partners and to provide insight into potential benefits of regular interaction with a consistent research care team. The primary goals of this study are to identify and characterize the impact that sponsor-initiated Alzheimer's clinical trial termination had on participants and their caregivers at McLean Hospital. <h3>Methods</h3> Study aims were accomplished by collecting mood, memory, function, and study satisfaction surveys from participants or study partners who were enrolled in Eli Lilly's LZAO, Eli Lilly's LZAX, or Biogen's Emerge trials at McLean when discontinued. For this one-time study visit, 7 subject and 8 caregiver surveys were administered to eligible individuals. Participants were asked to reflect on their experiences and mood at the time of study termination, 4-weeks after termination, and at the time of this visit. We evaluated qualitative trends in reported changes in mood, memory, function, social support and overall study experience for former subjects and caregivers. <h3>Results</h3> There were 17 participants enrolled in the study - 12 caregivers and 5 subjects. Caregivers reported that the aspects of trial participation they valued most were social interactions with staff, sense of giving back by contributing to AD research, feelings of hope related to trial participation, access to medical knowledge and experts, consistent health monitoring and structure from scheduled visits, and the safe space created to talk about AD. Caregivers tended to disagree when asked if they had less social contact with others following study termination but were more likely to agree that their study partner had less social contact with others following termination. When asked what resources they hoped would be available but were not offered at study termination, 4 caregivers wished they had longitudinal information about testing, specifically the amyloid PET scan data. Multiple caregivers wished the sponsor had provided more information about the rationale for study termination and offered other trial options or support resources. The majority of caregivers would have appreciated more help getting enrolled in other trials. Participants valued the social interaction with and quality of staff, transparent communication, interaction with experts, feeling more connected to others, and the hope of potential benefit from the study medication. Like caregivers, participants desired more specific information about their results and brain amyloid status and wished there had been additional clinical support offered at trial termination, such as facilitated group discussions with other participants. Two caregivers and one participant mentioned that the relationship between the sponsor and site should be closer for a better flow of information. Subjects and caregivers expressed feelings of disappointment, frustration, anger, and sadness at the abrupt ending of the trial, and two caregivers said they would not enroll another family member in a placebo-controlled trial. <h3>Conclusions</h3> Termination of a clinical trial had a significant qualitative impact on both participants and caregivers who were enrolled. Two themes, empowerment and support, emerged regarding the meaning of trial participation to subjects and study partners. When trials were ended abruptly, participants and caregivers were left without a source for the sense of empowerment and support previously provided by study participation. Increased attention should be directed to services provided by both the sponsor and site at the time of termination. Sponsors and study sites should focus on providing resources for emotional support and information to participants and study partners to ease negative feelings that may arise with trial discontinuation. <h3>This research was funded by</h3> Unfunded.

Data-Powered Positive Deviance during the SARS-CoV-2 Pandemic-An Ecological Pilot Study of German Districts.

We introduced the mixed-methods Data-Powered Positive Deviance (DPPD) framework as a potential addition to the set of tools used to search for effective response strategies against the SARS-CoV-2 pandemic. For this purpose, we conducted a DPPD study in the context of the early stages of the German SARS-CoV-2 pandemic. We used a framework of scalable quantitative methods to identify positively deviant German districts that is novel in the scientific literature on DPPD, and subsequently employed qualitative methods to identify factors that might have contributed to their comparatively successful reduction of the forward transmission rate. Our qualitative analysis suggests that quick, proactive, decisive, and flexible/pragmatic actions, the willingness to take risks and deviate from standard procedures, good information flows both in terms of data collection and public communication, alongside the utilization of social network effects were deemed highly important by the interviewed districts. Our study design with its small qualitative sample constitutes an exploratory and illustrative effort and hence does not allow for a clear causal link to be established. Thus, the results cannot necessarily be extrapolated to other districts as is. However, the findings indicate areas for further research to assess these strategies’ effectiveness in a broader study setting. We conclude by stressing DPPD’s strengths regarding replicability, scalability, adaptability, as well as its focus on local solutions, which make it a promising framework to be applied in various contexts, e.g., in the context of the Global South.

