Support Staff Research Articles

The relationship between serum vitamin D, bone mineral density, and injury in collegiate acrobatics and tumbling athletes.

Background: Medical staff for indoor aesthetic sports such as acrobatics and tumbling (A&T) is often concerned with athletes' bone mineral density (BMD), serum vitamin D (SvD), and associated injury risks. Aim: To evaluate the relationship between BMD, SvD, and injury among A&T athletes. Methods: 42 (19 tops, 23 bases) female A&T athletes aged 19.6 (±1.17) years participated. Two samples of SvD were taken. Injury and BMD data were provided by support staff. Bivariate and multivariate analysis assessed relationships between and among variables. Results: Participants experienced a decrease in SvD (6.093 ± 10.973). Spine BMD was significantly higher in bases compared to tops (p = 0.039). BMD and SvD did not differ based on injuries sustained. Conclusion: Relationships between SvD, BMD, and injury were not identified. Positional differences in BMD may be related to the demands of each role. Participants possessed low SvD and high BMDs, which may provide useful information for medical staff.

Impact of motherhood and social support on the wellbeing of UK female police officers and staff

Abstract Background Female officers and staff face gender-specific challenges, particularly, during pregnancy and motherhood. Our study explores whether and how motherhood affects mental health outcomes (e.g., probable depression and anxiety) and return to work following sickness absence (SA), considering mediating role of workplace social support. Methods Logistic regression analysed probable depression and anxiety using Airwave Health Monitoring Study (AHMS) data. Cox proportional hazards models assessed return to work after sickness absence, linking AHMS with sickness absence data from 26 police forces. Exposure variables were created by the interaction of motherhood status and social support, while covariates included sociodemographic, lifestyle, and work-related factors. Results Mothers with low social support from superiors had higher odds of probable depression (OR = 2.14, 95% CI = 1.81-2.54) and anxiety (OR = 1.86, 95% CI = 1.62-2.14) compared to non-mothers. Moderate and high social support reduced odds of depression (Moderate: OR = 0.97, 95% CI = 0.85-1.11; High: OR = 0.65, 95% CI = 0.57-0.73) and anxiety (Moderate: OR = 1.24, 95% CI = 1.12-1.36; High: OR = 0.82, 95% CI = 0.75-0.9) for mothers, but the impact varied when adjusted for covariates. Mothers with lower levels of social support were less likely to return to work after SA compared to non-mothers, as indicated by the survival analysis (Low social support: HR = 0.83, 95% CI = 0.95-1.13; High social support: HR = 1, 95% CI = 0.96-1.04). These trends persisted across social support sources-colleagues and combined support-emphasising the complex interplay between workplace social support, motherhood, mental health, and sickness absence in policing. Conclusions Our study emphasises boosting workplace social support for female police officers and staff, to aid them in navigating motherhood demands. This improvement can lead to better mental health, retention, job satisfaction, and organisational effectiveness, ultimately promoting community safety. Key messages • Highlighting the importance of workplace social support for female police officers and staff, informs policy makers and practitioners to prioritize social support initiatives within policing. • Lower social support was associated with a reduced likelihood of returning to work after sickness absence, particularly among mothers compared to non-mothers.

Barriers and Facilitators in Implementation of Nutritional Benefit Transfer to Tuberculosis Patients

