Staffing Decisions Research Articles

Inclusion and participation of children with epilepsy in schools: Views of young people, school staff and parents

ObjectiveTo gain an understanding of the views of children with epilepsy, their parents and staff regarding inclusion and participation of children with epilepsy in school. MethodsDuring the study period, 136 children with ‘active’ epilepsy (taking anti-seizure Medications (ASMs) for epilepsy), were identified in the study area and of these 68 (50% of those eligible) families agreed to participate. Children (n = 20) with ‘active epilepsy’ their parents (n = 68) and staff (n = 56) were interviewed or completed surveys. The quantitative data were analysed using descriptive statistics and chi-square analyses. The answers to open questions were analysed using thematic analyses. ResultsStaff in mainstream schools were more concerned about the child's attendance than staff in special schools (p = 0.008).Parents and school staff cited a number of negative aspects of the child's attendance difficulties including social–emotional and academic aspects. The majority of parents and staff felt that young people with epilepsy were included in school to the same extent as peers. Parents were however, significantly less likely than staff to agree that children were included in all playground activities (p = 0.045). Parents of children in special schools were more likely to agree that their child was included in school than parents of children attending mainstream schools (p = 0.041). Thematic analysis revealed that parents felt that their child could be excluded in school due to staff decisions, child's own choice and peer led exclusion. The majority of children (64%) and parents (56%) agreed that the child with epilepsy was restricted from doing things their peers could do because of their epilepsy. While more than half of children with epilepsy (63%) reported that they had been bullied, most did not attribute this bullying to having epilepsy. Parents were more likely to agree that their child was bullied because of their epilepsy (p = 0.035) and non-epilepsy reasons than staff (p<0.001). Parents of children with epilepsy attending mainstream schools were more likely to agree that their child was bullied because of their epilepsy (p = 0.017) and non-epilepsy reasons (p = 0.026), compared to parents of children with epilepsy attending special schools. ConclusionsSchool attendance difficulties for children with epilepsy can contribute to academic and social-emotional difficulties. Most parents and teachers feel that children with epilepsy are included in classroom activities to the same extent as peers. Children with epilepsy and their parents believe that they are more restricted in non-classroom activities compared with their peers. Difficulties with participation, friendships and bullying for children with epilepsy may be due to presence of other conditions as opposed to epilepsy per se. There is a need to increase understanding of the wide ranging impact of epilepsy on school life in order to enhance attendance and inclusion and to reduce bullying.

Average number of anesthetics still in progress in the early evening increased at least proportionally to the numbers of anesthetizing locations in the morning: A retrospective, long-term longitudinal study at two large hospitals

BackgroundAn earlier study examined weekend and holiday cases at many hospitals. Over a decade, treating weekend/holiday caseloads simply as proportional to total caseload resulted in a low error rate of <1 case per day, important when making weekend staffing decisions. In the current study, we examine the comparable issue related to evening staffing for the associations between numbers of anesthetics ongoing in the early evening, 6:00 PM, versus the total numbers of anesthetizing locations, specifically at 9:00 AM. MethodsData from two large teaching hospitals, November 2002 through May 2021 and November 2005 through June 2021, respectively, were retrieved and analyzed. ResultsAt one hospital, over 18.6 studied years, there was a 75% increase in anesthetics ongoing at 9:00 AM; Spearman rank correlation 0.99 (P < .0001). There was positive association with anesthetics ongoing at 6:00 PM; Spearman correlation 0.96 (P < .0001). The ratio of anesthetics at 6:00 PM to 9:00 AM increased over time; Spearman correlation 0.82 (P < .0001). Over the past decade, the simple model of proportional growth had a mean absolute predictive error in cases at 6:00 PM being less than 1 case per workday (mean 0.64 cases per workday, <1 case per workday P = .019). At the second hospital, over 15.6 years, there was a 17% increase in anesthetics ongoing at 9:00 AM; Spearman correlation 0.58 (P = .021). There was positive association between those anesthetic counts at 9:00 AM and those ongoing at 6:00 PM; Spearman correlation 0.85 (P < .0001). The ratio of anesthetics at 6:00 PM to 9:00 AM increased over time; Spearman correlation 0.92 (P < .0001). Over the past decade, the model of proportional growth had a mean absolute predictive error in cases at 6:00 PM that was minimal (mean 0.40 cases per workday, <1 case per workday P = .0001). ConclusionsHospitals should plan that as first case starts are added progressively, workload in the early evening may grow at least proportionally, as found for weekends and holidays. Such knowledge is important for operating room managers to consider when planning staffing, staff scheduling, and managerial decision-support for the end of the workday.

