Articoli di riviste sul tema "Community children's nurses perceptions and practices"

The mandatory reporting of intimate partner violence (IPV) is a controversial issue that is receiving increased attention. A related concern is whether children’s exposure to IPV constitutes child maltreatment, making it reportable to child protective services. These issues have been relatively unexplored within the context of home visitation programs. A secondary analysis of qualitative data collected from community stakeholders, clients, and home visiting nurses in the Nurse–Family Partnership program was carried out. Participants’ perceptions about mandatory reporting of IPV and reporting of children’s exposure to IPV are highlighted. Emergent themes and implications for research, practice, and policy are discussed.

Early intervention on frailty can help prevent or delay functional decline and onset of dependency. Community nurses encounter patients with frailty routinely and have opportunities to influence frailty trajectories for individuals and their carers. This study aimed to understand nurses' perceptions of frailty in a community setting and their needs for education on its assessment and management. Using an exploratory qualitative design we conducted focus groups in one Health Board in Scotland. Thematic content analysis of data was facilitated by NVivo© software. A total of 18 nurses described the meaning of frailty as vulnerability, loss and complex comorbidity and identified processes of caring for people with frailty. They identified existing educational needs necessary to support their current efforts to build capability through existing adversities. Our study indicates that current practice is largely reactive, influenced by professional judgement and intuition, with little systematic frailty-specific screening and assessment.

15 teachers of Kindergarten through Grade 2 in two schools from a rural southeastern United States community completed the Philosophy of Teaching Scale and indicated on the Child Behavior Checklist their perceptions of 309 children in their classrooms who might show problems of attention. A difference was found between teachers of structured and unstructured orientations in the number of children they reported to be hyperactive. The former group perceived significantly more children in their classrooms to be hyperactive.

Abstract Introduction Sleep disruption in intensive care unit (ICU) patients is highly prevalent and may contribute to adverse clinical outcomes. Although clinical practice guidelines recommend routine assessment of sleep, surveys of ICU clinicians indicate that sleep assessment programs (SAP) are rarely implemented. The purpose of the current project was to characterize sleep-related perceptions, practices, and knowledge among ICU nurses, to identify barriers and facilitators of implementation of a systematic SAP. Methods A 29-item, paper-based survey was administered to all nurses (N=220) in a medical ICU at a 750-bed academic medical center and a mixed ICU in a 300-bed community hospital. Voluntary survey completion was conducted over four weeks. Descriptive statistics were employed. Results A total of 163 surveys were completed (74.1%). Participants were primarily female (n=135; 82.8%), day-shift nurses (n=83; 50.9%), with 2-5 years of ICU experience (n=70; 42.9%). Respondents said they sometimes (n=52; 31.9%), and often (n=52; 31.9%), assess sleep, and 76.1% (n=124) reported not assessing sleep formally in the last three shifts. Approximately half of the respondents (n=85; 52.1%) were not aware of clinical practice guideline recommendations for sleep in the ICU. Most nurses reported that their unit could benefit from a SAP (n=101; 62.0%) and that they should have a primary responsibility in ensuring that sleep is discussed daily (n=144; 88.3%). Conclusion Despite published guidelines recommending routine sleep assessment, ICU nurses report infrequent assessment and a lack of awareness of these guidelines. However, ICU nurses believe implementation of routine sleep assessments would be beneficial to patient care. This suggests that SAP implementation would be positively received by ICU nurses. Future studies evaluating knowledge and site-specific perceptions and practices, as well as nursing staff characteristics, can further guide implementation of SAPs in the ICU. Support

Introduction: As the Arab American population grows in the United States, relatively little has been published about the health status of this population. The purpose of the research was to (1) discover health care perceptions of Arab Americans and (2) identify strategies to ensure the provision of culturally congruent health care. Method: Community-based participatory research methodology was used for this descriptive study. Interviews and focus groups were conducted with Arab Americans residing in northeast Pennsylvania. Results: Three themes were identified: (1) perceptions of health resulting in delays in seeking health care, (2) cultural values and practices resulting in need for culturally congruent provision of care, and (3) mistrust of the U.S. health care system resulting in underutilization of services. Discussion: Results indicate the need for nurses to implement culturally congruent community-based strategies and interventions for meeting health care needs of Arab Americans. By understanding the community’s perceptions and attitudes, nurses will be better positioned to ultimately move toward the goal of reducing health disparities in this underserved population.

Background/aims: Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service. Methods: This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes. Results: A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices. Conclusions: Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

Purpose The purpose of this project was to explore characteristics impacting the transmission of a heritage language from a parent to a child from the parent's perspective to better understand challenges that families may face when trying to pass on a heritage language to their children. Method In this pilot study, 14 interviews were conducted with individuals who reported they were currently raising or had raised at least 1 child to be able to speak about language transfer practices and beliefs. Participants were interviewed regarding their own language use and proficiency. Participants were asked questions pertaining to their attitudes and their children's attitudes toward their home language. Interviews were transcribed and analyzed for emergent themes related to language transmission and challenges to passing down the heritage language to their child. Results Common themes that emerged related to parents passing down their heritage language included the community the families resided in and the parent's proficiency level. Conclusion It is important for educators and clinicians to understand how a parent's decision to pass down their language may be impacted by how much community support they experience and how proficient parents are in their heritage language. Implications of these results for educators and caretakers are discussed.

PURPOSE: Uterotonic drugs, administered immediately after delivery, can prevent postpartum hemorrhage (PPH). As programs expand uterotonic access in settings of high maternal mortality, it is important to understand why and how these drugs are currently used. This qualitative study aimed to describe Ghanaian health care providers’ and community members’ knowledge, perceptions, and practices of uterotonic usage at or near labor and delivery.METHODS: In-depth interviews were conducted in 3 districts with 185 physicians, medical assistants, midwives, nurses, new mothers, mothers aged 50 years and older, traditional birth attendants, and chemists.FINDINGS: Providers described using misoprostol most commonly for labor induction, oxytocin for labor augmentation and PPH prevention, and ergometrine for PPH treatment. Unsafe practices and knowledge gaps were identified regarding labor augmentation and uterotonic storage. Community members reported experience with uterotonics in facility deliveries. Community-based use of pharmaceutical uterotonics was rarely reported, except misoprostol for pregnancy termination; however, community members described use of herbal medicines for intended uterotonic effect. Across respondent categories, uterotonics were more commonly associated with accelerating delivery than PPH prevention.CONCLUSION: Programs promoting facility childbirth and/or uterotonic coverage at home births should consider these underlying patterns of use and encourage safe practices through provider and community engagement.

Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.

Objectives: To assess knowledge and perceptions of health care workers regarding optimal care for patients with hyperglycemia and identify commonly perceived barriers for the development of a hospital-wide education program. Research Design and Methods: A cross-sectional design was utilized to survey health care workers involved in managing hyperglycemia in an urban, community teaching hospital. Each health care worker received a survey specific to their health care role. Results: Approximately 50% of questions about best clinical practices were answered correctly. Correct responses varied across disciplines (n, mean ± standard deviation [SD]), that is, physicians (n = 112, 53% ± 26%), nurses (n = 43, 52% ± 35%), pharmacists (n = 20, 64% ± 23%), dietitians (n = 5, 48% ± 30%), and patient care assistants (n = 12, 38% ± 34%). Most health care workers perceived hyperglycemia treatment to be very important and that sliding scale insulin was commonly used because of convenience but not efficacy. Conclusion: Knowledge regarding hyperglycemia management was suboptimal across a sample of health care workers when compared to clinical best practices. Hyperglycemia management was perceived to be important but convenience seemed to influence the management approach more than efficacy. Knowledge, perceptions, and barriers seem to play an important role in patient care and should be considered when developing education programs prior to implementation of optimized glycemic protocols.

Background: The development of generic medicines that are cost-effective and affordable aims to facilitate improved availability of essential medicines to meet the health care needs of the majority of the population. However, these essential generic medicines are not regularly available at the community health centres and clinics. Aim: This study aimed to determine the perceptions of professional nurses regarding the status of stock-outs of generic medicines at primary health care health facilities in a selected province of South Africa. Materials and Methods: The study was conducted in five primary health care facilities; three clinics and two health centres in Thulamela B municipality of Vhembe District, Limpopo Province. A qualitative, exploratory, descriptive and contextual research design was used to obtain the perceptions of the participants. Thirteen professional nurses were purposively selected. Data were collected through face-to-face in-depth interviews until data saturation was reached. Data were analysed using Tesch’s open coding method. Results: Key findings showed that essential medicines were not always available, with the health centres reporting fewer stock-outs than clinics. The perceived major contributors to stock-outs were institutional inefficiency and practices by both health service providers and patients. Conclusion and Recommendations: The study concluded that primary health care facilities in rural communities still grapple with poor access to essential medicines due to poor availability. Therefore, the provision of sufficient funding for procurement, and training of inventory management practices were recommended. In addition, community public awareness campaigns to discourage patients’ self-medication and multiple consultations should be put in place.