Abstract Background Malnutrition & Tuberculosis (TB) form a vicious cycle. Nikshay Poshan Yojana (NPY) is a key strategy for a TB free India, that seeks to provide financial assistance for nutritional support to TB patients. The study is a qualitative study to identify operational challenges and facilitators in implementation of NPY Methods In Depth Interview (IDI) of 18 Senior Treatment Supervisor (STS) at Tuberculosis Unit (TU) and 19 Tuberculosis Health Visitor (TB HV) at Designated Microscopy Centre’s (DMC) was done. For further insights, the STS, at District Tuberculosis Centre, Lucknow was also interviewed. Informal discussion was done with about 50 Tuberculosis patients. We explored providers perspective on impact of NPY on other duties/services, case load, hours dedicated to NPY, practice protocols, record keeping and data management, compliances, capacity building needs, quality protocols, key enablers, motivating factors, challenges, best practices and beneficiary’s perspectives on quality of life, facilitators and challenges in availing services. Results Motivating leadership, supportive staff, good working relationship and seamless communication, teamwork, use of technology, supportive supervision & collaboration and support of NGO for private sector were the key facilitators. Barriers comprised system level barriers (Budget constraints, issues with NIKSHAY software and bank account), provider level barriers (shortage of human resource, nonfunctional tablets) and patient level barriers (stigma and bank account related challenges). The encouraging finding was majority of recipients, responding that they used the incentive to purchase ration, vitamin supplements etc. Conclusions NPY is having its intended benefit but there are barriers that need to be resolved for successful roll out. The study yield suggestions for removing barriers and found a set of innovations that can be replicated across other settings with high Tuberculosis burden Key messages • Malnutrition and Tuberculosis form a vicious cycle. Nutritional support to TB patients improves treatment outcome and can save lives. • Operational research on implementation of NPY offers insights for successful roll out of this key initiative across other resource limited settings in developing countries.

Hearts and minds: a community-based systems diagram exploring mental health following a cardiac event

Abstract Background/Introduction Following an acute cardiac event, individuals commonly face multiple emotional and mental health challenges. For many people, this change in their mental health will resolve over time. However, one in five will go on to develop major depressive disorder. The development of major depressive disorder is a complex co-morbidity that, if left unchecked, can increase the risk of subsequent cardiac events and mortality. Systems thinking methodology offers a novel approach to investigating factors that contribute to mental health following a cardiovascular event. Purpose This project aims to (1) unravel the complex system influencing mental health after a cardiac event and (2) pinpoint priorities for supporting individuals' mental well-being following a cardiac event. Methods Group model building workshops using Deakin University’s purpose-built STICKE software were conducted over Zoom to explore the interrelationships contributing to mental health following a cardiovascular event. Twelve participants, including consumers (n = 3) and healthcare professionals (n = 9) from across Australia, engaged in two 1.5-hour workshops. Guided by the prompt "Reflect on factors influencing a person’s mental health post-cardiac event", participants worked together to construct a systems diagram. This facilitated exploration, visual mapping, and identification of factors and priority areas influencing mental health post-cardiac event. The diagram was then analysed using the theoretical domains framework. Results The STICKE diagram developed demonstrates the interplay of various factors impacting mental health across the cardiac healthcare journey at both patient and system levels (see Figure 1). Using the theoretical domains framework, eight domains were identified: knowledge, skills of healthcare professionals, environmental context, personal context, emotional response to event and recovery, social influences, behavioural regulation, and beliefs about individual capacity. Knowledge (including health literacy and staff training), environmental context (addressing gaps in care and navigating the system), and social influences (such as social isolation) were domains that were consistently raised in the workshop (see Figure 2). Stakeholders also identified the following key priority areas: highlighting the need for additional support for staff and intervention to increase health literacy and knowledge around mental health. Conclusion(s) Supporting mental health post-cardiac events is a multifaceted challenge requiring a comprehensive community-level intervention, particularly in the initial weeks post-hospitalisation. The insights gained from this study will inform the co-design of an intervention aimed at increasing health literacy and knowledge around mental health following a cardiovascular event.

Socioemotional instruction in learning support staff across Italian primary schools: a call for using the ‘multidimensional, scaffolding framework’ in training programmes

ABSTRACT International research has illustrated that learning support staff (LSS) play a crucial role in the instruction of children with special educational needs and/or disabilities (SEND): they support the children’s classwork while teachers manage the whole-class instruction. However, fewer research studies have explored LSS’s role in the children’s socioemotional learning, although this support is highly important for pupils’ regulation of negative emotions, effective participation in whole-class conversations, and academic learning. The current research explores LSS socioemotional practices in a relatively unexamined country (Italy), providing LSS with a high level of training. Thirty-one primary-school-LSS members completed a questionnaire and interview. The LSS reported infrequently supporting the socioemotional learning of children with (and without) SEND despite their difficulties. Also, they appeared to overly control the children’s peer interactions and emotions, minimising their self-management. The participants associated their infrequent socioemotional instruction with their limited socioemotional training and preparedness, and insufficient persuasion by the national curriculum to promote socioemotional education. Findings are largely interpreted using a new ‘multidimensional, scaffolding framework’ linking LSS socioemotional practices and related children’s learning. Findings also suggest that the framework could usefully guide LSS training.