Management of Infrastructure and Traffic Volume versus Road Traffic Safety

Purpose: The objective of the article is to present the impact of the environment and the use of telematics on the safety of road users, paying particular attention to changes in the death rate in road accidents, comparing Poland and other European countries. Design/Methodology/Approach: The author has applied the Delphi method, which uses the knowledge, experience and opinions of experts in a given field. In addition, the focus was on the use of IT systems, e.g., by using them to monitor intersections, creating a system of informing drivers about the existing hazards, weather conditions, possible bypasses in order to more effectively manage transport and ensure a better flow of information, which leads to the improvement of road safety, increasing the driver's comfort and significantly shortening the driving time. The dynamic development of road traffic is associated with the emergence of risks for road users. In the first part of the research method, variables were characterized by frequency (N), standard deviation (SD), minimum value, lower quartile value (Q1), below (or equal to) 25.0% of observations, median - average value, below (or equal to) 50.0% of the observations, the value of the upper quartile, below (or equal to) 75.0% of the observations, and the maximum value. The percentage of people choosing a particular assessment of a given answer variant is also presented. The Mann-Whitney U test was also used in the second research part for comparison of the number of fatalities in accidents in Poland and other European countries. Findings: The results of the analyses made it possible to answer the question whether the use of modern telematics solutions can significantly affect road safety. In addition, subsequent analyses allowed to find an answer to the question of whether there were any changes in the accident fatality rate in Europe from 2009 to 2018. The research indicates an important role in the issues of road safety and hazards. Practical Implications: The research provides pragmatic tips for practical road safety solutions. In addition, this research significantly expands the literature on the impact of modern telematics solutions on road safety. Originality/value: It is an original research that can be used to solve specific problems on its own or also simultaneously with other research methods.

Communication as a non‐technical skill in the operating room: A qualitative study

AimThe aim of this study was to explore how operating room nurses (ORNs) experience operating room (OR) team communication concerning non‐technical skills.DesignBased on the Scrub Practitioners List of Intraoperative Non‐Technical Skill (SPLINTS), qualitative individual in‐depth semi‐structured interviews were conducted with 11 ORNs in a Norwegian university hospital. Braun and Clarke's six analytic phases for thematic data analysis were used.ResultsSurgeons being unprepared or demanding different instruments than the preoperative information indicates, cause stress and frustration. So does noise and brusquely or poor communication. Ensuring good information flow within the entire team is important. When silence is required, the ORNs communicate with gestures, looks and nods. Creating a positive and secure team culture facilitates discussions, questions and information sharing.ConclusionInappropriate dynamics, inaccurate and/or disrespectful communication and noise may reduce patient safety. Interdisciplinary team training may bring attention to the value of communication as a non‐technical skill.

Social network analysis of project procurement in Iranian construction mega projects

Several construction projects, worldwide, are suffering from delays and budget overruns; and Western Asia is not an exception. Studies have identified delays in progress payments and change order approvals as two of the main root causes of overruns in large building projects in the Middle East. In this study, the effect of procurement methods on these two factors has been investigated by analyzing the structure of social networks formed during these processes and evaluating the efficiency of information diffusion in such networks. Three contract types are focused, i.e., unit-rate; lump-sum; and EPC (Engineering, Procurement and Construction) to evaluate the functional performance of actor networks associated with them, and social network analysis (SNA) is used as the main analysis tool. After extracting the social networks formed in the mega-projects from the public domain in the Iranian construction industry, metrics from SNA were used to evaluate their functional performance concerning progress payment and change order management. The processes were compared at both network-level and the individuals involved. The observations were turned into an industry questionnaire and the key stakeholders involved in the projects were surveyed for validation and additional insights. The results identified the actors/roles of the most prominence in change and invoice networks of projects, as well as the strength and weaknesses of the three forms of standard contracts reviewed, as manifested in the performance of invoice and change management processes. It was observed that the formation of flat actor-networks in more modern contracts (such as the EPC) effectively supports a better flow of information, hence improves the performance of the processes under the study.

Accessing Private Rental Housing in the Absence of Housing Information in Ghana

While housing research in the developed world illustrates rental information channels, little is known about the situation in developing countries. This study examines the channels of information that are used in the private rental housing market by renters using Kumasi metropolis in Ghana as a case study. Using qualitative research methods involving interviews, findings show that unlike the developed world where rental information is readily available online, renters rely on a network of friends, relatives, co-worshippers and informal agents to find rental properties. A personal search is also common amongst renters. The use of these channels of information is founded on the absence of publicly available rental data. It is suggested that the rental space be regulated as a starting point to ensuring more formality and a better flow of information in the rental market.