INFLUENCE OF PRINCIPALS' LEADERSHIP STYLES ON STUDENTS' ACADEMIC PERFORMANCE IN PUBLIC SECONDARY SCHOOLS IN NJORO DISTRICT, NAKURU COUNTY

Purpose: This study investigates the influence of principals' leadership styles on students' academic performance The study was guided by the following specific objective: identify the leadership styles used by Principals in public secondary schools in Njoro District, determine the influence of Principals' leadership on the managements of schools, establish the influence of Principals' leadership on teachers' job satisfaction in secondary schools and identify the influence of Principals' leadership on the performance of students.&#x0D; Design/ Methodology/Approach: This study used descriptive survey design. Purposive sampling was used to select the school principals, while simple random sampling technique was used to sample teachers, subordinate staff and students. A total of 380 respondents were targeted by the study (constituting 20 principals, 80 teachers, 40 subordinate staff and 240 students) out of which 372 responded (20 principals, 78 teachers, 34 subordinate staff and 240 students) giving a response rate of 98%. In sampling of the students, 12 students were sampled from form three classes in the schools selected. Questionnaires and interview schedules were used as instruments for data collection.&#x0D; Findings: Principals' leadership style influences school management in that it affects staff morale and decision making which impacts on service delivery among the teaching and non-teaching staff. The study further concludes that leadership style affects job satisfaction among the staff through their participation in decision making.&#x0D; Contribution to policy and practice: The study concluded that principals should adopt the use of leadership style such as the participative style where the staff ideas are also considered in decision making. This will improve their morale and hence job satisfaction.&#x0D; Originality/Value: The study extends the literature on leadershp style and management to improve performance in learning institutions.

UK Healthcare Workers' Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation.

The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.

The Effect of Health Systems' Opioid Quality Improvement (QI) Efforts on Prescribing Practices: Findings from the CDC Opioid QI Collaborative

Research ObjectiveTo address the opioid overdose epidemic, the Centers for Disease Control and Prevention (CDC) developed the Guideline for Prescribing Opioids for Chronic Pain. Recognizing that releasing a guideline alone is insufficient for transforming practice, CDC supports initiatives to promote uptake and use, including the CDC Opioid Quality Improvement (QI) Collaborative (“Collaborative”). This presentation describes a mixed‐methods analysis combining systems‐level context, individualized approaches to QI, selected implementation strategies, and preliminary outcomes from the eleven systems in the Collaborative.Study DesignThe Collaborative design is an observational case study of Opioid QI implementation across two cohorts totaling eleven systems. Participating health systems reported QI measure data available in their electronic health records (EHRs) for a self‐determined subset of the sixteen CDC‐developed opioid QI measures. Each system selected a minimum of five QI measures to monitor and report. We calculated odds ratios to determine whether patients were more likely to receive guideline‐concordant care at the end of their system's participation in the Collaborative than at baseline. Qualitative data included interviews conducted with a system representative at the beginning of each cohort, notes from monthly group implementation calls, monthly liaison check‐in calls, and documents provided by systems.Population StudiedThe Collaborative consists of eleven health systems, including over 120 practices representing urban, rural and frontier areas and serving underserved and tribal populations. Systems volunteered to participate, received an honorarium and engaged in the Collaborative for a minimum of 18 months. The baseline measure data reflects approximately 10,000 patients on long‐term opioid therapy (LTOT) across the systems.Principal FindingsThe QI efforts varied based on contextual factors, including: having QI team members in leadership roles, systems' experiences with past QI efforts, availability of IT staff, and external pressure to change practice. QI teams took different approaches to implementing the QI efforts, including selecting “easy wins” first for proof of concept before implementing more difficult QI activities, allowing each clinic to decide how to implement the QI activities at the local level, and heavily involving clinical staff in decisions to change workflow. Most systems used similar implementation strategies to improve practice, including developing a dashboard to audit and provide clinician feedback, providing clinician education, creating standardized treatment agreements in the EHR, using or building clinical decision support tools within the EHR, integrating the prescription drug monitoring program within the EHR, and updating opioid initiatives and workflow. Based on the preliminary outcomes, one system saw significant improvement over seven quarters in two measures of guideline‐concordant care: decreased days' supply for new opioid prescriptions to three days or less (OR = 1.34; CI 1.06–2.89), and increased rates of urine drug testing for patients on LTOT (OR = 1.81; CI 1.12–3.08). We expect to have complete results in February 2021 for five systems.ConclusionsInitial results suggest the potential for improvement in safer opioid prescribing and management practices after implementing a dedicated QI initiative within participating health systems.Implications for Policy or PracticeSupporting health systems in their opioid QI initiatives may improve their ability to measure and improve their prescribing practices and advance safer, more effective pain management.Primary Funding SourceCenters for Disease Control and Prevention.