Applying a theory of change framework to create transformative and equity‐based community engagement experiences at a small, liberal arts, Lasallian institution

AbstractSaint Mary's College of California is a small, Catholic Lasallian, liberal arts institution located in the San Francisco Bay area. Founded in 1863, the institution currently serves approximately 2,000 enrolled students. The Catholic Institute for Lasallian Social Action (CILSA) is the social justice and community engagement center that provides institutional support for curricular and co‐curricular community engagement (CE) experiences. In the academic year 2020–2021, CILSA staff collaborated with CE faculty, alumni, staff, and community partners to develop a Theory of Change to explore the challenges, values, and strategies of engagement work and make change in our community. In this article, we will highlight our engaged learning programs, describe our process to create CILSA's Theory of Change, share the ways CILSA staff support and collaborate with each other, and showcase the Head‐Heart‐Hands framework for student reflection.

Experience of Continuous Ambulatory Peritoneal Dialysis In Remote Area of Southeast Bangladesh

Background: Chronic kidney disease (CKD) is a major public health problem that continues to increase in prevalence globally. The prevalence of chronic kidney disease is increasing day by day in low to middle income countries (LMICs). People living in LMICs have the highest need for renal replacement therapy (RRT) despite they have lowest access to various modalities of treatment. As continuous ambulatory peritoneal dialysis (CAPD) does not require advanced technologies, very much infrastructure, dialysis staff support, it should be an ideal form of RRT in LMICs, particularly for those living in remote areas. To authors knowledge there was scarcity of data regarding CAPD performance in remote area of Bangladesh. This study was aimed to report the characteristics and outcomes of CAPD in ESRD patients lived in least developed area of Bangladesh. Methods: This prospective study was conducted in Cox’sbazar Medical College Hospital, Cox’sbazar and Parkview hospital Ltd, Chattogram, Bangladesh. Data were collected by questionnaire from the patients of any age with end-stage renal disease (ESRD) who underwent CAPD in 2018–2021. The baseline characteristics, PD-related complication as well as patient and technique survivals were analyzed. Results: Out of 31 patients who underwent CAPD, 18 (58%) were male on the age range of 15–79 years. The mean follow-up duration was 18 months. Mortality was inversely related with the EF of echocardiography. The peritonitis rate was 0.48 episodes per patient per year. The 1, 3 and 4-year patient survival rates were 64.34% (95% CI = 52.5–81.5), 23.79% (95% CI = 17.9 – 57.4) and 3.22% (95% CI = 31.2–77.5) respectively. Conclusions: In this study, CAPD performance was poorer than usual reference. Cardiac compromised patient and inappropriate dwell might be the main contributing factors behind this scenario. The peritonitis rate was nearly similar to that of developed countries. CAPD was cost effective than HD in remote area. Some accessible measures may be taken to make CAPD a more acceptable RRT modality with improved outcomes in poor socioeconomic backgrounds area. J Dhaka Med Coll. 2023; 32(1) : 24-31

Impact of Human Resource Policy Implementation on Service Delivery at the Office of the Director of Public Prosecutions, Western Region, Kenya