Rapid super resolution for infrared imagery.

Infrared (IR) imagery is used in agriculture for irrigation monitoring and early detection of disease in plants. The common IR cameras in this field typically have low resolution. This work offers a method to obtain the super-resolution of IR images from low-power devices to enhance plant traits. The method is based on deep learning (DL). Most calculations are done in the low-resolution domain. The results of each layer are aggregated together to allow a better flow of information through the network. This work shows that good results can be achieved using depthwise separable convolution with roughly 300K multiply-accumulate computations (MACs), while state-of-the-art convolutional neural network-based super-resolution algorithms are performed with around 1500K MACs. MTF analysis of the proposed method shows a real ×4 improvement in the spatial resolution of the system, out-preforming the diffraction limit. The method is demonstrated on real agricultural images.

Can self-regulation work in environments of high corruption?

PurposeThe purpose of this paper is to investigate if market discipline and legal environment are sufficient to motivate firms to disclose optimal level of corporate information voluntarily in the context of a developing country that is Pakistan. Furthermore, it was examined if regulators have sufficient regulatory capacity to influence the extent up to which politically connected companies disclose corporate information.Design/methodology/approachAn in-depth investigation was carried out through qualitative content analysis of 200 annual reports from 40 companies listed on Karachi Stock Exchange along with 26 semi-structured interviews from experts in the field of corporate governance.FindingsFindings from the research indicated that there is an absence of culture for disclosure of information and country’s existing institutional environment is not sufficiently strong to support self-regulation or voluntary disclosure of information. It is argued that stringent disclosure regulation results in better flow of information in politically connected companies and helps in curbing opportunistic behaviour.Practical implicationsThis research carries significant policy implications. It is proposed that in addition to mandatory disclosure requirements, the code of corporate governance should indicate desirable disclosure levels for voluntary corporate information as well.Originality/valueThis is the first study to examine the effectiveness of role and usefulness of mandatory corporate disclosure regulation, voluntary disclosure practices, and capacity of regulators to enhance dissemination of corporate information in a developing country with high levels of political corruption and cronyism through an in-depth research.

Towards Energy Efficient Smart Grids Using Bio-Inspired Scheduling Techniques

Electric power grids are lagging in flexibility and time-response. A smart grid is an improved version of electrical grids that leverages Internet of Things (IoT) based devices to improve the overall infrastructure from the grid stations to intelligent appliances. It provides better understanding of supply and demand and overall flow of data depending based upon the requirements. Modern approach towards Smart grid envisions to provide electricity consumers with the opportunity to manage their respective power usage. Population increase has played a major role in the adoption of smart grid as a lot of electrical energy is consumed in the residential sector and a lot of architectures have been proposed for better flow of information from the smart meter to connectors and devices for improved customer participation. Customer needs have been very important in the smart grid. However, the customers have never been provided with the ease of choosing their own kind of benefits from the smart grid. In this work, we propose an enhanced architecture working effectively for multiple users based on their requirements. The users would be able to choose their type of scheduling techniques based on their requirements. These requirements may include cost reduction and increasing user comfort for better consumption of electricity and reliable systems. These requirements can be achieved using different Bio inspired computing based scheduling algorithms. Furthermore, in this work, we provide a comparison of these bio inspired scheduling techniques, i.e., Enhanced Differential Evolution, Bacterial Foraging Algorithm and Grey Wolf Optimization integrated in smart grid architecture for providing better consumption of electricity and achieving reliable systems. These algorithms mainly aim to schedule load, minimize electricity bills and maximize the user comfort depending on user demand.