The benefits of using a first generation SEM scanner versus an equipment selection pathway in preventing HAPUs.

Several studies have demonstrated improved clinical outcomes in pressure ulcer prevention using the SEM scanner, but none have compared it with other methods. In one of Scotland's health boards, 'hot spot' wards had been unable to reduce the number of hospital-acquired pressure ulcers (HAPUs) after several years of focused improvement work. In addition, other wards showed high use of dynamic therapy systems with associated costs. This review compares the use of a first generation SEM scanner versus a mattress and equipment selection pathway over a 6-week period. The findings show that the SEM scanner wards had zero HAPU while the equipment pathway wards developed a total of 4 HAPU. The two SEM scanner wards showed a 11% and 33% reduction in dynamic therapy use, while the pathway wards showed an average 40% increase. Consideration should be given to using SEM scanners to support staff decision-making to reduce HAPU development and dynamic therapy usage.

Bringing order or creating exclusion: systems for managing disability in a university

PurposeClassification schemes make things happen. The Australian Disability Discrimination Act (DDA), which derives its classification system from the World Health Organization's International Classification of Functioning, Disability and Health (ICF), legislates for adjustments to support the inclusion of people with disability. This study explores how students with disability enrolled in a university experience the systems intended to facilitate their studying “on the same basis” as students without disability.Design/methodology/approachThrough an online questionnaire and interviews comprising open and closed questions made available to students registered with the disability services unit of a university and follow-up interviews with a small number of students, students’ views of their own disability and effects on their participation in learning were gathered, alongside reports of their experiences of seeking support in their learning. Interview data and responses to open-ended questions were analysed using a priori and emergent coding.FindingsThe findings demonstrate that students are aware of the workings of the classification scheme and that most accept them. However, some students put themselves outside of the scheme, often as a way to exercise autonomy or to assert their “ability”, while others are excluded from it by the decisions of academic staff. Thus, the principles of fairness and equity enshrined in legislation and policy are weakened.Originality/valueThrough the voices of students with disability, it is apparent that, even though a student's classification according to the DDA and associated university policy remains constant, the outcomes of the workings of the scheme may reveal inconsistencies, emerging from the complexity of bureaucracy, processes and the exercises of power.

Inpatient Staffing Dashboard: A Nursing-Information Technology Collaborative Project.

Inadequate staffing negatively impacts hospital operations, quality of patient care, and employee engagement. Traditional staffing approaches to address clinical staffing and scheduling are not as effective in a complex healthcare environment. Organizations must leverage innovative strategies and use of technology to improve clinical staffing. To address the staffing challenges, nursing staffing and information technology at Loma Linda University Medical Center developed an inpatient staffing dashboard. A staffing dashboard is a staffing tool comprised of several tabs and staffing measures, which include filled percentage as the key performance indicator. During the staffing dashboard development, evaluation took place to determine the staffing and scheduling system's extract-transform-load capacity. Data were analyzed, defined, and profiled. Tableau software was used to create an interactive staffing dashboard and integrated with EPIC Hyperspace for user accessibility. The interactive features and staffing measures available in this staffing tool empowered staffing and nursing leaders to utilize data visualization for day-to-day nursing operations, proactively plan for staffing demands, and use data to drive staffing decisions. Our collaborative experience proved that nursing and information technology collaborative projects produce innovative solutions and workflow efficiencies. Leaders must promote nursing-information technology collaborations in healthcare organizations.

Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data

BackgroundMedical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia.MethodsClinically coded data routinely submitted for inter-hospital benchmarking purposes was used to identify the cohort of medical admission patients presenting to the ED in February 2016 (summer) and June 2016 (winter). A retrospective review of patient medical records for this cohort was then conducted to extract MAU admission data, de-identified patient demographic data, and clinical criteria. The primary outcome was the proportion of admissions that adhered to the MAU admission criteria.ResultsOf the total of 540 included patients, 386 (71 %) patients were deemed to meet the MAU eligibility admission criteria. Among patients with MAU indications, 66 % were correctly transferred (95 % CI: 61 to 71) to the MAU; this estimated sensitivity was statistically significant when compared with random allocation (p-value < 0.001). Transfer outcomes for patients with contraindications were subject to higher uncertainty, with a high proportion of these patients incorrectly transferred to the MAU (73 % transferred; 95 % CI: 50 to 89 %; p-value = 0.052).ConclusionsBased on clinical criteria, approximately two-thirds of patients were appropriately transferred to the MAU; however, a larger proportion of patients were inappropriately transferred to the MAU. While clinical criteria and judgement are generally established as the process in making decisions to transfer patients to a limited-capacity MAU, our findings suggest that other contextual factors such as bed availability, time of day, and staffing mix, including discipline profile of decision-making staff during ordinary hours and after hours, may influence decisions in directing patient flow. Further research is needed to better understand the interplay of other determinants of clinician decision making behaviour to inform strategies for improving more efficient use of MAUs, and the impact this has on clinical outcomes, length of stay, and patient flow measures in MAUs.

Intensive care unit nurses living through COVID‐19: A qualitative study

AimsTo understand how nurses experience providing care for patients hospitalized with COVID‐19 in intensive care units.BackgroundAs hospitals adjust staffing patterns to meet the demands of the pandemic, nurses have direct physical contact with ill patients, placing themselves and their families at physical and emotional risk.MethodsFrom June to August 2020, semi‐structured interviews were conducted. Sixteen nurses caring for COVID‐19 patients during the first surge of the pandemic were selected via purposive sampling. Participants worked in ICUs of a quaternary 1,000‐bed hospital in the Northeast United States. Interviews were transcribed verbatim, identifiers were removed, and data were coded thematically.ResultsOur exploratory study identified four themes that describe the experiences of nurses providing care to patients in COVID‐19 ICUs during the first surge: (a) challenges of working with new co‐workers and teams, (b) challenges of maintaining existing working relationships, (c) role of nursing leadership in providing information and maintaining morale and (d) the importance of institutional‐level acknowledgement of their work.ConclusionsAs the pandemic continues, hospitals should implement nursing staffing models that maintain and strengthen existing relationships to minimize exhaustion and burnout.Implications for Nursing ManagementTo better support nurses, hospital leaders need to account for their experiences caring for COVID‐19 patients when making staffing decisions.

Follow-up evaluation of a web-based pediatric brain tumor board in Latin America.

Since 2013, pediatric oncologists from Central and South America discuss neuro-oncology cases with experts from North America and Europe in a web-based "Latin American Tumor Board" (LATB). Here, we evaluate the feasibility of recommendations rendered by the Board. An electronic questionnaire was distributed to physicians who had received recommendations between October 2017 and October 2018. Physicians were asked regarding the feasibility of each recommendation given during the LATB discussion. Baseline case characteristics of all presented cases were obtained from anonymized minutes. Of the 142 patients discussed, data on 103 patients from 15 countries were available, corresponding to 283 recommendations. Physicians followed 60% of diagnostic procedural recommendations and 69% of therapeutic recommendations. The most difficult recommendations to follow were genetic and molecular testing, pathology review, chemotherapy, surgery, and molecular targeted therapies. Histological diagnoses changed in eight of 18 cases in which a pathology review was undertaken. Fifty-four percent of the recommendations that could not be implemented were considered not feasible in the specific context of the patient, while 31% were not implemented due to a decision of the medical staff or the parents (15% not specified). However, 96% of respondents considered the recommendations useful. Recommendations were frequently perceived as useful, and were applicable in the participating institutions. Nevertheless, limitations in availability of diagnostic procedures and treatment modalities affected the feasibility of some recommendations. Tele-oncology tumor boards offer physicians from low- and middle-income countries access to real-time, high-level subspecialist expertise and provide a valuable platform for worldwide information exchange.