Efficient implementation of policies has a crucial function in improving service delivery in the public and private domains. The success of policy execution directly impacts how much the policy contributes to enhancing service delivery. To achieve high-quality, efficient, and timely service delivery, the Directorate has adopted a strategy of revamping, retooling, and continuous learning. The Office of the Director of Public Prosecutions (ODPP) follows the Excellence Charter and adheres to the ODPP Strategic Commitments for the period 2020-2023. In this context, the researcher focused on examining the impact of human resource policy implementation on service delivery at the Office of the Director of Public Prosecutions, Western Region, Kenya. Implementation Theory and Organizational Culture Theory guided the study. Descriptive research design was utilized. The target population was 198 individuals working within the ODPP Western Region of Kenya. Individual respondents were selected randomly from Legal, Administration, and Support Staff in region. Data collection was done through questionnaires distributed to staff and document analysis was conducted in the resource centres available in the region. Face-to-face interviews with selected County Heads were carried out by the researcher. Descriptive statistics, such as means, percentages, and frequencies, was used in the research's quantitative and qualitative approaches to analyze the data using SPSS. The findings indicated that human resource has a significant impact on service delivery at the ODPP, Western Region, Kenya. The results upon Analysis of Variance (ANOVA) established human resource policy implementation had an r of 0.265, β = 0.252, t= 3.786, p= 0.05. It was concluded that Policy Implementation had a statistically significant impact on service delivery in the ODPP. The study recommends that ODPP should enhance HR policy implementation and service delivery in the Western Region by improving communication, offering regular training, fostering open dialogue, establishing a robust monitoring framework, deploying dedicated HR Officers, and ensuring transparent and unbiased career progression and training opportunities. The study will be part of references materials for all ODPP Staff, stakeholders, policy makers and other institutions in Kenya as an insightful tool in advancement of efficacy and efficiency in policy implementation.

Developing Independent Living Support for Older Adults Using Internet of Things and AI-Based Systems: Co-Design Study.

The number of older people with unmet health care and support needs is increasing substantially due to the challenges facing health care systems worldwide. There are potentially great benefits to using the Internet of Things coupled with artificial intelligence to support independent living and the measurement of health risks, thus improving quality of life for the older adult population. Taking a co-design approach has the potential to ensure that these technological solutions are developed to address specific user needs and requirements. The aim of this study was to investigate stakeholders' perceptions of independent living and technology solutions, identify stakeholders' suggestions on how technology could assist older adults to live independently, and explore the acceptability and usefulness of a prototype Internet of Things solution called the NEX system to support independent living for an older adult population. The development of the NEX system was carried out in 3 key phases with a strong focus on diverse stakeholder involvement. The initial predesign exploratory phase recruited 17 stakeholders, including older adults and family caregivers, using fictitious personas and scenarios to explore initial perceptions of independent living and technology solutions. The subsequent co-design and testing phase expanded this to include a comprehensive web-based survey completed by 380 stakeholders, encompassing older adults, family caregivers, health care professionals, and home care support staff. This phase also included prototype testing at home by 7 older adults to assess technology needs, requirements, and the initial acceptability of the system. Finally, in the postdesign phase, workshops were held between academic and industry partners to analyze data collected from the earlier stages and to discuss recommendations for the future development of the system. The predesign phase revealed 3 broad themes: loneliness and technology, aging and technology, and adopting and using technology. The co-design phase highlighted key areas where technology could assist older adults to live independently: home security, falls and loneliness, remote monitoring by family members, and communication with clients. Prototype testing revealed that the acceptability aspects of the prototype varied across technology types. Ambient sensors and voice-activated assistants were described as the most acceptable technology by participants. Last, the postdesign analysis process highlighted that ambient sensors have the potential for automatic detection of activities of daily living, resulting in key recommendations for future developments and deployments in this area. This study demonstrates the significance of incorporating diverse stakeholder perspectives in developing solutions that support independent living. Additionally, it emphasizes the advantages of prototype testing in home environments, offering crucial insights into the real-world experiences of users interacting with technological solutions.

The burden of sustaining communication: communication breakdowns experienced by deaf students and their communication support workers in a further education college

ABSTRACT The educational inclusion of deaf students in England is usually interpreted as placement in mainstream settings alongside hearing students, creating unintended pressure for assimilation to the communicative needs of hearing people. In this context, it is deaf students and their communication support staff who are left to deal with communicative disparities found in educational settings. This ethnographic study explored episodes of communication breakdown in communicative interactions of 5 deaf college students in a further education college in Northern England. Analysis coded what was the source of breakdown, who noticed it, who repaired communication and what strategy was used. Findings were organised into three themes, reflecting how breakdowns were dealt with either by deaf students or their Communication Support Workers, or as a shared concern with teaching staff. Overall, deaf students were noted to deal with miscommunication through translanguaging, deploying their multilingual and multimodal repertoires to engage with multiple audiences and repair communication. Findings reflect how deaf students are overburdened with responsibility for ensuring communication is sustained, which opens further questions regarding the pressure to assimilate to hearing normative ways of communicating. Restricting deaf students’ communication to English may limit their development as bi/multilinguals and their learning experiences.