Organization and functioning of the onion, zucchini and mandarin sectors supplying Antananarivo

Markets in Madagascar are characterized by a myriad of traders exchanging low product volumes. The organization between the actors is thus rather complicated. The aim of this study is to determine the bottlenecks in relation to the organization of the actors. This makes it possible to propose solutions to ensure a better flow of information and products between the actors. The identification of actors, the forms of coordination and the types of technical organization they maintain are analyzed according to their respective constraints; their level of access and information needs are determined. Thus, for each of the onion, courgette and mandarin sectors, there are five types of actors: producer-collector, collector-wholesaler, wholesaler, semi-wholesaler and retailer. Translated with www.DeepL.com/Translator , the majority of actors on the onion chain have no legal status, except the collector-wholesaler and the wholesaler. This majority practices their activities at the sidewalks and is present only at very limited schedules. For the onion chain, the actors are specialized in this product only or with other condiments. For the zucchini, the actors also market various vegetables according to the seasons, similar for mandarin, the actors treat all the fruits according to their season. The onion and mandarin sectors are characterized by the importance of collectors-wholesalers in transactions. They are the best informed among all actors. Nevertheless, for all these sectors, the collector-producers who collect from remote villages are of equal importance. Almost half of the respondents stated that they were interested in setting up a market information system. These are the information on the contact of new buyers and the prices in the production basins they wish to obtain.

Information and communication support of climate diplomacy

The article poses the problem of popularizing climate change as a factor of climate diplomacy. The subject of the study was the means and measures for implementing climate communication in the system of climate diplomacy. It is focused on event communications, which provide the best flow of events of various formats. To strengthen climate diplomacy, it is necessary to ensure a better flow of information and increase the effectiveness of disseminating information about climate change through formalized local meetings, focal points for climate change in the embassies of individual countries; studying needs for training and meeting them because of the diversity of activities of various information formats; integration of climate policy into broader dialogues and meetings, for example, annual meetings or regional conferences of delegations; preparation of materials on climate change available for different target audiences.

It's All About Communication: A Mixed-Methods Approach to Collaboration Between Volunteers and Staff in Pediatric Palliative Care.

Multidisciplinary teamwork is considered central to pediatric palliative care. Although different studies state that volunteers play an essential role in palliative care, little is known about the collaboration between volunteers and staff. This study aims to explore and compare the perspectives of volunteers and staff regarding collaboration in a pediatric palliative care unit. A mixed-methods approach was chosen to appropriately reflect the complex aspects of collaboration. Both face-to-face interviews with staff who work together with volunteers and a group discussion with all volunteers were conducted. These were supplemented by 2 questionnaires designed for this study that examined participants' characteristics and their estimation of what information volunteers need before they meet a patient. Nine staff members and 7 volunteers participated in this study. Their ideas of collaboration could be grouped into 3 categories: (i) factual level of collaboration, (ii) relationship level of collaboration, and (iii) overall appraisal of collaboration (suggestions for improvement). Communication can be considered a key factor in successful collaboration between volunteers and staff. Because many patients in pediatric palliative care units are not able to communicate verbally, good information flow between volunteers and staff is crucial for ensuring quality patient care. Moreover, communication is the key to establishing a team philosophy by clarifying roles and building relationships between volunteers and staff.

Application of computers in modernization of teaching science

The basic tendency of this paper is to point to the increasing application of information technology in teaching, and therefore also in the teaching of science and society. This means that educational process is constantly developing and improving, but teaching aids also are modernizing. Modern didactic and methodical knowledge are increasingly pointing out the shortcomings of traditional teaching and they offer solutions for overcoming these drawbacks, among the others, and through the modern informational technologies. In this sense, the use of computers is not just something that is recommended but it is becoming more necessary since it is the path to the active acquisition of knowledge and creativity. Multimedia teaching resources, contents and educational computer software enable students to critically use knowledge sources, to independently learn, analyze, systematize, compare and explore. The advantages offered by informational technologies are also in the fact that the teacher is relieved from one part of the obligation, teaching type, so it leaves him more time for the design of the teaching process. Purposefully use of teaching aids and forms of work, takes into account the capabilities of each student. The use of the computers and educational software in teaching provides a better flow of information since the presentation of information is performed through the multiple senses, so students can receive them visually or acoustically. Temporarily use of modern teaching aids (computers, educational software, etc.) allows students to come up quickly with different information and thus fulfill not only their increased interest in a particular area but also gain new knowledge.