COVID-19's Financial Impact on Primary Care Clinicians and Practices.

Coronavirus disease 2019 (COVID-19) disrupted and undermined primary care delivery. The goal of this study was to examine the financial impacts the pandemic has had on primary care clinicians and practices. The American Academy of Family Physicians National Research Network and the Robert Graham Center distributed weekly surveys from March 27, 2020, through June 15, 2020, to a network of more than 1960 physicians. Responses to the question, "Could you please tell us about any financial impact the COVID-19 pandemic has had on your practice, if any?" were analyzed using a grounded theory approach of qualitative analysis. The number of unique respondents who answered the financial impact question totaled 461 over the 12 weeks. Severe declines in patient visits, causing drastic revenue reductions, greatly impacted the ability to serve patients. Primary care clinicians and practices experienced significant changes in several areas about financial implications: patient visits, financial strain, staffing and telehealth. Preliminary findings revealed that even with Coronavirus Aid, Relief, and Economic Security Act, also known as CARES Act, funding, business viability remains questionable for some primary care practices. Low patient visits directly resulted in decreased revenues, which in turn, impacted staffing decisions and fueled telehealth implementation. It is difficult to predict whether patient visits will increase after June. Alternate payment models could provide some financial stability and address business viability.

PLANNING THE FUNCTIONAL POSITIONS WITHIN THE SPORTS ENTITY: MODEL AND ANALYSIS

The human resources are the only ones resources able to produce and reproduce all the other resources available to a sports organization, although the material and financial ones are important. The jobs’ analysis is the process that determines the tasks, the activities specific to a position and the type of persons recommended for its occupation, involving a common effort by the specialist in human resources, hierarchical chief and employee, being necessary to provide us exact information regarding the job and to justify the staff decisions. The productivity in all sports organizations is influenced by how they interact and combine the human resources in order to use the other resources of the management system. Factors such as preparation, age, job experience and the level of formal education play a role in establishing the person compatibility with a certain organization. The process of assurance of human resources suitable for a sports structure is an engaging process and slightly subjective. In order to assure the human resources that cover both managerial positions, as well as the execution ones, the managers follow the next sequentially steps: recruitment; selection; training and improvement; evaluation. There is a reciprocal interdependence between the management and execution positions established by the nature of relations that exists between the decision centers of the sports organization and its effective centers.

Initial testing of the use of the Safer Nursing Care Tool in a Canadian acute care context.

AimInitial testing of England's Safer Nursing Care Tool for adult in‐patient acute care wards in a university‐affiliated Canadian hospital.BackgroundSafe‐nursing staffing decisions have significant impacts on patients' safety and quality of care. The Safer Nursing Care Tool was developed in England to provide managers with a validated formula for making appropriate nursing staffing decisions. The tool has been widely used and studied in the UK but has yet to be tested in a Canadian context.MethodTen high service quality acute care wards from a university‐affiliated Canadian hospital tested the use of the Safer Nursing Care Tool. Service quality, patients' dependency/acuity and staff activity data were benchmarked against information collected in 726 comparable UK wards.ResultsHigher bed occupancy and patient dependency/acuity mix were found in the 10 Canadian wards compared to their UK counterparts. Overall staff activity was comparable between UK and Canadian wards.ConclusionThe Safer Nursing Care Tool can be applied in this Canadian hospital, and further testing in other hospitals and specialties is required.Implication for Nursing ManagementThe Safer Nursing Care Tool is a valid staffing tool to use that, when combined with professional judgement, can help managers to properly establish nursing staff in acute care wards.