Performance support team effectiveness in elite sport: a narrative review

ABSTRACT In pursuit of competitive advantage, elite sport organizations are increasingly relying on the support of diverse sport medicine and sport science staff, who are collectively referred to as the performance support team. Whilst it has been suggested that the accumulative input from diverse multiteam systems has the potential to contribute to a resultant whole that is greater than the sum of its parts, team effectiveness is reliant on more than the mere aggregate of diverse experts. The aim of this narrative review was to appraise, summarize, and apply pertinent performance support team literature to a conceptual framework for teamwork and team effectiveness in sport. It specifically explores team effectiveness, with reference to its inputs (i.e. characteristics of individual, team, and environment) and mediators (i.e. team processes and emergent states). This review provides an insight into the individual (i.e. disciplinary knowledge, technical competency, and interpersonal qualities), team (i.e. team composition and leadership), and external (i.e. hierarchical arrangement and environmental factors) inputs that are necessary for team effectiveness, as well as the mediators (i.e. behavioral processes and emergent states) that translate such inputs into desired outcomes.

Accessibility in an Inclusive Academic Environment: The Case of Takoradi Technical University

This study examines the extent to which Takoradi Technical University (TTU) in Ghana has achieved an inclusive academic environment for students with disabilities. Despite Ghana's commitment to inclusive education and various policies supporting persons with disabilities (PWDs), there remains a significant research gap regarding the practical implementation and effectiveness of these policies at the university level. This research addresses this gap by evaluating TTU's accessibility measures and support services. The study employs a phenomenological approach to explore the lived experiences of students with disabilities, faculty, and staff at TTU. It investigates the alignment of TTU’s practices with national and international inclusive education policies, such as the Persons with Disability Act (715) and the United Nations Convention on the Rights of Persons with Disabilities. The research focuses on three main objectives: identifying the teaching and learning needs of disabled students, assessing the accessibility of TTU's built environment, and evaluating the satisfaction of students with the available support services. Data were collected through qualitative interviews with 28 participants, including students with disabilities, lecturers, and support staff. Findings reveal that TTU has established various support services, including sign language interpretation, e-learning support, and assistive devices. However, students reported inadequacies in these services, citing needs for additional support such as braille services and extended examination time. Furthermore, the built environment at TTU was found to be largely inaccessible to students with physical disabilities, leading to widespread dissatisfaction among the student body. The study highlights that while TTU has made commendable efforts in providing institutionalized support for disabled students, significant gaps remain in service adequacy and physical accessibility. The findings underscore the need for enhanced strategies to improve inclusivity at TTU and similar institutions, aligning practical implementations with policy frameworks to better serve students with disabilities

Experiences of residents in a therapeutic community model of substance use disorder treatment in a mental hospital in Ghana

BackgroundIn Ghana, the use of illegal drugs and alcohol has been classified as endemic. To manage this menace, the Therapeutic Community model for Substance Use Disorders (SUD) was introduced in Ghana about a decade ago as an alternative to other existing strategies. However, the effectiveness of this treatment modality for substance use disorders in Pantang Mental Hospital and Accra Psychiatric Hospital has not been scientifically studied.ObjectiveThis study, therefore, sought to explore the experiences of substance users or residents enrolled in the Therapeutic Community programme toward recovery from substance use disorders.MethodThis research employed an explorative-descriptive design. Participants (N = 20) were enrolled purposively sampled and recruited into the study. Face-to-face interviews were conducted using a semi-structured guide and data were analyzed using Colaizzi’s descriptive phenomenology data analysis process.ResultsTwo main themes emerged from the data: “Why I stayed” (Motivation), and “All things are new” (Life transformation). The study pointed out that residents or participants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction.ConclusionIn conclusion, the study found that participants in the Therapeutic Community (TC) program generally had positive experiences and believed in its effectiveness for recovery. Factors such as a relaxed environment, supportive staff, and interactions with other residents contributed to their positive experience. The study discovered that motivation, a conducive environment for care, structured program activities, and relationships among residents were key factors that motivated participants to stay and actively participate in the therapeutic community program. These factors fostered hope and a sense of belonging, ultimately contributing to their recovery journey. However, participants expressed the need for self-actualization, which they hoped to achieve after completing the program and reintegrating into the community.