Avoiding the Risks of Regulatory Red Tape: Insurance Regulation for the 21st Century

The extent of regulation of insurance companies has grown significantly in recent decades. The ‘freedom with publicity’ regime which defined the regulatory approach from 1870 to 1970 appeared to work and ran with the grain of the market. Arguments that are given today for prudential regulation of insurers tend to be spurious or not well founded. Much government regulation of insurance companies is unlikely to achieve its declared objective and might even encourage problematic behaviours within insurance markets. Regulation to ensure good governance and good information flows to markets may have some benefits and is less likely to cause the problems that other forms of regulation create. A case can be made for regulation designed to promote the objective of consumer protection. However, all the benefits of such regulation can be achieved with far fewer costs by creating a voluntary system of government regulation. Whether an insurance policy was written by a company which was part of the government regulatory system should be very clear to consumers at the point of sale.

Employment Experience of Immigrant Workers in Tourism

This research explores the experience of immigrants employed in tourism in Slovenia. Four main areas were studied: (1) formal regulation of working and living, (2) health and social care, (3) job satisfaction, and (4) integration into the Slovenian environment. The causes for this research were recent stories in various media regarding foreign workers in Slovenian economy and little to no research studies in the field of tourism. The idea of the article was to demonstrate the employment of labour migrants’ experiences in tourism and to make proposals to improve the employment experience in the future. We started out by studying the existing theory, and then performed qualitative research, in which the employment experiences of four immigrants was studied in the previously mentioned four identified areas. Interviews were carried out with immigrants from different countries and of different professions, and were later evaluated with content analysis. The results of the study show that the employment experience of immigrants employed in tourism in Slovenia is both positive and negative, as there were positive and negative factors of experience identified in all areas of research. We do not want to give a generalised assessment of the experience, but rather show certain views and experiences; based on that, we can learn. The results do not apply to the entire population, but with them we present the diversity of the subject. The greatest limitation while researching was finding participants. Initially, proposals for improvement are given on three levels; government, employer, and society. The main improvement should be the better flow of information, for which we suggest transferring more information online. Slovene society should be striving for tolerance so that foreigners would feel more welcomed.

Integrated Home Care Service: Qualitative Study on Collaboration between Home Care Nursing and Social Service

Introduction: Strategic aims of health authorities internationally call for a strengthening of home care service. An overriding majority of the expanding older population prefers to live at home as long as possible, given that the appropriate assistance is available. This trend demands a close cooperation of a wide range of specialized workforce in close coordination. Integration of home care nursing and social service in Reykjavik has been in process since 2009. At time of study, in 2015, the home care services were considered fully integrate. Collectively governed and financed with shared administrative structure¹. Studies show that integration improves quality of service with better flow of information, resource optimization and simplification of daily routines of treatments and care at home. Collaboration is prerequisite for integration but cooperation requires effective flow of information with closed loop communication, mutual trust and clear definition of staff members’ roles and responsibilities². Aim: Explore nature of collaboration of nursing and social services in a fully integrated service. Analyse actual situation of cooperation, its motivation and obstacles using Leutz´s integration model¹ and Salas´s model of teamwork². Method: Qualitative interview study with participants from a broad range of staff members. Data collection in two phases. 1) Individual semi-structured interviews (n=14), interview guide developed from literature on integration. 2) Five focus groups (n=25) where issues from interviews were further explored. Findings analysed using qualitative content analysis and framework analysis. Results: Integration of work between nursing and social services team leaders, who readily shared tasks and information, was successful. On other hand shortcomings were voiced by other members of both teams. They did not know each other, had no common meetings and therefore not a shared vision of the service provided. They had limited knowledge of the assistance provided by the other team members and felt unclear about their role in coordinated teamwork. Discussions: Although the home care services studied were seen as fully integrated our findings showed that the process was incomplete. The coordination between different team leaders is functional while opportunities for discussions among other staff members were lacking. Staff members needed more support and information about their role in coordinated teamwork. Conclusions: Full integration of home care nursing and social services calls for attention to opportunities among staff members to meet and discuss the care provided. Such meetings enhance mutual understandings of the services provided. The fundamental of successful teamwork is to understand one’s own role and others within the team. In order to complete integration, team members need continuous flow of information and strong supportive leadership. Lessons learned: Integration does not come instantly by combining workgroups under one roof with one director. Priority must be in terms of time and space to getting staff together, with common meetings, providing support and understanding. Limitations: Each focus group only met once. Repeated sessions could have provided more trust between participants with deeper conversation and more sincere answers. Suggestions for future research: Impact of regular meetings among social service and home care nursing staff members.