Aims and Method To compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment. Results There was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)). Clinical Implications Further research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

Aims and MethodTo compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.ResultsThere was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).Clinical ImplicationsFurther research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

Background: Cervical cancer is the second most common cancer among women worldwide. The knowledge and attitude of nursing personnel towards cervical cancer screening can grossly influence the community. As the doctor to patient ratio is low in India, staff nurses if trained can act both as health educators and service providers. Objectives of the study were to determine the baseline information about the knowledge of cervical cancer and explore attitude and practice of Pap smear screening among staff nurses.Methods: In this cross-sectional study sample of 100 nurses was selected randomly out of the total 445 nurses employed in the hospital at a rural tertiary care centre from August 2016 to October 2016. A self-administered, structured, open ended and pretested questionnaire comprising of questions on the general characteristics, awareness, perceptions and actual practices of nursing personnel was used to gather information about cervical screening.Results: In this study, 82% knew that Pap smear can detect cancer. About 48% knew that it can present as post-menopausal bleeding and 32% of the respondents knew that HPV is a risk factor for cancer cervix, but only 30% knew about HPV vaccine and only 35% have ever been screened.Conclusions: The study showed that, knowledge about cancer cervix, screening and practice of Pap smear is low among nursing staff. There is an urgent need for integration of cervical cancer prevention issues in the nurses existing training curriculum.

Health workers' awareness and understanding of clients' attitudes and practices regarding “health” is an important but insufficiently studied factor in planning health promotion programs. A group of thirty-seven rural Colombian campesino (peasant) women were interviewed to determine their health beliefs and practices. Following interviews and observation, the health workers (doctors, nurses, and nursing assistants) who worked with these women and their families, were interviewed regarding their perceptions and awareness of the campesinos' health attitudes and practices. The results show that the women had both western and “popular” (traditional) health practices. The health workers' awareness of their clients' beliefs and practices varied greatly and was influenced by various factors including: professional level, type of illness, local conditions, and experience. In general, however, the health workers were largely unaware of the more subtle health attitudes and practices—those attitudes which may strongly influence health seeking and health maintenance behavior. Concerted efforts must be made to determine the health beliefs and practices of a client or community in order for health promotion programs to be successful.

The Western Australian Community Child Health Service (CCHS) has problematised aspects of parental conduct and sought to transform parent/child interaction in order to produce a specific kind of person: responsible, self-disciplined, caring. As a consequence, management strategies that harness parents' and children's self- regulating capacities rather than corporal punishment are promoted as the more appropriate means to discipline young children. However, the prevailing child health position, informed by medical and psychological expertise and grounded empirically, is contested from within and outside its ranks. Prominence is given to accounts of disciplining practices produced by interviewing several parents, Pentecostal believers and nurses. The analysis presented brings to the fore contradictions, inconsistencies and oppositions that emerge when the CCHS, a governmental practice, is operationalised.

Abstract Development and protection of children's health is important for the promotion and protection of public health. Primary responsibility for the development and protection of public health isin the family then the health care team members and the social environment. Hospitalization of a child is a stressful process both for the child and the family. In the literature, requirements of families are reported about staying with their children at hospital during hospitalization, taking active role in caring for their children and being informed for the health condition of the child, diagnosis and treatment tests. Therefore, family centered care is suggested for accelerating child’s recovery process with decreased child’s and families anxiety and providing the most convenient health service for expectations and needs of families in the hospital environment. Family centered care philosophy is based on recognition of the family’s central role in the child’s life and providing active participation of the family for health related decisions about their children. To effectively practice family centered care, nurses must be clear and consistent in their understanding and practices about the care of children and their families. Child Health Nurses need valid and reliable measurement tools to show their perceptions and practices regarding family centered care. In the literature, Family Centered Care Questionnaire, Family Centered Care Survey and Measure of Processes of Care for Service Providers were found to assess family centered care applications. However, the studies showing status of family centered care model in our country and studies introduce this measurement tools are very limited. Introduction and use of this measurement tools is very important for the quality of care given by nurses. Keywords: family centered care, child health nurses, assessment.

THIS PAPER DESCRIBES A project conducted with the parents of children in early childhood classes from two different district high schools 1 . The project investigated the perceptions held by these parents in relation to mathematics education, and used an intervention program designed to encourage them to engage in numeracy activities with their child. Preliminary results indicated that, although the parents were not necessarily familiar with contemporary numeracy classroom practices, they were able to describe and evaluate their children's mathematical understandings. The findings add to the limited research available on the ways parents can support their child's mathematical education at home through encouraging home–school community partnerships. 1 District high schools in this context refers to rural schools with classes ranging from Kindergarten–Year 10.

ABSTRACT BACKGROUND The Medical Council of New Zealand requires graduating doctors to have community attachments within their first two years of practice by 2020. Counties Manukau Health has developed a programme where house officers (HOs) are attached to a general practice for three months. AIM This study aimed to establish the value of four HO general practice attachments in Counties Manukau and describe how HOs are being used in these practices. METHODS A mixed-methods design was used to evaluate three attachment runs. Two practices provided the number of patients seen by HOs. Fifty-eight patients were surveyed to assess patient perceptions of the HOs. Six HOs, four supervising general practitioners, two PHO senior staff and one practice manager participated in semi-structured interviews. Focus groups were held with nurses, doctors and administrative staff at all four practices. FINDINGS HOs saw 300–600 patients in one practice and 800–1000 in the other during their attachment. Practices developed their own approach to mentoring and teaching HOs. Most patients reported positive perceptions of the HOs. Themes from interviews and focus groups were consistent among participants and included: improved HO confidence, clinical skills and understanding of general practice; extra capacity and improved quality of care and staff satisfaction among practices. CONCLUSION HOs and practices viewed HO attachments in general practice positively. HOs developed clinical skills and understanding of primary health care. Practice teams enjoyed the energy and enthusiasm of the HOs, while providing clinical support to ensure quality patient care.

Objective.To elucidate behavioral determinants of handwashing among nurses.Design.Statistical modeling using the Theory of Planned Behavior and relevant components to handwashing behavior by nurses that were derived from focus-group discussions and literature review.Setting.The community and 3 tertiary care hospitals.Participants.Children aged 9-10 years, mothers, and nurses.Results.Responses from 754 nurses were analyzed using backward linear regression for handwashing intention. We reasoned that handwashing results in 2 distinct behavioral practices—inherent handwashing and elective handwashing—with our model explaining 64% and 76%, respectively, of the variance in behavioral intention. Translation of community handwashing behavior to healthcare settings is the predominant driver of all handwashing, both inherent (weightedβ= 2.92) and elective (weightedβ= 4.1). Intended elective in-hospital handwashing behavior is further significantly predicted by nurses' beliefs in the benefits of the activity (weightedβ= 3.12), peer pressure of senior physicians (weightedβ= 3.0) and administrators (weightedβ= 2.2), and role modeling (weightedβ= 3.0) but only to a minimal extent by reduction in effort (weightedβ= 1.13). Inherent community behavior (weightedβ= 2.92), attitudes (weightedβ= 0.84), and peer behavior (weightedβ= 1.08) were strongly predictive of inherent handwashing intent.Conclusions.A small increase in handwashing adherence may be seen after implementing the use of alcoholic hand rubs, to decrease the effort required to wash hands. However, the facilitation of compliance is not simply related to effort but is highly dependent on altering behavioral perceptions. Thus, introduction of hand rub alone without an associated behavioral modification program is unlikely to induce a sustained increase in hand hygiene compliance.

This paper presents the findings from three separate qualitative studies that sought to explore the current and potential role of nurses employed in general medical practices in Australia. General practitioners', practice nurses' and consumers' views and perceptions were gathered from individual and group interviews. The data indicate that practice nurses (PNs) are involved in first level or primary care of individuals and engage in some form of preventive health care. Some PNs have a family/community focus in addition to their focus of care on individuals. Engagement in health promotion was found to be opportunistic rather than planned, and focussed on interventions to free individuals from medically defined diseases - the aim being compliance with therapeutic procedures and advice. The broader concept of health promotion, as documented in the Ottawa Charter for Health Promotion, was not pronounced in the PNs' reported practice. Consumers do not articulate confidence in PNs acting autonomously as primary health care practitioners but rather as complementary to general practitioners (GPs), undertaking initial assessment for triage purposes and providing ongoing management, education and support under the GPs' delegation. They would also like them to be family-oriented and holistic in their practice; supporting emotional and social needs in the context of their family lives.