Patient-Initiated Communication After Parotidectomy.

We sought to study the incidence of patient-initiated communication after parotidectomy, identify patient and surgical factors associated with patient-initiated communication, and evaluate trends and possible areas for improvement. A retrospective cohort study of patients who underwent parotidectomy without combined procedures from 2018 to 2022 in a single tertiary-care institution was performed. We reviewed all patient communications documented within the electronic medical record within 30 days of discharge. We categorized patient communications as requiring an action by the surgeon, instruction by support staff, or reassurance. A total of 363 patients were included. Most patients were women (55.4%), Caucasian (78.8%), and had an average age of 56 years ± 16. We found 123 (33.9%) patients initiated postoperative communications. Swelling (47.2%) was the most common concern followed by wound concerns (15.4%). Switching from planned inpatient to outpatient surgery increased (OR = 2.635; 95% CI = 1.200-6.146, p = 0.026) propensity for postoperative communication. We found 31 (25.2%) postoperative communications required an action by the surgeon, 40 (32.5%) required instruction by the support staff, and the other 52 (42.3%) required reassurance or clarification. Multivariate analysis showed swelling (OR = 6.5, CI = 2.2-19, p < 0.001), male sex (OR = 3.27, CI = 1.127-9.459, p = 0.029), previous smoking (OR = 3.468, CI = 1.181-10.185, p = 0.024), and cancer (OR = 6.862, CI = 1.757-26.804, p = 0.006) were predictive of requiring an action by the surgeon. This is the first study to evaluate patient-initiated communication after parotidectomy and found it occurred 33.4% of the time. We found significant opportunities to improve perioperative care, enhance patient satisfaction, and reduce the overall burden on medical personnel. Level IV Laryngoscope, 2024.

A Preliminary Analysis of a Prosocial Intervention to Support Teachers and Staff Implementing Behavioral Interventions in a Specialized School Setting

A Preliminary Analysis of a Prosocial Intervention to Support Teachers and Staff Implementing Behavioral Interventions in a Specialized School Setting

Intermediate and secondary school food environment in New Zealand: Food and drink menu assessment.

Nutrition-related obesity is rising among adolescents in New Zealand with an estimated one in eight children being obese. The school environment is an ideal community setting for encouraging a healthy lifestyle as schools contain a diverse population and involve students and parents. However, the healthiness of food available to intermediate and secondary school students (Years 7-13) is unknown. This study assessed how food and drink menus from schools align with policy guidelines for healthy school food environments. A convenience sample of NZ schools' (years 7-13; ages 10-19) menus was collected in 2020. Menus were classified using traffic light criteria. A toolkit was developed by three nutritionists and one dietitian (with trained staff support) to aid with menu classification. Menu quality was evaluated against school characteristics and policy use. Of the school menus assessed (n = 60), 3.3% met the recommendation for the provision of 75% 'green' items. 'Red' items were the main contributors (mean = 53.6%). Schools with high socio-economic status (deciles 8-10; 14.3%; p < 0.05) and small school size (<749 students; 14.1%; p < 0.025) were associated with a higher proportion of 'green' items. Community (19.3%) and in-house (25.9%) food providers provided a lower percentage of 'amber' items than school providers (39.3%; p < 0.001). In-house providers (64.6%) had a greater percentage of 'red' items than school providers (48.2%; p = 0.017). Food available in schools (Years 7-13) tends to be unhealthy. A national nutrition policy could improve the school food environment, especially in schools with large populations and low socio-economic status. SO WHAT?: School demographics have been associated with menu quality but further research within these schools is needed to identify the gaps to improve equitable outcomes within school food environments.

Systematic Review of the Effect of Financial Management Practices on Service Delivery in Secondary Schools

In this systematic review analysis design, we explore the available peer-reviewed literature on the effect of financial management practices on service delivery in African secondary schools. Specifically, we reviewed the effect of budgeting, auditing and financial internal control on the service delivery in secondary schools. Study findings reveal that budgeting ensures effective implementation of education programs. In addition, the activities in the secondary school system are adequately planned and allocate resources apportioned to ensure effective execution and implementation. Besides, audits of school accounts result in good financial management and effective control mechanism that ensures overall operational efficiency. From the results of this review, we hereby suggest that Head teachers need to manage financial resources more responsively for effective performance and fulfilling of institutional needs, those of the teachers, students and other stakeholders of respective secondary schools. It is very crucial for school administrators and support staff in charge of finances and resource mobilization to regularly attend professional development course in order to acquire relevant financial skills and competencies required for effective management of resources in the school so as to tremendously improve on the quality of secondary schools’ service delivery.

Sherpas and Sagarmatha: complexity theory, ‘Edge of Chaos’ and implications for tourism risk management

ABSTRACT Sagarmatha (Everest) has long been recognised as one of the principal goals of global adventure tourism. Supported by high-altitude workers, paying climbers on Sagarmatha have the opportunity to tread in the footsteps of colonial pioneers such as George Mallory and Sir Edmund Hillary. Ever since the first attempt was made to summit Sagarmatha there has been an appreciation amongst the climbing community of the risks involved. However, approaches to risk management on Sagarmatha have often not considered the social and cultural circumstances around a climbing expedition’s relationship to its local support staff. This paper uses the notion of an ‘edge of chaos’ to explore the evolving relationship between climbers and other stakeholders on Sagarmatha. Then, through reference to Holling's (2001) adaptive cycle and concept of panarchy, we consider on what basis might one stakeholder on Sagarmatha impose a greater risk burden on another stakeholder.

노인요양시설 간호사의 역할기대, 역할수행, 재직의도

Objectives The purpose of this study were to investigate the role expectations, role performance, and retention intention of nurses in nursing home, analyze their correlations, and identify factors influencing role performance. Methods A structured questionnaire was administered to 116 nurses working in nursing home in Gyeonggi Province, Seoul, and Incheon. The questionnaire aimed to investigate role expectations, role performance, and retention intention. The collected data were analyzed using IBM SPSS 29.0, employing the Wilcoxon signed-rank test, partial correlation coefficients, and multiple linear regression. Results Through this study, differences were found between the subjects' role expectations and their level of role performance. Specifically, the largest difference was observed in the area of research, education, counseling, leadership, and consultation/cooperation, while the difference was minimal in the area of expert nursing practice. Discrepancies between role expectations and performance were correlated with role performance in the domains of education and counseling, research, leadership, and consultation/cooperation. It was observed that the difference between role expectations and performance, retention intention, and the level of support staff in the organization had an impact on role performance. The explanatory power of the regression analysis was 32.1% (adjusted R² = .321). Conclusions To enhance the role performance of nurses in nursing home, it is necessary to develop improvement plans for areas where there are differences between role expectations and performance. Efforts should also be made to increase retention intention among nurses and ensure an adequate level of support staff in the organization.

Neurodivergent (Autism and ADHD) student experiences of access and inclusion in higher education: an ecological systems theory perspective

AbstractHigher Education (HE) can be a complicated and isolating experience for neurodivergent students. Many systemic barriers and injustices create challenges for the accessibility and inclusivity of learning environments and curriculums. However, with the appropriate accommodations, staff guided by neurodiversity-affirming practices, accessible curricula, and opportunities to connect with neurodivergent peers, it can be highly rewarding. Through 15 in-depth, lived-experience-informed interviews with neurodivergent HE students who are Autistic and/or ADHDers in Australia, we analyse experiences at different system levels. By validating the robust framework of ecological systems theory in this context, we extend the academic understanding and add to the limited research on HE experiences for this marginalised, often ignored, but important student segment. We discover pivotal micro-systems of curricula, assessments, reasonable adjustment plans, spaces, teachers, students, and support services. Further contributions are made through the first extension of ‘feedback loops’ into research of HE micro-systems, and descriptions of macro and chrono-systems. With many HE systems erected and emergent to cater to the student majority, illuminating the experiences of neurodivergent students with these intersecting HE systems provides concrete insights for leadership, teachers, and support staff to improve accessibility and inclusion in HE.