Communicative Model of Presidential Chief of Staff in Decision Making of Public Policy

This research examined the communicative institution of the presidential chief staff of the Republic of Indonesia during Jokowi’s administration. The purpose of this research was to find a communicative model applied by the presidential chief staff in making public decisions. The theory used was the role of Communicative Constitutive of Organization, the management concept of bureaucracy and public office, and the rational model of public decision making. The method used in this research was case study in which cases analyzed from policies through interview and observation, and literature study. The results of the research on decision-making processes of public policies based on national development planning in Jokowi’s Nawacita were institutional communications carried out by the Presidential Chief of Staff (PCS) in the form of monitoring, solving barriers related to bureaucracy management in communication toward public through various online media, talk shows, and news. Communication across institutions and internal communication were carried out exclusively. Based on rational decision making, the communicative model of the presidential chief of staff was one-way process providing no room for discussion or negotiation involving the community. stakeholder external participation in the institutional communicative model were in ministry department, non-institutional department, provincial, district, and city governments. Keywords: Model, communicative, presidential, public policy, decision making ABSTRAK Studi ini mengkaji kelembagaan komunikatif para staf Kepala Kepresidenan Republik Indonesia pada masa pemerintahan Jokowi. Tujuan dari penelitian ini adalah untuk mengetahui model komunikatif yang diterapkan oleh jajaran pimpinan presiden dalam pengambilan keputusan publik. Teori yang digunakan adalah peran Konstitutif Komunikatif Organisasi, konsep manajemen birokrasi dan jabatan publik, dan model rasional pengambilan keputusan publik. Metode yang digunakan dalam penelitian ini adalah studi kasus di mana analisis kasus dari kebijakan melalui wawancara dan observasi, serta studi pustaka. Hasil penelitian proses pengambilan keputusan kebijakan publik berdasarkan perencanaan pembangunan nasional dalam Nawacita Jokowi adalah komunikasi kelembagaan yang dilakukan oleh Kepala Staf Kepresidenan (PCS) dalam bentuk pemantauan, penyelesaian hambatan terkait pengelolaan birokrasi dalam komunikasi menuju publik melalui berbagai media online, talk show, dan berita. Komunikasi lintas institusi dan komunikasi internal dilakukan secara eksklusif. Berdasarkan pengambilan keputusan yang rasional, model komunikatif Kepala Staf Kepresidenan merupakan proses satu arah yang tidak memberikan ruang untuk diskusi atau negosiasi yang melibatkan masyarakat. Partisipasi eksternal pemangku kepentingan dalam model komunikatif kelembagaan berada di departemen kementerian, departemen non-kelembagaan, pemerintah provinsi, kabupaten, dan kota. Kata Kunci: Model, komunikatif, presidensial, kebijakan publik, pengambilan keputusan

Prototyping and Validating a Non-immersive Virtual Reality Serious Game for Healthcare Fire Safety Training

In a healthcare context, the success of a fire safety procedure in a real-life emergency mainly depends on staff decisions and actions. One of the factors influencing staff decision-making is their training. In most healthcare facilities, safety educators use slide-based lectures as a training tool. Virtual Reality (VR) is gaining fire safety community attention for being an interesting training tool. However, few studies have assessed the effectiveness of VR-based fire safety training simulators compared with a slide-based lecture. The present research proposes a novel non-immersive VR-based training for healthcare fire safety education. This paper describes the prototyping steps required to develop a non-immersive VR serious game (SG) to train the staff of Vincent Van Gogh (VVG) hospital in Belgium. The paper finally validates the VR SG comparing its effectiveness against slide-based lecture training. 78 staff from VVG hospital in Belgium participated in this study. They were divided into two groups: Group A was trained using a slide-based lecture, and Group B was trained using the VR SG. The results indicated that the VR SG was more effective than the slide-based lecture in terms of knowledge acquisition and retention and in terms of self-efficacy increment in short and long terms than the slide-based lecture.

Using Weather, Lunar Cycles, and Time of Year to Predict Trauma Incidents in an Urban, Level I Pediatric Trauma Center.

Trauma patterns in adults are influenced by weather conditions, lunar phases, and time of year. The extent to which these factors contribute to pediatric trauma is unclear. The present study aimed to review patients from a single Level I pediatric trauma center to determine the influence of weather, the lunar cycle, and time of year on trauma activity. A retrospective review of trauma activations (n = 1,932) was conducted from 2015 to 2017. Injury type and general demographics were collected. Weather data and lunar cycles were derived from historical databases. Days with no precipitation increased the total number of injuries of all types compared with those with precipitation (p < .001). Blunt and penetrating injuries were more likely to occur during full moons, whereas burn injuries were significantly higher during new moons (p < .001). Blunt trauma was significantly higher in September than all other months, F(11, 1,921) = 4.25, p < .001, whereas January had a significantly higher number of burns than all other months (p < .001). Pediatric trauma trends associated with external factors such as weather, lunar cycles, and time of year can inform hospital staffing decisions in anticipation of likely injuries and help direct injury prevention efforts.

Adaptative vital signs monitoring system based on the early warning score approach in smart hospital context

AbstractChanges in vital signs are an important indicator of physiological decline and provide opportunities for early recognition and intervention. The collected vital signs data can be evaluated using several approaches such as the Early warning score (EWS) approach to predict the risk level of patients. By exploring the Internet of things (IoT), vital signs monitoring solutions are automated based on various medical devices and sensors. However, there is a lack of efficient tools that enable an adaptative monitoring depending on the patient situations. This article explores the IoT technologies to provide an EWS system in smart hospital situation. The proposed solution presents an adaptative configuration of the vital signs monitoring process depending on the patient’s health status variation and the medical staff decisions. Also, an intelligent notification mechanism that reduces the delay of the medical staff intervention in the case of risk detection is proposed.

Acute Care Decision-Making for Patients with Advanced Dementia: An Exploratory Study Using Cognitive Task Analysis

Decision-making by medical and health care staff forms the core of professional practice. Thought processes, including non-clinical considerations, significantly impact how clinical decisions are made. Such considerations become more relevant when addressing end-of-life care decisions for patients with advanced dementia (PAD). Though palliative care is recommended for this population, its implementation tends to vary. Given the medical staff’s significant influence in guiding clinical decisions, we examined thought processes that accompany staff decisions. We used Cognitive Task Analysis (CTA) to analyze interviews conducted with 15 physicians and 11 nurses working in acute care wards in Central Israel. Participants were interviewed regarding their clinical decision-making in a hypothetical scenario of a PAD who presents with an acute, potentially life-threatening medical problem. Moral judgment orientation was the primary factor affecting clinical decision-making for advanced dementia, with a pronounced dichotomous split between deontological and utilitarian approaches. This polarization was highly associated with the medical specialty. Practitioners in surgical wards tended to focus on the patient’s current medical condition, as an isolated or disease-centered illness perspective, supported by deontological moral lines of thinking. This perspective was contrary to that of staff in medical wards who mostly treated the patient from a holistic perspective with a patient-focus approach, supported by utilitarian moral lines of thinking. Although all respondents presented the patient or family as primary decision partners, the practitioners were motivated to make decisions based on unit hierarchies or positions of authority figures. Therefore, clinical end-of-life decisions are influenced by different thinking processes of the health staff and several non-clinical factors. The moral thinking paradigm was found to be associated with a professional orientation. Understanding the subjective, non-clinical aspects of decision-making for PAD might improve end-of-life care in this population.

Factors Affecting the Organizational Silence of Academics Employed at the Universities in Pakistan

This study aims to reveal various factors affecting the organizational silence of academics employed at the universities in Pakistan. The teaching staff of the universities in Pakistan is among the most experienced and intellectual individuals and represents the elite sections of the society and the nation. For this reason, their opinions are considered to be very important for the generations of posterity. The teaching staff at the universities is also composed of planners, analysts, supervisors, and evaluators. The survey was conducted on 410 teaching staff such as lecturers, assistant professors, associate professors, and professors of various universities from six different provinces: public, private, and army. The data were analyzed through the Statistical Business Analyst (SAS) program. Organizations generally hire employees who have some experience, ideas, knowledge in order to develop their organizations. In summary, it can be said that there are generally two options for the staff working in any organization when perceiving wrongdoing in their workplace. They must either decide to speak up or continue to be silent. It is a fact that there is a prevalence of wrongdoings in every kind of organization, but unfortunately, not a lot is known about the decision making of staff related to this practice. While trying to find out factors affecting organizational silence, the observers believe that fear is one of the main factors in staff decisions to be silent about the issues and concerns in organizations. To overcome organizational silence, polyphony is accepted as one of the ways to solve the existing problem