27 Background: In outpatient oncology, clinicians working in various locations and at different times, rely on each other for information to coordinate and manage care. Increasingly complex treatment algorithms magnify risk for adverse events precipitated by failures of communication/coordination. We implemented team training in 16 adult practices across five campuses (community and academic) to reduce errors and increase efficiency/quality. Methods: 1,000+ MDs, NPs, PAs, RNs, pharmacists, and support staff were trained in teamwork concepts. Interventions and methods included baseline data collection on key clinical processes, (e.g. same-day chemotherapy changes not communicated to treating RN); observations and interviews with teams; “train-the-trainer” sessions; identification of “pain points”; interdisciplinary "process meetings" to develop agreements, tools and systems changes to support better communication/efficiency; trained all staff; collected data six months post-training. Results: Despite infrequency of noncommunicated same-day changes in chemotherapy at baseline (~2%), an improvement trend was seen (chi-square p=0.068). Incidence of missing infusion orders, not associated with an MD visit, decreased significantly. Providers reported fewer unnecessary pages. Nurses reported quicker, more reliable responses to pages sent. Staff reported improved practice efficiencies and safer, respectful work environments. Qualitative interviews elicited patient perceptions of communication, teamwork, and care coordination. Patients’ quantitative perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, interactions with team members, staff perceptions of efficiency, quality, and safety and patient perception of teamwork in the outpatient practices of a comprehensive cancer center. [Table: see text]

Background: In Oregon in the United States’ Pacific Northwest, Native Hawaiians/ Pacific Islanders including Micronesian Islanders (MI) substantially grew by 68%; however, research is sparse. This is often due to data aggregation as Asian and Pacific Islanders and community members’ reluctance and wariness to participate in research due to a history of unethical research in the Pacific. The MI community experienced miscarriages, stillbirths, and mental intellectual and developmental disabilities. Organizational MI community leaders expressed a need to explore the voices of MI parent leaders. The purpose of the qualitative descriptive pilot study was to explore the perceptions and experiences of Micronesian Islander parent leaders (MIPL) with maternal and children’s health, the school system, and the influence of culture. Methods: A trained MI community health worker recruited eight MIPL from an urban area of the Pacific northwest in the U.S. A group level assessment included illustrative storytelling and is a participant-driven qualitative method that guided data collection and analysis in real-time with MIPL. The discussions lasted for 90 minutes. MIPL shared stories by writing and drawing pictures onto the flip chart papers, transcribed main points, and analyzed the data with researchers. Researchers recorded field notes of the interactions. Researchers debriefed with MIPL to assure trustworthiness and credibility of the findings. Findings: MIPL are Compact of Free Association citizens. Their age ranged from 26 to 42 years, have lived in the U.S. an average of 12.63 years, and most reported having less than $15,000 total household income before taxes. Four main themes were identified: MI cultural identity, English language and MI culture disharmony, zero or delayed prenatal care, and uncertainty for the future of MI children who have disabilities or developmentally delayed as they progress through the school system. Conclusion: Health care providers including nurses and school officials need to have a culturally specific understanding of the MI community and must consider their needs, culture, and language barriers.

Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses’ emotional labor, and organizational culture.

Introduction India has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India. Methods A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities. Results Most of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite. Conclusions Inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.

e16559 Background: Increasingly complex diagnostic and multimodality treatment algorithms have yielded superior outcomes, but also magnified the risk for adverse events precipitated by failures of communication and coordination. We implemented team training principles in 14 outpatient oncology practices across 3 campuses (community and academic) to reduce the risk of errors and increase operational efficiency and quality. Methods: Over 950 physicians, nurses, pharmacists, and staff were trained in evidence-based concepts of teamwork. Intervention included 1) baseline data collection regarding key clinical processes, (e.g. non-communication of same-day chemotherapy order changes); 2) observations/interviews with care team members; 3) process meetings to identify vulnerabilities and develop agreements and tools to support them; 4) Train the Trainer methodology; 5) staff training; 6) post-training data collection. Results: Despite the infrequency of non-communicated same-day changes in chemotherapy orders at baseline (~2%), a trend toward improvement was seen (chi-square p=0.068). The incidence of missing chemotherapy orders for infusion visits not associated with an MD visit decreased significantly. Staff reported improved practice efficiencies and a more respectful, safer environment. Press Ganey patient-reported perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, perceptions of efficiency, quality, safety and interactions among team members, as well as patient perception of teamwork in both community and academic environments of a comprehensive cancer center. [Table: see text]

PURPOSE There is increasing interest in implementing digital systems for remote monitoring of patients’ symptoms during routine oncology practice. Information is limited about the clinical utility and user perceptions of these systems. METHODS PRO-TECT is a multicenter trial evaluating implementation of electronic patient-reported outcomes (ePROs) among adults with advanced and metastatic cancers receiving treatment at US community oncology practices (ClinicalTrials.gov identifier: NCT03249090 ). Questions derived from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) are administered weekly by web or automated telephone system, with alerts to nurses for severe or worsening symptoms. To elicit user feedback, surveys were administered to participating patients and clinicians. RESULTS Among 496 patients across 26 practices, the majority found the system and questions easy to understand (95%), easy to use (93%), and relevant to their care (91%). Most patients reported that PRO information was used by their clinicians for care (70%), improved discussions with clinicians (73%), made them feel more in control of their own care (77%), and would recommend the system to other patients (89%). Scores for most patient feedback questions were significantly positively correlated with weekly PRO completion rates in both univariate and multivariable analyses. Among 57 nurses, most reported that PRO information was helpful for clinical documentation (79%), increased efficiency of patient discussions (84%), and was useful for patient care (75%). Among 39 oncologists, most found PRO information useful (91%), with 65% using PROs to guide patient discussions sometimes or often and 65% using PROs to make treatment decisions sometimes or often. CONCLUSION These findings support the clinical utility and value of implementing digital systems for monitoring PROs, including the PRO-CTCAE, in routine cancer care.

AbstractObjective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.

Purpose The purpose of this paper is to explore community professionals’: opinions concerning social worker’s roles and statutory functions; understanding of collaborative and cooperative work; experiences of professional support; opinions on the aspects of anti-oppressive practices in social work; views on social work identity within multi-disciplinary team structures; exploring perceptions regarding the challenges of cultural; and contextual drivers of social work practice. Design/methodology/approach Design: thematic analysis of free-text data from a survey. Setting and participants: social workers, occupational therapists and nurses working within an integrated Health and Social Care NHS Trust. Main outcome measures: free-text coded and categorised by theme. Overarching themes are identified incorporating comment categories. Methods: 41 respondents (of n=600 survey respondents) provided free-text comments. Data were coded using a multistage approach: coding of comments into general categories (e.g. resources, budgets); coding of subcategories within main categories (e.g. s75 agreement, staffing levels); cross-sectional analysis to identify themes cutting across categories; and mapping of categories/subcategories to corresponding comparable research for comparison. Findings Most free-text respondents (51 per cent) were from social workers, with 32 per cent from occupational therapists and 17 per cent from nurses. These respondents provided comments that the authors developed into four overarching themes: first, culture – cultural biases and clashes of culture within an integrated care organisation which result in a negative experience for professionals and confusion for service users and/or carers. A lack of shared socialisation and the development of a shared culture. Second, austerity: the impact of economic austerity. Third, organisation: conceptual confusion in respect of defining/organising/structuring integrated care within a health organisation. Fourth, political: the political drivers of integration. Originality/value This study presents specific areas of concern for social workers and for integrated social care and health as a whole, revealing a number of themes present across the integration journey. While the majority of comments were negative, analysis reveals concerns shared by significant numbers of respondents: conceptual confusion in respect of organising integrated care within a health organisation, a lack of shared socialisation and the development of a shared culture within the integrated organisation, and the impact of economic austerity on integration.

Abstract Speech-language pathologists, working in a multicultural, community-based environment for young children with special needs in Vancouver, Canada, collected information on 84 clients using AAC from a chart review. The speech-language pathologists collected additional usage information and attended a group interview to discuss barriers and facilitators of AAC. Thirty-one percent of the children were using AAC. Children aged between 16 and 72 months typically relied on multiple modes of communication, including sign, communication boards and binders, and low- and high-tech communication devices. All of the children used at least one type of unaided mode. Fifty-five percent used pictures or communication boards/displays, and 29% used technology with speech output. Similarities in usage of AAC were noted in home and child-care settings with increased use of unaided in homes and a slightly increased use of aided communication in child care settings. Speech-language pathologists reported that the time needed for AAC intervention as well as limited funding for high-tech devices continue to be major barriers. Additional research is needed to describe current AAC practices with young children particularly from minority linguistic and cultural backgrounds. Stakeholder input is needed to explore perceptions of children's usage of AAC in daily life with familiar and unfamiliar communication partners.

PurposeThis research explores community professionals' opinions concerning social worker's roles and statutory functions. It explores the perspectives of professionals and their understanding of collaborative and cooperative work; experiences of professional support; opinions on the aspects of anti-oppressive practices in social work; views on social work identity within multidisciplinary team structures; and perceptions regarding the challenges of cultural and contextual drivers of social work practice.Design/methodology/approachThis study adopts an interpretivist paradigm and social constructionist epistemology in that there are multiple realities to be understood and different perspectives and perceptions to be explored. This study adopted a data collection approach of thematic analysis of semi-structured interviews.Setting and participantsSocial workers and nurses working within an integrated social care and health NHS trust.MethodsSix respondents volunteered for interviews in 2017. Data were coded as follows using a multistage approach: (1) coding of comments into general categories (e.g. culture, models of practice), (2) coding of subcategories within main categories (e.g. values, knowledge and skills), (3) cross-sectional analysis to identify themes cutting across categories and (4) mapping of categories/subcategories to corresponding comparable research for comparison.FindingsMost interviewees (5) were social workers, with one from the nursing field. Respondents provided comments that fell under four overarching themes: cultural theme, the impact of economic austerity, organisational structures and the political drivers of integration.Originality/valueThis study contributes to the evidence regarding the role of social workers within integrated health and adult social care organisations (as opposed to mental health social work) and also contributes to the evidence around social work in times of austerity.

Objectives To outline the prevalence and disparities of hearing problems among school-aged urban minority youth, causal pathways through which hearing problems adversely affect academic achievement, and proven or promising approaches for schools and parents to address these problems. Methods Literature review. Results Most school-aged youth will experience a temporary, fluctuating hearing loss at least once and about 20% of U.S. adolescents have some kind of permanent hearing problem. When nationally representative samples of hearing loss among youth under age18 were conducted, those from lower socioeconomic families were more likely to have a hearing loss (23.6%) than those from families above the poverty threshold. Hearing screening is widespread in schools, but the benefits are jeopardized by non-standardization, inadequate methods for commonly occurring losses, and lack of follow-up. Conclusions Hearing problems are disproportionately prevalent among school-aged urban minority youth, and have a negative impact on academic achievement through sensory perceptions, cognition, and school connectedness. Effective practices are available for schools to address these problems. To better realize the benefits of current investments in screening, programs will require improved prevention efforts and follow-up/coordination between agencies conducting screening, school nurses, teachers, speech-language pathologists (SLPs), audiologists, parents, and in some cases, physicians and community resources.

AbstractObjective To explore management by general practitioners of victimised female patients, male partners who abuse, and children in the family.Design Triangulated qualitative study comparing doctors' reported management with current recommendations in the literature.Participants 28 general practitioners attending continuing medical education about management of domestic violence.Results Doctors perceived partner abuse in diverse ways. Their gender, perceptions, and attitudes could all affect identification and management of this difficult problem. A few doctors practised in recommended ways, but many showed stress and aversion, difficulties in resolving the tensions involved in managing all family members, and neglect of the risks to children. Some doctors used contraindicated practices, such as breaking confidentiality and undertaking or referring for couple counselling. Doctors who were not familiar with community based agencies were reluctant to use them. A lack of expertise and support could have a negative impact on doctors themselves.Conclusions General practitioners managing partner abuse need to be more familiar with and apply the central principles of confidentiality and safety of women and children. Recommended guidelines for managing the whole family should be developed. Doctors should consider referring one partner elsewhere and avoid couple counselling; always ask about and act on the children's welfare; refer to specialist family violence agencies; and seek training, supervision, and support for the inherent stress. Medical education and administration should ensure comprehensive training and support for doctors undertaking this difficult work.

Contents: Families of children with congenital heart disease face frequent healthcare encounters due to their child's care trajectory. With an emphasis on assuring caring in healthcare, it is necessary to understand parents’ perceptions of healthcare providers’ actions when their child undergoes heart surgery. Aim: This study aimed to evaluate the effect of family-centered care intervention on maternal coping and participation in care for their children with congenital heart diseases. Methods: A quasi-experimental design was used. The study was carried out at the pediatric inpatient department in Cardiovascular Hospital, affiliated to Ain Shams University Hospitals. A purposive sample of 50 children undergoing heart surgery and their accompanying mothers. The study was used a structured interview questionnaire, the family-centered care scale, the index of mothers' participation, mothers’ practice observational checklists, and the coping process scale to collect the study’s data. Results: The study reveals a statistically significant difference in the mothers' total coping pattern after family-centered care intervention compared to before intervention at p=0.000. A statistically significant difference was also revealed regarding the total mothers' participation in the care of their children with congenital heart disease at p=0.000. There was a strong positive correlation between total mothers' coping patterns, participation, and mothers' total actual practices regarding their children's care suffering from congenital heart diseases after the intervention. Conclusion: The family-centered care intervention effectively improved mothers' coping patterns and participation in care for their children with congenital heart diseases. Emphasizing the importance of family (usually the mother) participation in care for their children with congenital heart diseases during hospitalization for heart surgery. Designing and carrying out educational programs for pediatric nurses to promote family-centered care in clinical practice.

PURPOSE: Although the hospital remains the dominant site for delivering most pediatric cancer care, home-based care is increasingly provided. To effectively deliver comprehensive, relevant, and acceptable care in children's homes, the voices of these key informants must be considered. We examined the views of children with cancer, their family caregivers, and clinicians on home-based cancer care to identify necessary strategies to improve the delivery of care. METHODS: Children with cancer, their family caregivers, and multiprofessional clinicians who provide care at a tertiary pediatric care center or in the community participated in audio-recorded, semistructured interviews in French and English. Interviews were conducted until data saturation in each participant group was achieved. Interviews were transcribed, coded, and analyzed using thematic analysis. RESULTS: Thirteen children, 20 family caregivers, and 22 clinicians participated. Home-based care was endorsed as a means to improve child health-, family social- and financial-, and system-level outcomes. The success of a home-based model is built on care that addresses child and family informational, treatment and care, material, and psychosocial needs. Mechanisms to improve care include enhanced homecare agency-hospital-family communication, training for homecare nurses in pediatric cancer care, virtual solutions, and an expanded breadth of services provided in-home. Child-, family-, and system-related factors affect the delivery of optimal home-based care. CONCLUSION: Children, families, and clinicians value a model of pediatric cancer care that incorporates home-based services. The insights of these key informants should be reflected in the principles that become the basis of home-based cancer care best practices.

Objective The aim of the present study was to explore the perspectives of older people following their recent participation in a 75+ Health Assessment (75+HA) and interrogate these perspectives using a person-centred lens. Methods A qualitative descriptive study design was used within a larger study funded by the Australian Primary Health Care Research Institute. Nineteen participants from four different general practices in one Australian state described their perceptions of the 75+HA in a face-to-face interview. Data were then analysed using a qualitative content analysis approach. Results The purpose of the 75+HA was not well understood by participants. Participant responses reveal that where, when, who and how a primary health professional conducted the 75+HA affected what older people talked about, the guidance they sought to deal with issues and, in turn, the actioning of issues that were discussed during the 75+HA. Conclusion To enable older people to make informed decisions about and successfully manage their own health and well being, and to choose when to invite others to act on their behalf, primary health professionals need to ask questions in the 75+HA within a person-centred mindset. The 75+HA is an opportunity to ensure older people know why they need support, which ones, and agree to, supports and services they require. What is known about the topic? The Australian Medicare Benefits Schedule includes the 75+HA, developed as a proactive primary care opportunity for general practitioners and practice nurses to identify issues affecting community-dwelling older people’s health and well being. The aim of the 75+HA is to consider a broad range of factors that could affect physical, psychological and social functioning, which, in turn, affects overall health, and the capacity of older people to live independently in the community. Underlying the 75+HA is the importance of detecting early functional decline to enable healthy aging. What does this paper add? There is scant, if any, attention in the literature to the views of consumers who have completed a 75+HA, especially with regard to whether this opportunity is conducted with a person-centred mindset. This paper addresses this gap. Even after participating in the 75+HA, most participants were unclear as to the purpose of the assessment, what information had been recorded and what would happen from any concerns identified in the assessment. Comments about the 75+HA included that it did not ask people about their goals and what comprised their functionality to ensure their independent living. What are the implications for practitioners? A person-centred approach requires active collaboration between primary health professionals and older people who are living the process of, and planning for, aging-in-place. Assessments like the 75+HA can assist in identifying whether older people may be experiencing early signs of functional decline, even if older people self-report living without problems in their home. Practitioners need to ask questions of older people and respond to what they say with a person-centred mindset.

A Review of: Giles-Smith, L., Spencer, A., Shaw, C., Porter, C., & Lobchuk, M. (2017). A study of the impact of an educational intervention on nurse attitudes and behaviours toward mobile device and application use in hospital settings. Journal of the Canadian Health Libraries Association/Journal de l'Association des bibliothèques de la santé du Canada, 38(1), 12-29. doi: 10.5596/c17-003 Abstract Objective - To describe nurses’ usage of and attitudes toward mobile devices and apps and assess the impact of an educational intervention by hospital librarians and educators Design - Descriptive, cross-sectional survey, one-group pre- and post-test, and post-intervention focus group Setting - One 251-bed community hospital and one 554-bed tertiary care hospital in Winnipeg, Canada Subjects - 348 inpatient medical and surgical nurses Methods – The study had two phases. In Phase I, respondents completed a survey of 21 fixed and open-ended questions offered online or in print to a convenience sample from the community hospital and a random sample of medical and surgical units from the tertiary hospital. The survey collected demographic data and included questions about mobile devices and apps covering current awareness of hospital policy, ownership, internet access, usage patterns, concerns, and attitudes toward their use for direct patient care. It also included information to recruit volunteers for Phase II. In Phase II, participants attended four 30-minute educational sessions facilitated by the researchers. The first session addressed the regional health authority’s policies, Personal Health Information Act, and infection control practices. Subsequent sessions covered relevance, features, and training exercises for one or more selected apps. Participants installed five free or low-cost apps, which were chosen by the librarians and nurse educators, on their mobile devices: Medscape, Lab Tests Online, Lexicomp, Twitter, and Evernote. Participants were then given a two-month period to use the apps for patient care. Afterward, they completed the same survey from Phase I and their pre- and post-intervention responses were matched for comparative analysis. Phase II concluded with a one-hour audio-recorded focus group using ten open-ended questions to gather feedback on the impact of the educational sessions. Main Results – 94 nurses completed the Phase I survey for a response rate of 27%. Although 89 respondents reported owning a mobile device, less than half used them for patient care. Just under half the respondents were unsure if they were allowed to use mobile devices at work and a similar number answered that devices were not allowed. Two-thirds of respondents were unsure whether any institutional policies existed regarding mobile device use. Of the 16 participants that volunteered for Phase II, 14 completed the post-intervention survey and 6 attended the focus group. In comparison to the Phase I survey, post-intervention survey responses showed more awareness of institutional policies and increased concern about mobile devices causing distraction. In the Phase I survey, just over half of the nurses expressed a desire to use mobile devices in patient care. Four themes emerged from the survey’s qualitative responses in Phase I: (1) policy: nurses were unsure of institutional policy or experienced either disapproval or bans on mobile device use from management; (2) barriers to use, namely cost, potential damage to or loss of devices, infection control, and lack of familiarity with technology; (3) patient perceptions, including generational differences with younger patients seen as more accepting than older patients; and (4) nurse perceptions: most valued access to information but expressed concerns about distraction, undermining of professionalism, and use of technology. Qualitative responses in the Phase II survey and focus group also revealed four themes: (1) barriers: participants did not cite loss of device or infection control as concerns as in Phase I; (2) patient acceptance and non-acceptance: education and familiarity with mobile devices were noted as positive influential factors; (3) information need, accessibility, and convenience: nurses reported needing easy-to-use apps, particularly Lexicomp, and appreciated improved access to information; and (4) nurse behaviour and attitude: participants reported more time would be needed for changes to occur in these areas. Conclusion – The study found that although most nurses own mobile devices and express strong interest in using them for patient care, there are significant barriers including lack of clarity about institutional policies and concerns about infection control, risk of damage to personal devices, costs, lack of experience with the technology, distraction, and negative patient perceptions. To address these concerns, the authors recommend that hospital librarians and educators work together to offer training and advocate for improved communication and policies regarding use of mobile devices in hospital settings. Moreover, the study affirmed the benefits of using mobile devices and apps to support evidence-based practice, for example by providing access to reliable drug information. The authors conclude that additional research is needed to inform policy and develop strategies that hospital librarians and nurse educators can use to promote the most effective application of mobile technologies for patient care.

Abstract Objectives To build an understanding of factors that influence exclusive breastfeeding practices (EBF) of lactating mothers which will contribute to the development a behavior change intervention targeting mothers in households with children 0–6 months in Mwenezi and Chiredzi districts of Zimbabwe. Methods A cross sectional study was conducted in May 2018 according to the protocol laid out in United States Agency for International Development (USAID)’s “A Practical Guide to Conducting a Barrier Analysis.” It was carried out in four administrative wards in Mwenezi district and six in Chiredzi district. The behavior under study was “Mothers of children ages 0 – 6 months feed them only breast milk.” Structured in-depth interviews were administered to a total of 90 mothers with children aged 0–6 months, targeting 45 doers and 45 non-doers for the behavior, as part of formative research for the development of a social behavior change intervention. Perceived self-efficacy, social-cultural norms, perceived positive-negative consequences, cues for action and community rules and laws were identified. Qualitative analysis included coding, sorting and identifying themes. Results Barriers to EBF included high labor burden, perceived milk insufficiency and influence from mother-in-law. The main enablers were spousal support with chores and information from nurses. Mothers said that other factors that made EBF easier were a desire to have a healthy baby, feeling that breastmilk was enough to satisfy the baby and family support, while breast pain, and needing to give the baby water and other concoctions due to the heat or religious practices made it difficult. Some mothers felt that the negative consequences of breastfeeding were that it is time-consuming, increases workload and increases the risk of HIV transmission. Conclusions High labor burden, limited support with chores, in-law influence and perceived milk insufficiency impeded optimal EBF. Approval from in-laws and spouses was important in EBF. These findings were used to develop a social behavior change program that is currently being implemented in Zimbabwe, targeting pregnant and lactating women and key influencers such as mothers-in-law and spouses. Funding Sources The funding for the barrier analysis study was provided by the European Union through United Nations Children's Fund (UNICEF).

OBJECTIVES/SPECIFIC AIMS: Calls for health care organizations to promote health equity, through reducing health care disparities and addressing the social determinants of health, are growing and disrupt assumptions about equal care and the role of the health care delivery system more generally. This paper uses qualitative data to explore the emotions that health care personnel express as they make sense of the newfound emphasis on equity. To do so, we consider the relationships between social identity, sense of control, emotion, cognition, and action. METHODS/STUDY POPULATION: The principle investigator conducted 21 semistructured interviews with senior leaders and equity team members and 7 focus groups with providers and staff employed at one of Minnesota’s largest health care system. The PI asked respondents to describe recent conversations about equity in their workplaces and to identify barriers and facilitators to addressing equity. Focus group participants were also asked to imagine colleagues’ reactions—“what would they say, think, and feel”—should they be asked to adapt practices to address the social determinants of health, community health, and healthcare disparities. Interviews and focus groups were audiotaped and transcribed. Two coders independently coded each transcript for themes and then compared and reconciled their coding. Reactions to equity work emerged inductively during the coding process. RESULTS/ANTICIPATED RESULTS: Findings suggest that discourses on health equity can disrupt personal and professional identities and trigger a mixture of emotions, including fear, sadness, and excitement. Personnel with broad, or flexible, constructions of their work roles experienced less disruption, and more positive emotions, than those personnel who constructed narrow, or rigid, professional identities. Those who expressed a stronger sense of control also expressed more positive emotions, such as happiness and hope, and were excited about the prospect of greater accountabilities related to equity. Those who doubted the existence of disparities were defensive and pointed to cues such as standardized care protocols and perceptions of colleagues’ professionalism to oppose change. Those who perceived low organizational self-efficacy, due to a lack of time, skills, or knowledge, often expressed frustration and helplessness. Their sensemaking focused on the lack of progress and sought sensegiving about ways to “make it workable.” DISCUSSION/SIGNIFICANCE OF IMPACT: Discussions about equity are new in healthcare and trigger mixed reactions, drawing out provider and staff’s hopes, fears, and anxieties. Variations in emotional reactions may be related to differing perceptions about sense of control over disparities and the social determinants of health. If we want to enlist health care providers, nurses, and managers in efforts to improve health equity, we need to understand these emotions and sensemaking processes.

Jumlah narapidana atau warga binaan pemasyarakatan perempuan terus meningkat sehingga perlu mendapat perhatian. Hal ini berkaitan dengan kebutuhan kesehatannya yang unik serta subyek yang terkena dampak termasuk anak. Pemenjaraan menimbulkan pemikiran, perasaan, sikap, dan gagasan tersendiri bagi warga binaan pemasyarakatan perempuan untuk menjalankan perannya sebagai ibu. Tujuan penelitian. Penelitian ini bertujuan untuk menggali persepsi warga binaan pemasyarakatan perempuan di Rutan Kelas IIA Jakarta Timur dalam menjalankan peran sebagai ibu. Metode. Penelitian menggunakan desain kualitatif dengan pendekatan fenomenologi. Pengumpulan data dilakukan dengan wawancara mendalam terhadap tujuh warga binaan perempuan. Transkrip wawancara dianalisis dengan mengorganisasikan kata kunci yang ditemukan ke dalam kategori, sub tema, dan tema. Hasil. Hasil penelitian menjelaskan bahwa warga binaan pemasyarakatan perempuan memiliki persepsi yang sama tentang peran seorang ibu dalam pengasuhan anak. Peran penting seorang ibu yaitu memperhatikan kesehatan anak, mendidik anak, mendampingi anak, dan mencukupi semua kebutuhan anak. Partisipan tetap dapat menunjukkan perilaku-perilaku positif dan pengasuhan. Partisipan memiliki efikasi diri yang tinggi dalam pengasuhan anak. Kesimpulan. Efikasi diri yang dimiliki ibu berdampak pada persepsi dan kemampuannya untuk menjalankan peran selama dan setelah dipenjarakan. Hasil penelitian ini diharapkan dapat menjadi acuan bagi kolaborasi profesi antara lembaga peradilan, perawat komunitas, akademisi, dan elemen terkait untuk meningkatkan perhatian terhadap pelaksanaan peran ibu di lembaga pemasyarakatan Kata kunci: pemenjaraan; pengasuhan; peran sebagai ibu; warga binaan pemasyarakatan PERCEPTION OF FEMALE INMATE ON ROLE AS MOTHER: PHENOMENOLOGY STUDY ABSTRACT The number of female inmate continues to increase and needs attention. It is related to their unique health needs as well as affected subjects including children. Imprisonment creates their own thoughts, feelings, attitudes, and ideas for women in prison to carry out their role as mothers. This study was aimed to explore the perceptions of female inmate in Class IIA detention centers in East Jakarta in carrying out their role as mothers. The study used a qualitative design with a phenomenological approach. Data was collected by in-depth interviews of seven female inmates. Interview transcripts were analyzed by organizing the keywords found into categories, sub themes, and themes. The results of the study explained that female inmates have the same perception about the role of a mother in childcare. An important role of a mother is to pay attention to children's health and education, accompany their children, and meet all the needs of children. Participants can still show some positive parenting behaviors. The self-efficacy of the mother has an impact on her ability to perform roles during and after imprisonment. The results of this study are expected to be a reference for professional collaboration between the judiciary, community nurses, academics, and related elements to raise awareness of imprisoned mothers and children affected by female inmate. Keywords: imprisonmen; parenting; mother’s role; female inmate

Reproductive health is concerned with the people’s ability to have a satisfyingand safe sex life ensuring their capability to reproduce with a liberty of making a decision that if,when and how often they have to do so. In Pakistan, culturally females are married at a youngage; become mothers and are at risk of health complications i.e. HIV/ STD and STI. There isless utilization of reproductive health services throughout Pakistan that ultimately affects healthstatus of people at very young age. Most of the communities are not aware of reproductivehealth services, thus not availing these facilities. Objective: So the present study was designedto examine the females perceptions, attitude and practices about reproductive health servicesas well as to determine the level of their empowerment to take decisions and make choicesregarding their own reproductive health besides determining the level of the quality, availabilityand accessibility of reproductive health services and to suggest some measures for policymakers to improve the reproductive health state of young mothers in district Faisalabad. StudyDesign: A sample of 600 young married females of age 15-32 years was selected throughmultistage sampling technique. Period: 2009. Setting: Rural and urban area of DistrictFaisalabad. Material and Method: Uni-variate (frequency distribution and percentage) and Bivariateanalysis (Chi square and Gamma Statistics) was carried out. Results: Most (44.0%) ofthe respondents belonged to age category of 26-30 years; 35.5% were married for 18 years;39.3% had been married for 5 years; 71.8% had primary and above level of education. Majority(65.9%) had up to Rs.10,000 per month income, 49.2% possessed 6-10 family members,73.5% had at least 2 and above live children. Majority had the knowledge of reproductive health(67.7%) and HIV/AIDs (54.7%) whereas most of females had no knowledge of STIs (69.8%),RTIs (52.3%) and its development (51.8%). Most of the females experienced headache (62.8%),swelling of different body parts (61%) and back pain (62.7%) during their reproductive life. Bivariateanalysis showed highly significant relation among age at marriage, number of children,cultural hindrance and age of respondents vs. their reproductive health. Conclusion: Althoughmost of the females were young & educated mothers with good reproductive health experiencebut still lacking in knowledge about STIs, HIV/AIDS, RTIs and breast cancer that is because ofcultural hindrance, early age marriage pattern and male dominancy which indicates that weneed to pay more attention towards female education and empowerment and decision makingauthority status at domestic level through community mobilization with the help of NGOs,Religious scholars and existing health system/ Health personnel’s .i.e. doctors/ nurses /LHV/FHW.

Purpose Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research. Design/methodology/approach Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database. Findings A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality. Research limitations/implications Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias. Practical implications The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles. Originality/value There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Playing curriculum development based on early childhood learning is a major issue in international early childhood education discussions. This study aims to look at the concepts and practices of play-based curriculum in early childhood education institutions. The study uses qualitative methods with the CIPP model program evaluation on play-based curriculum. Data collection techniqueswere carriedout using participatory observation, document studies and interviews. Participants are early childhood educators, early childhood and parents. The results found that the play-based curriculum has not yet become the main note in the preparation and development of concepts and learning practices in early childhood. Play-based curriculum quality standards have not provided a solid and clear concept foundation in placing play in the center of learning models. Other findings the institution has not been able to use the DAP (Developmentally Appropriate Practice) approach fully, and has not been able to carry out the philosophy and ways for developing a curriculum based on play. However, quite a lot of research found good practices implemented in learning centers in early childhood education institutions, such as develop children's independence programs through habituation to toilet training and fantasy play. Keywords: Play Based Curriculum, Center Learning Model, Curriculum Quality Standards, Early Childhood Education Reference Alford, B. L., Rollins, K. B., Padrón, Y. N., & Waxman, H. C. (2016). Using Systematic Classroom Observation to Explore Student Engagement as a Function of Teachers’ Developmentally Appropriate Instructional Practices (DAIP) in Ethnically Diverse Pre- kindergarten Through Second-Grade Classrooms. Early Childhood Education Journal, 44(6), 623–635. https://doi.org/10.1007/s10643-015-0748-8 Ali, E., Kaitlyn M, C., Hussain, A., & Akhtar, Z. (2018). the Effects of Play-Based Learning on Early Childhood Education and Development. Journal of Evolution of Medical and Dental Sciences, 7(43), 4682–4685. https://doi.org/10.14260/jemds/2018/1044 Ashiabi, G. S. (2007). Play in the preschool classroom: Its socioemotional significance and the teacher’s role in play. Early Childhood Education Journal, 35(2), 199–207. https://doi.org/10.1007/s10643-007-0165-8 Berk, L. E., & Meyers, A. B. (2013). The role of make-believe play in the development of executive function. American Journal of Play, 6(1), 98–110. Bodrova, E., Germeroth, C., & Leong, D. J. (2013). Play and Self-Regulation: Lessons from Vygotsky. American Journal of Play, 6(1), 111–123. Retrieved from http://eric.ed.gov/?id=EJ1016167 Chien, N. C., Howes, C., Burchinal, M., Pianta, R. C., Ritchie, S., Bryant, D. M., ... Barbarin, O. A. (2010). Children’s classroom engagement and school readiness gains in prekindergarten. Child Development, 81(5), 1534–1549. https://doi.org/10.1111/j.1467-8624.2010.01490.x Cortázar, A. (2015). Long-term effects of public early childhood education on academic achievement in Chile. Early Childhood Research Quarterly, 32, 13–22. https://doi.org/10.1016/j.ecresq.2015.01.003 Danniels, E., & Pyle, A. (2018). Defining Play-based Learning. In Encyclopedia on Early Childhood Development (Play-Based, pp. 1–5). OISE University of Toronto. Ejuu, G., Apolot, J. M., & Serpell, R. (2019). Early childhood education quality indicators: Exploring the landscape of an African community perspective. Global Studies of Childhood. https://doi.org/10.1177/2043610619832898 Faas, S., Wu, S.-C., & Geiger, S. (2017). The Importance of Play in Early Childhood Education: A Critical Perspective on Current Policies and Practices in Germany and Hong Kong. Global Education Review, 4(2), 75–91. Fisher, K. R., Hirsh-Pasek, K., Newcombe, N., & Golinkoff, R. M. (2013). Taking shape: Supporting preschoolers’ acquisition of geometric knowledge through guided play. Child Development, 84(6), 1872–1878. https://doi.org/10.1111/cdev.12091 Hennessey, P. (2016). Full – Day Kindergarten Play-Based Learning : Promoting a Common Understanding. Education and Early Childhood Development, (April), 1–76. Retrieved from gov.nl.ca/edu Holt, N. L., Lee, H., Millar, C. A., & Spence, J. C. (2015). ‘Eyes on where children play’: a retrospective study of active free play. Children’s Geographies, 13(1), 73–88. https://doi.org/10.1080/14733285.2013.828449 Jay, J. A., & Knaus, M. (2018). Embedding play-based learning into junior primary (Year 1 and 2) Curriculum in WA. Australian Journal of Teacher Education, 43(1), 112–126. https://doi.org/10.14221/ajte.2018v43n1.7 Kathy, E. (2016). Play-based versus Academic Preschools. Parent Cooperative Preschool International, 1–3. Klenowski, V., & Wyatt-Smith, C. (2012). The impact of high stakes testing: The Australian story. Assessment in Education: Principles, Policy and Practice, 19(1), 65–79. https://doi.org/10.1080/0969594X.2011.592972 Martlew, J., Stephen, C., & Ellis, J. (2011). Play in the primary school classroom? The experience of teachers supporting children’s learning through a new pedagogy. Early Years, 31(1), 71– 83. https://doi.org/10.1080/09575146.2010.529425 Mcginn, A. (2017). Play-based early childhood classrooms and the effect on pre-kindergarten social and academic achievement (University of Northern Iowa). Retrieved from https://scholarworks.uni.edu/grp Miller, E., & Almon, J. (2009). Crisis in the Kindergarten. Why children need to to Play in School. In Alliance for childhood. Retrieved from www.allianceforchildhood.org. Özerem, A., & Kavaz, R. (2013). Montessori Approach in Pre-School Education and Its Effects. Tojned The Online Journal of New Horizons in Education, 3(3), 12–25. Pendidikan, K., & Kebudayaan, D. A. N. Menteri Pendidikan Dan Kebudayaan Republik Indonesia Nomor 137 Tahun 2013 Tentang Standar Nasional Pendidikan Anak Usia Dini. , (2015). Peng, Q. (2017). Study on Three Positions Framing Kindergarten Play-Based Curriculum in China: Through Analyses of the Attitudes of Teachers to Early Linguistic Education. Studies in English Language Teaching, 5(3), 543. https://doi.org/10.22158/selt.v5n3p543 Pyle, A., & Bigelow, A. (2015). Play in Kindergarten: An Interview and Observational Study in Three Canadian Classrooms. Early Childhood Education Journal, 43(5), 385–393. https://doi.org/10.1007/s10643-014-0666-1 Pyle, A., & Danniels, E. (2017). A Continuum of Play-Based Learning: The Role of the Teacher in Play-Based Pedagogy and the Fear of Hijacking Play. Early Education and Development, 28(3), 274–289. https://doi.org/10.1080/10409289.2016.1220771 Reid, A. (2009). Is this a revolution?: A critical analysis of the Rudd government’s national education agenda. Curriculum Perspectives, 29(3), 1–13. Ridgway, A., & Quinones, G. (2012). How do early childhood students conceptualize play-based curriculum? Australian Journal of Teacher Education, 37(12), 46–56. https://doi.org/10.14221/ajte.2012v37n12.8 Rogers, S., & Evans, J. (2007). Rethinking role play in the Reception class. Educational Research, 49(2), 153–167. https://doi.org/10.1080/00131880701369677 Samuelsson, I. P., & Johansson, E. (2006). Play and learning-inseparable dimensions in preschool practice. Early Child Development and Care, 176(1), 47–65. https://doi.org/10.1080/0300443042000302654 Saracho, O. N. (2010). Children’s play in the visual arts and Literature. Early Child Development and Care. Saracho, O. N. (2013). An integrated play-based curriculum for young children. In An Integrated Play-Based Curriculum for Young Children. https://doi.org/10.4324/9780203833278 Stufflebeam, D. L. (2003). The CIPP model for evaluation. 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Language skills are essential for early childhood, being able to speak clearly and process speech sounds, understand others, express ideas, and interact with others are the building blocks for a child's development. Therefore, this study will examine the effect of the Inside Outside Circle (IOC) instructional strategies with media images on children's language skills. This research is a quasi-experimental design with a posttest only and using a control group. The sample in this study were children in two kindergartens in the village of Banjar Tegal. Data analysis in this study was carried out by quantitative descriptive methods using t-test analysis techniques. The results of this study in kindergarten students in Banjar Tegal Village show that there is an influence of the IOC learning model with picture media on children's language skills (tcount = 6.28> ttable = 2.00). This shows that language skills achieved by groups of children participating in learning with the IOC model with drawing media are better than groups of children who attend learning without the IOC model. The implication is that further research is expected to develop other aspects of child devel- opment through the IOC model. Keywords: Children Language skills, Image media, Inside-Outside Circle Instructional Strategies Reference: Afrida, Ni., & Mahriza, R. (2019). Visual and Cognitive Media : The Language Acquisition of Children With Dyslexia in Aceh. IJLRES - International Journal on Language , Research and Education Studies, 3(1), 112–126. https://doi.org/10.30575/2017/IJLRES-2019010409 Al Otaiba, S., & Fuchs, D. (2006). Who are the young children for whom best practices in reading are ineffective? An experimental and longitudinal study. Journal of Learning Disabilities, 39(5), 414–431. https://doi.org/10.1177/00222194060390050401 Asrifan, A. (2015). 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Parental Involvement in their children's schooling has long been recognized as a critical component of good education. This study aims to find out the relationship between socioeconomic status, interpersonal communication, and school climate with parental involvement in early childhood education. Using survey and correlational research design, data collection was carried out through accumulation techniques with tests and questionnaires. The data analysis technique used statistical analysis and multiple regressions. The findings in the socio-economic context of parents show that the measure of power is an indicator in the very high category with a total score of 5, while the measures of wealth, honour and knowledge are included in the high category with a total score of 4 in relation to parental involvement. The form of interpersonal communication, the openness of parents in responding happily to information / news received from schools about children is a finding of a significant relationship with parental involvement in early childhood education. The school climate describes the responsibility for their respective duties and roles, work support provided, and interpersonal communication relationships, parents at home and teachers at school. Keywords: Socio-economic Status, Interpersonal Communication, Climate School, Parental Involvement, Early Childhood Education References Amato, P. R. (2005). The Impact of Family Formation Change on the Cognitive, Social, and Emotional Well-Being of the Next Generation. The Future of Children, 15(2), 75–96. https://doi.org/10.1353/foc.2005.0012 Arnold, D. H., Zeljo, A., Doctoroff, G. L., & Ortiz, C. (2008). Parent Involvement in Preschool: Predictors and the Relation of Involvement to Preliteracy Development. 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Journal of Youth and Adolescence, 45(6), 1053–1064. https://doi.org/10.1007/s10964-016-0431-4 Berkowitz, R., Astor, R. A., Pineda, D., DePedro, K. T., Weiss, E. L., & Benbenishty, R. (2021). Parental Involvement and Perceptions of School Climate in California. Urban Education, 56(3), 393–423. https://doi.org/10.1177/0042085916685764 Berkowitz, R., Moore, H., Astor, R. A., & Benbenishty, R. (2017). A Research Synthesis of the Associations Between Socioeconomic Background, Inequality, School Climate, and Academic Achievement. Review of Educational Research, 87(2), 425–469. https://doi.org/10.3102/0034654316669821 Brand, S., Felner, R. D., Seitsinger, A., Burns, A., & Bolton, N. (2008). A large-scale study of the assessment of the social environment of middle and secondary schools: The validity and utility of teachers’ ratings of school climate, cultural pluralism, and safety problems for understanding school effects and school improvement. Journal of School Psychology, 46(5), 507–535. https://doi.org/10.1016/j.jsp.2007.12.001 Brand, S., Felner, R., Shim, M., Seitsinger, A., & Dumas, T. (2003). Middle school improvement and reform: Development and validation of a school-level assessment of climate, cultural pluralism, and school safety. Journal of Educational Psychology, 95(3), 570–588. https://doi.org/10.1037/0022-0663.95.3.570 Culp, A. M., Hubbs-Tait, L., Culp, R. E., & Starost, H.-J. (2000). Maternal Parenting Characteristics and School Involvement: Predictors of Kindergarten Cognitive Competence Among Head Start Children. Journal of Research in Childhood Education, 15(1), 5–17. https://doi.org/10.1080/02568540009594772 Dearing, E., McCartney, K., Weiss, H. B., Kreider, H., & Simpkins, S. (2004). The promotive effects of family educational involvement for low-income children’s literacy. Journal of School Psychology, 42(6), 445–460. https://doi.org/10.1016/j.jsp.2004.07.002 Desforges, C., Abouchaar, A., Great Britain, & Department for Education and Skills. (2003). The impact of parental involvement, parental support and family education on pupil achievements and adjustment: A literature review. DfES. El Nokali, N. E., Bachman, H. J., & Votruba-Drzal, E. (2010). Parent Involvement and Children’s Academic and Social Development in Elementary School: Parent Involvement, Achievement, and Social Development. Child Development, 81(3), 988–1005. https://doi.org/10.1111/j.1467-8624.2010.01447.x Englund, M. M., Luckner, A. E., Whaley, G. J. L., & Egeland, B. (2004). Children’s Achievement in Early Elementary School: Longitudinal Effects of Parental Involvement, Expectations, and Quality of Assistance. Journal of Educational Psychology, 96(4), 723–730. https://doi.org/10.1037/0022-0663.96.4.723 Epstein, J. L. (Ed.). (2002). School, family, and community partnerships: Your handbook for action (2nd ed). Corwin Press. Fan, X. (2001). Parental Involvement and Students’ Academic Achievement: A Growth Modeling Analysis. The Journal of Experimental Education, 70(1), 27–61. https://doi.org/10.1080/00220970109599497 Fan, X., & Chen, M. (2001). Parental Involvement and Students’ Academic Achievement: A Meta-Analysis. Educational Psychology Review, 23. Georgiou, S. N., & Tourva, A. (2007). Parental attributions and parental involvement. 10. Gorski, P. (2008). The Myth of the Culture of Poverty. Educational Leadership, 65(7), 32–36. Hamre, B. K., & Pianta, R. C. (2005). Can Instructional and Emotional Support in the First-Grade Classroom Make a Difference for Children at Risk of School Failure? Child Development, 76(5), 949–967. https://doi.org/10.1111/j.1467-8624.2005.00889.x Hill, N. E., & Taylor, L. C. (2004). Parental School Involvement and Children’s Academic Achievement: Pragmatics and Issues. Current Directions in Psychological Science, 13(4), 161–164. https://doi.org/10.1111/j.0963-7214.2004.00298.x Hong, S., & Ho, H.-Z. (2005). Direct and Indirect Longitudinal Effects of Parental Involvement on Student Achievement: Second-Order Latent Growth Modeling Across Ethnic Groups. 11. Hornby, G., & Lafaele, R. (2011). Barriers to parental involvement in education: An explanatory model. Educational Review, 63(1), 37–52. https://doi.org/10.1080/00131911.2010.488049 Hoy, W. K., Tarter, C. J., & Hoy, A. W. (2006). Academic Optimism of Schools: A Force for Student Achievement. American Educational Research Journal, 43(3), 425–446. https://doi.org/10.3102/00028312043003425 Jeynes, W.H. (2014). Parent involvement for urban youth and student of color. In Handbook of urban education (In H. R. Milner&K. Lomotey (Eds.)). NY: Routledge. Jeynes, William H. (2005). Effects of Parental Involvement and Family Structure on the Academic Achievement of Adolescents. Marriage & Family Review, 37(3), 99–116. https://doi.org/10.1300/J002v37n03_06 Jeynes, William H. (2007). The Relationship Between Parental Involvement and Urban Secondary School Student Academic Achievement: A Meta-Analysis. Urban Education, 42(1), 82–110. https://doi.org/10.1177/0042085906293818 Kaplan, D. S., Liu, X., & Kaplan, H. B. (2010). Influence of Parents’ Self-Feelings and Expectations on Children’s Academic Performance. 12. Kuperminc, G. P., Leadbeater, B. J., & Blatt, S. J. (2001). School Social Climate and Individual Differences in Vulnerability to Psychopathology among Middle School Students. Journal of School Psychology, 39(2), 141–159. https://doi.org/10.1016/S0022-4405(01)00059-0 Kutsyuruba, B., Klinger, D. A., & Hussain, A. (2015). Relationships among school climate, school safety, and student achievement and well-being: A review of the literature. Review of Education, 3(2), 103–135. https://doi.org/10.1002/rev3.3043 Long, H., & Pang, W. (2016). Family socioeconomic status, parental expectations, and adolescents’ academic achievements: A case of China. Educational Research and Evaluation, 22(5–6), 283–304. https://doi.org/10.1080/13803611.2016.1237369 Loukas, A. (2007). High-quality school climate is advantageous for all students and may be particularly beneficial for at-risk students. 3. Mattingly, D. J., Prislin, R., McKenzie, T. L., Rodriguez, J. L., & Kayzar, B. (2002). Evaluating Evaluations: The Case of Parent Involvement Programs. Review of Educational Research, 72(4), 549–576. https://doi.org/10.3102/00346543072004549 McWayne, C., Hampton, V., Fantuzzo, J., Cohen, H. L., & Sekino, Y. (2004). A multivariate examination of parent involvement and the social and academic competencies of urban kindergarten children. Psychology in the Schools, 41(3), 363–377. https://doi.org/10.1002/pits.10163 Miedel, W. T., & Reynolds, A. J. (1999). Parent Involvement in Early Intervention for Disadvantaged Children: Does It Matter? 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STEAM-based learning is a global issue in early-childhood education practice. STEAM content becomes an integrative thematic approach as the main pillar of learning in kindergarten. This study aims to develop a conceptual and practical approach in the implementation of children's education by applying a modification from STEAM Learning to R-SLAMET. The research used a qualitative case study method with data collection through focus group discussions (FGD), involving early-childhood educator's research participants (n = 35), interviews, observation, document analysis such as videos, photos and portfolios. The study found several ideal categories through the use of narrative data analysis techniques. The findings show that educators gain an understanding of the change in learning orientation from competency indicators to play-based learning. Developing thematic play activities into continuum playing scenarios. STEAM learning content modification (Science, Technology, Engineering, Art and Math) to R-SLAMETS content (Religion, Science, Literacy, Art, Math, Engineering, Technology and Social study) in daily class activity. Children activities with R-SLAMETS content can be developed based on an integrative learning flow that empowers loose part media with local materials learning resources. Keyword: STEAM to R-SLAMETS, Early Childhood Education, Integrative Thematic Learning References Ali, E., Kaitlyn M, C., Hussain, A., & Akhtar, Z. (2018). the Effects of Play-Based Learning on Early Childhood Education and Development. Journal of Evolution of Medical and Dental Sciences, 7(43), 4682–4685. https://doi.org/10.14260/jemds/2018/1044 Ata Aktürk, A., & Demircan, O. (2017). A Review of Studies on STEM and STEAM Education in Early Childhood. Journal of Kırşehir Education Faculty, 18(2), 757–776. Azizah, W. A., Sarwi, S., & Ellianawati, E. (2020). Implementation of Project -Based Learning Model (PjBL) Using STREAM-Based Approach in Elementary Schools. Journal of Primary Education, 9(3), 238–247. https://doi.org/10.15294/jpe.v9i3.39950 Badmus, O. (2018). Evolution of STEM, STEAM and STREAM Education in Africa: The Implication of the Knowledge Gap. In Contemporary Issues in Science, Technology, Engineering, Arts and Mathematics Teacher Education in Nigeria. Björklund, C., & Ahlskog-Björkman, E. (2017). Approaches to teaching in thematic work: early childhood teachers’ integration of mathematics and art. International Journal of Early Years Education, 25(2), 98–111. https://doi.org/10.1080/09669760.2017.1287061 Broadhead, P. (2003). Early Years Play and Learning. In Early Years Play and Learning. https://doi.org/10.4324/9780203465257 Canning, N. (2010). The influence of the outdoor environment: Den-making in three different contexts. European Early Childhood Education Research Journal, 18(4), 555–566. https://doi.org/10.1080/1350293X.2010.525961 Clapp, E. P., Solis, S. L., Ho, C. K. N., & Sachdeva, A. R. (2019). Complicating STEAM: A Critical Look at the Arts in the STEAM Agenda. Encyclopedia of Educational Innovation, 1–4. https://doi.org/10.1007/978-981-13-2262-4_54-1 Colucci, L., Burnard, P., Cooke, C., Davies, R., Gray, D., & Trowsdale, J. (2017). Reviewing the potential and challenges of developing STEAM education through creative pedagogies for 21st learning: how can school curricula be broadened towards a more responsive, dynamic, and inclusive form of education? BERA Research Commission, August, 1–105. https://doi.org/10.13140/RG.2.2.22452.76161 Conradty, C., & Bogner, F. X. (2018). From STEM to STEAM: How to Monitor Creativity. Creativity Research Journal, 30(3), 233–240. https://doi.org/10.1080/10400419.2018.1488195 Conradty, C., & Bogner, F. X. (2019). From STEM to STEAM: Cracking the Code? How Creativity & Motivation Interacts with Inquiry-based Learning. Creativity Research Journal, 31(3), 284–295. https://doi.org/10.1080/10400419.2019.1641678 Cook, K. L., & Bush, S. B. (2018). Design thinking in integrated STEAM learning: Surveying the landscape and exploring exemplars in elementary grades. School Science and Mathematics, 118(3–4), 93–103. https://doi.org/10.1111/ssm.12268 Costantino, T. (2018). STEAM by another name: Transdisciplinary practice in art and design education. Arts Education Policy Review, 119(2), 100–106. https://doi.org/10.1080/10632913.2017.1292973 Danniels, E., & Pyle, A. (2018). Defining Play-based Learning. In Encyclopedia on Early Childhood Development (Play-Based, Issue February, pp. 1–5). OISE University of Toronto. DeJarnette, N. K. (2018). Implementing STEAM in the Early Childhood Classroom. European Journal of STEM Education, 3(3), 1–9. https://doi.org/10.20897/ejsteme/3878 Dell’Erba, M. (2019). Policy Considerations for STEAM Education. Policy Brief, 1–10. Doyle, K. (2019). The languages and literacies of the STEAM content areas. Literacy Learning: The Middle Years, 27(1), 38–50. http://proxy.libraries.smu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eue&AN=133954204&site=ehost-live&scope=site Edwards, S. (2017). Play-based learning and intentional teaching: Forever different? