Institutional Policies Research Articles

Nurses' experience of end-of-life care for patients with COVID-19: A descriptive phenomenology study.

The mortality rates among critically ill patients with COVID-19 have been high. The national and institutional infection control policies and resource shortages caused by the pandemic led patients to undergo deaths without dignity and inevitably changed intensive care unit (ICU) end-of-life care (EOLC) practices. This study explores ICU nurses' experiences of providing EOLC for patients with COVID-19 who died. Eight nurses participated in a qualitative phenomenological study. Semi-structured interviews were conducted from July to September 2022. Colaizzi's data analysis method was used, and the following four main themes emerged: (i) only companion in the death journey; (ii) helping families prepare for death; (iii) EOLC trapped within a framework; and (iv) EOLC in retrospect. To secure high-quality EOLC in ICU, it is important to promote practical support for nurses and EOLC-related discussions/education. Technical support, such as digital communication technologies, should be reinforced to help patients and their families participate in EOLC.

Improving Compliance with a Nurse-Driven Protocol for Unfractionated Heparin Infusions in Patients with Venous Thromboembolism.

Unfractionated heparin (UFH) is a high-risk medication that can cause bleeding and/or thrombotic complications if not managed appropriately. Between January and July 2019, our institution experienced a high number of patient safety events related to UFH infusion for the treatment of venous thromboembolism (VTE). The aim of this quality improvement (QI) initiative was to prevent these safety events by improving compliance with our institution's nurse-driven VTE UFH infusion protocol. Baseline data for patients on the VTE UFH protocol were collected to identify improvement opportunities. Compliance with eight standards of care related to the VTE UFH infusion protocol was measured. Time to first therapeutic activated partial thromboplastin time (aPTT) was recorded to assess the benefit of improved compliance. Institutional policy updates were made to clarify the management of UFH infusions and documentation in the electronic health record. A multidisciplinary workgroup implemented order set changes, nursing communication orders, UFH infusion reports, and a nursing education module to promote compliance with the protocol. The overall rate of compliance with the VTE UFH infusion protocol increased from 79.4% at baseline to 85.2% following implementation of the QI initiative, and the median time to first therapeutic aPTT decreased from 831.5 minutes to 808 minutes over the same period. A multidisciplinary initiative to address improvement opportunities in a nurse-driven UFH protocol for VTE treatment increased compliance with the protocol and decreased the time to first therapeutic aPTT.

중학생의 사회적 지지와 삶의 만족도의 구조적 관계

Objectives This study reveals, from a middle school student perspective, the social support from parents, teach-ers, and friends, as well as the structural relationship of life satisfaction and self-esteem. Moreover, it explores the direct and indirect effects of social support on life satisfaction, focusing on the mediating effect of self-esteem. Methods For this purpose, the structural equation model was applied to Wave 4 of the Korean Children and Youth Panel Survey 2018(KCYPS 2018) data set(7th grade, N = 2,275), conducted by the National Youth Policy Institute. Results The results are as follows: First, teacher support perceived by middle school students had a direct and significant effect on life satisfaction. Second, friend support perceived by middle school students did not sig-nificantly affect life satisfaction through the mediating effect of self-esteem, indicating a complete mediation ef-fect of self-esteem on life satisfaction. Third, parents support perceived by middle school students did not sig-nificantly affect life satisfaction, suggesting that middle school students may be more influenced by relationships with teachers and friends than by their relationships with parents. Conclusions This study confirms the significant impact of teacher support on life satisfaction and the significant influence of friend support on self-esteem among middle school students. It is significant in confirming the struc-tural relationship between social support, self-esteem, and life satisfaction among middle school students and verifying the mediating effect of self-esteem between social support and life satisfaction.

성별에 따른 미혼 청년의 결혼의향 요인 연구

Objectives This study analyzed the factors affecting the marriage intention of unmarried young people by gender. Methods For this purpose, 1,691 unmarried young people (947 men, 744 women) between the ages of 18 and 34 conducted by the Korea Youth Policy Institute were selected as research subjects, and personal characteristics, parental factors, workplace factors, and policy factors were used as independent variables. Marriage intention was selected as the dependent variable. Results The main research results are: First, personal factors had a significant effect only on men in terms of age (the younger the age, the higher the intention to marry). Second, parental factors had a significant effect on the mother's education level only for men (the higher the mother's education level, the higher the intention to marry). Third, as for workplace factors, job welfare level and work values had a significant effect only on women (job The lower the welfare level and the higher the value of work, the higher the intention to marry). Fourth, in terms of poli-cy factors, only men had a significant effect on training/career policy and childbirth/childcare policy (the higher the training/career policy, the higher the childbirth/childcare policy, the higher the intention to marry). Conclusions As there is a clear difference between men and women in the intention to marry among unmarried young people, customized support should be provided for each factor that can increase the intention to marry. Through this, the government and local governments should carry out various promotional activities and activate programs for single young men and women.

The narrative policy framework and institutions

The narrative policy framework and institutions

When, at what speed, and how? Resilient transformation of the Vesdre river basin (Belgium) following the 2021 floods

BackgroundDual crises happen when an acute shock unfolds in the context of a creeping crisis. The July 2021 floods in the Vesdre river basin (Wallonia, Belgium) is a typical case of such dual crises in the context of climate change. This study is based on 16 semi-structured interviews (conducted in Spring 2023) with 10 mayors, 4 representatives of the Public Service of Wallonia, 1 person working for the federal government, and 4 project managers, coupled with a document analysis (n = 13). It investigates the temporal strategies that connect short and long-term considerations in the aftermath of this disaster (timing, futuring, pacing, cyclical adaptation, and determining time horizons), at two different governmental levels: river basin and municipal level.ResultsIn general, the window of opportunity to improve disaster resilience has been seized. Several studies were initiated by the Walloon region that shape the idea of an ideal future for the river basin and give recommendations for how to reach it. Unfortunately, those recommendations still come late compared to the temporal reality of the reconstruction process. Municipalities wish to strengthen disaster resilience as soon as possible, but they have to prioritize certain actions over others because of limited resources. The recommendations are considered flexible enough to adapt strategies to future contexts, but no monitoring and evaluation system for doing so has been implemented so far. In addition, clear policy agendas with transformational goals are scarce, and they diverge between the river basin and the municipalities. All these temporal strategies are shaped by elements of the institutional policy arrangement: resources, which affect them all, as well as actors, power, and formal rules, which affect some. These policy dimensions notably slow down the implementation of disaster resilience strategies and limit the determination of consensual time horizons.ConclusionsThe temporal strategies are passively shaped by the policy arrangement dimensions to a greater extent than actively chosen by the stakeholders. A structural transformation of the institutional policy arrangement is therefore needed to enable more coherent temporal strategies between different governance levels and to facilitate the consideration of long-term resilience during the recovery process from disasters.

Exploring disaster preparedness in an obstetric unit in a district hospital in the Western Cape Province

BackgroundResearch on disaster preparedness in public hospitals is limited, and specialised units such as obstetric departments need to be even more prepared when rendering health care to vulnerable populations. Disasters can be natural, such as floods due to human interventions, sinkholes due to mining, or pandemic occurrences, such as the recent COVID-19 pandemic. Research on disaster preparedness is limited, and even more so in specialised units such as obstetrics and evacuating a ward of maternal and neonatal patients present unique challenges. Being prepared for any disaster is the only assurance of effective patient healthcare during a disaster. This study explored and described nurses’ knowledge and attitudes regarding preparedness for a disaster in an obstetric unit in a public institution. The study aimed to make recommendations to improve disaster preparedness in an obstetric ward based on the nurses’ knowledge and attitudes.MethodsThis study utilised an exploratory, descriptive qualitative design within a contextual approach. The data were acquired through individual interviews that were done using a semi-structured interview schedule. An observational walkabout was performed with the unit manager to validate interviewee responses. The study employed purposive sampling with a sample size of 17 nurses (N = 32, n = 17) and a response rate of 53%. The interviews were transcribed verbatim, and later, the data underwent analysis using theme analysis and a co-coder.ResultsThe results indicate that the participants demonstrate an awareness of disaster terminology but need more assertiveness in executing the institutional disaster policy. The results illustrate that more frequent training, disaster rehearsals, and simulations should be implemented to improve disaster readiness. Strategies are recommended to enhance preparedness for a disaster in the obstetric unit.ConclusionThe study findings recommend more education and training opportunities that should be regularly instilled as a practice within the obstetric ward. More disaster drills and simulation exercises should be performed to ensure confidence in disaster preparedness. Obstetric staff of all levels should be involved with policymaking and disaster plan development.

Retraction: Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle.

Retraction: A. M. Maged, H. Rashwan, S. AbdelAziz, W. Ramadan, W. A. I. Mostafa, A. A. Metwally, M. Katta, "Randomized controlled trial of the effect of endometrial injury on implantation and clinical pregnancy rates during the first ICSI cycle," International Journal of Gynecology & Obstetrics 140, no. 2 (2018): 211-216, https://doi.org/10.1002/ijgo.12355. The above article, published online on 19 October 2017 in Wiley Online Library (wileyonlinelibrary.com) has been retracted by agreement between the journal's Editor-in-Chief, Michael Geary, International Federation of Gynecology and Obstetrics and John Wiley & Sons Ltd. The retraction has been agreed following an investigation based on concerns raised by a third party. Significant inconsistencies were found between the P-values calculated in Table3 and data provided within the paper. The original data was no longer available as this is archived after a period of five years according to institutional policies. Thus, the inconsistencies in the paper could not be resolved. Accordingly, the editors consider the conclusions of this manuscript insufficiently supported. The authors disagree with the retraction.

The silent shift: Pregnant women doing aesthetic and emotional labor at work

AbstractAlthough the U.S. Pregnancy Discrimination Act protects people from discrimination, there remain risks for individuals who become pregnant while working. Therefore, many choose to stay quiet about their pregnancies before beginning to show. Doing so, however, requires a constant management of appearance and behavior that feels necessary for employment. To investigate how pregnant people manage occupational settings while growing visibly pregnant, I draw on data from interviews with 54 women in the U.S. who were employed during their pregnancy. Findings reveal that efforts to manage the pregnant body are both aesthetic and emotional, and they constitute a form of unpaid labor that I term the “silent shift.” The silent shift encompasses two types of labor: the labor of concealing and the labor of dealing. Concealing—typically done during the first trimester—involves trying to strategically hide a pregnancy from co‐workers through alterations to work attire (i.e., aesthetic labor) or behavioral changes, such as napping in the office or discretely running to the bathroom. When concealing was no longer an option, pregnant women had to deal with awkward comments from co‐workers about their bodies. In these instances, women employed emotional labor to keep silent about how such remarks made them feel by suppressing negative emotions, rationalizing co‐workers’ comments, or by laughing them off. These findings suggest that even though laws and institutional policies have created space for pregnant workers, there remains a tension between the professional and pregnant body—a tension that women themselves feel compelled to manage.

A qualitative exploration of challenges and factors in research data management across Indonesian research institutes

This research investigates the challenges and factors that influence the implementation of research data management (RDM) in Indonesian research institutes. This study conducted in-depth interviews with six data managers from five Indonesian research institutions using a qualitative research approach. The interview data were analyzed using NVivo software, and the TOPE framework guided the identification of factors and challenges in (RDM) implementation. Critical aspects in RDM implementation are applications, hardware, culture, organizational units, institutional policies, leadership support, awareness, knowledge, education, skills, funder regulations, and government policies. Challenges in RDM implementation encompass access control, data quality, ease of use, building trust, availability of responsible staff, user understanding, researchers’ resistance, awareness, and inter-institutional relations. Research on data management, especially in developing countries like Indonesia, is limited. This study contributes by providing a high-level overview of research institutions in Indonesia, enhancing their understanding of the challenges and critical aspects involved in establishing effective RDM within their institutions.

Food Insecurity Pipeline: How Latinx Immigration-Impacted Students in Higher Education Navigate the Food Insecurity Cycle

Systemic inequities increase the risk of material hardships, including food insecurity, among immigrant households. Informed by 33 qualitative interviews with Latina/o/x undergraduate students who are undocumented or U.S. citizens with undocumented parents, we examine their experiences of food insecurity in their day-to-day lives. We find a food insecurity pipeline as students’ experiences of food insecurity begin early in childhood in their homes and continue in their adulthood on their college campuses. Food insecurity has implications for their well-being, and they rely on their strengths and networks to survive food insecurity. The study has implications for immigration policy, practice, and higher education institutions serving this vulnerable population.

“Scholars in Great Need:” Responses to Refugee Staff and Students at the University of Birmingham 1933–1945

ABSTRACT This article examines the ways in which the University of Birmingham assisted refugee academics and students from Nazi Germany and other Nazi occupied countries across Europe between 1933 and 1945. It draws on the university’s rich but underused archives to explore institutional policy and to assess the influence of individual staff members in driving it. As a case study it examines and evaluates the role played by a British provincial university in supporting displaced academics before the Second World War and refugee students during the war. Analysis of the primary source material reveals the importance of personal connections and the agency of individual university staff in helping refugees. This study aids our understanding of the roles played by British universities in helping displaced scholars and identifies areas for further research.

Exploring the Interplay between Writing Practices and Identity Formation in Academic Contexts

In academic settings, the relationship between writing practices and identity formation is a cornerstone of scholarly inquiry. As individuals engage in writing, they convey information and construct and negotiate their identities within disciplinary, cultural, and linguistic frameworks. This review paper provides a comprehensive synthesis of existing scholarship on the intricate relationship between writing practices and identity formation in academic contexts. Drawing upon a systematic analysis of 30 studies, the paper illuminates the complex interplay between language, culture, and academic discourse in shaping authorial identities. Key themes explored include conceptualizing writing as an act of identity construction, the challenges faced by distinct student populations in establishing authorial voices, disciplinary variations in identity formation, and pedagogical implications for academic writing instruction. The review integrates diverse theoretical frameworks, such as sociocultural perspectives, academic literacy approaches, and integrationist models, offering a nuanced understanding of the mechanisms underlying identity construction through writing. Furthermore, this review also identifies gaps and potential avenues for future research, including the need for longitudinal studies, the exploration of individual agency in identity formation, and the examination of emerging technologies and interdisciplinary collaborations. Ultimately, this synthesis adds to ongoing conversations about how writing practices affect identity formation. It does this by informing teaching methods and institutional policies that support positive identity development among diverse academic communities.

The basis of Russia's financial sovereignty

Subject. The article investigates the policy of the largest Russian financial institutions and countering the international sanctions. Objectives. The purpose is to analyze indicators that determine the stability of the Russian financial system. Methods. The study draws on methods of statistical analysis. Results. The paper determined that the basis of Russia's financial sovereignty is made up of enterprises, the production costs of which are reimbursed at the expense of proceeds from goods and services. Conclusions. The findings can be taken into account when determining the main directions of Russia's monetary policy.

Variation in Time-to-Gender-Affirming Hormone Therapy in the US Active Duty Service Members.

Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired. This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System. This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository. A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code. Time-to-gender-affirming hormone initiation after diagnosis receipt. A total of 2439 Service members were included (Mage 24y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female (P<0.001), and Asian and Pacific Islander (P=0.02) and Black (P=0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis. The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.

Seven years of embracing the sustainable development goals: perspectives from University of South Africa’s academic staff

As this article was being finalised, the world was left with less than 7 of the 15 years of Sustainable Development Goals (SDGs) implementation to 2030. There were still huge gaps in the attainment of the SDGs in institutions of higher learning globally, especially that COVID-19 brought a barrier leading to a known pushback. However, the pandemic did not imply there was no work done prior, during and after COVID-19. This article investigates the extent to which the University of South Africa’s academic staff activated and mainstreamed the SDGs in their core mandates between 2016 and 2022. Data was generated through a survey (n = 121), participatory action research, and document analysis. It emerged there is a greater degree of awareness of the SDGs, with 78% of academic respondents confirming this. However, the percentages drop across the four core mandate areas when it comes to SDGs implementation. About 52.6% of academics indicated they were promoting SDGs in their teaching, research (63.3%), community engagement (55.5%) and academic citizenship (54.5%). Findings further reveal key enabling institutional policies like the SDGS Localisation Declaration, and the Africa-Nuanced SDGs Research Support Programme. Large gaps remain on the publication front, where over 60% of the responding academics had not published an article explicitly on SDGs. There is also bias in publications towards certain SDGs. The work recommends that University of South Africa management continue raising awareness on the SDGs and systematically address barriers identified in the main article to enhance the mainstreaming of the SDGs across all core mandate areas.

OER based capacity building to overcome staff equity and access issues in higher education

Open educational resources (OER) have already impacted educational systems around the world. In higher education more specifically, it has benefited learners, and has influenced institutional strategic plans and policies. Additionally, the benefits of OER also extend to staff in higher education, such as academic staff. For this group, OER can provide opportunities for collaboration, promote curriculum innovation and student led content development, as well as contribute to university teachers’ much needed continuing professional development. In this paper, we examine the potential of OER to build capacity of academic staff in higher education, in particular to overcome some equity and access issues that they may face. It also examines some existing activities and strategies for professional development in higher educational institutions and provides some recommendations for academics, academic developers, institutions, and the sector in general.

‘I Am a Broken Policy’: A Critical Reflection on Whiteness and Gender Anti-Black Racism in Institutions of Higher Education and Social Services

This personal narrative is a critical reflection and affirmation letter to Black women. Throughout this commentary, at the end of each section, I have included what I call “gems”. I hope they serve as a manifesto for our collective healing from working in institutions that center on the ideologies and practices of dominance. This piece particularly focuses on the dominant ideology and practice of “whiteness” within institutions as a surveillance tool through policy that directly impacts Black women’s wellbeing through gender anti-black racism. Through storytelling and drawing on Black feminist scholarship, this narrative exposes the challenges I faced with institutional policies and practices as I pursued my career in both academia and social service work. Throughout this narrative, I highlight how the undercurrent of whiteness is embedded in the foundation of institutional policy and practices. This narrative serves as a demand for institutional accountability and reckoning with the coloniality of epistemology and ontology. There is a great emotional toll for Black women who are confronting and resisting gendered anti-black racism with deep internal struggles and triumphs. The violent institutional practices seek to eclipse Black women’s ability to dream, imagine and create. Whiteness is centered in institutional infrastructure, serves as a distraction, and impedes our ability to conceptualize the world we desire. We deserve to have imagination in our work. This narrative is a reflection of the harm of whiteness, a guide for Black women academics, a manifesto for change, and a testament to our humanity.

Ideologies of teachers and students towards meso-level English-medium instruction policy and translanguaging in the STEM classroom at a Malaysian university

Abstract English medium instruction (EMI) as a language policy in higher education is based on monolingual conceptions and limits the use of the full linguistic repertoire of bilinguals/multilinguals in the university classroom. Informed by the constructs of language ideology (Spolsky, Bernard. 2009. Language management. Cambridge, UK: Cambridge University Press), translanguaging (Li, Wei. 2018. Translanguaging as a practical theory of language. Applied Linguistics 39(1). 9–30) and pedagogical translanguaging (Creese, Angela &amp; Adrian Blackledge. 2010. Translanguaging in the bilingual classroom: A pedagogy for learning and teaching? The Modern Language Journal 94(1). 103–115), this case study aimed to examine the ideologies held by micro-level stakeholders (i.e., teachers and students) towards institutional English-only EMI policy, translanguaging, and the significance and scope of pedagogical translanguaging in EMI classrooms. Semi-structured interviews were conducted with six teachers and 10 students at a public research university in Malaysia. Also collected were a variety of publicly accessible institutional documents, including the focal university’s programme brochures, promotional materials and policy statements on its website. Analyses of the interviews and documents revealed that although EMI was officially adopted in the programmes, both teachers and students advocated for translanguaging and underscored its important role in the transmission of new information, effective communication, and scientific meaning-making. In light of these findings, the study concludes that an inclusive language policy is required that allows teachers and students to access all their linguistic resources.

Resilience, Burnout and Mental Health in Nurses: A Latent Mediation Model.

Background/Objectives: The burnout syndrome in nurses has been related to the development of mental health problems. On the contrary, resilience is related to adequately coping with stressful situations and better mental health. The objective was to analyze the relationship between resilience and mental health problems in nurses and estimate the proportion mediated by burnout in the association. Methods: In 2021, a total of 1165 Spanish nurses were selected through a stratified random sampling method. Participants anonymously filled in the Resilience Scale (RS-14), the Maslach Burnout Inventory Survey, and the General Health Questionnaire. To test the hypothesis proposed and explain the mediating effect of burnout empirically, structural equation modeling (SEM) was applied. A latent mediation model was computed. Results: Resilience was negatively related to burnout and mental health problems. The direct relationship between burnout and the latent health variable was positive. In addition, in view of the total effect of resilience on mental health problems and the magnitude of the indirect effect, we stated that the proportion of this effect mediated by burnout ranged from 0.486 to 0.870. Conclusions: This study reveals that fostering resilience in nurses directly and indirectly reduces burnout and improves their mental health. The implementation of resilience programs and supportive institutional policies is recommended to improve working conditions and the quality of patient care.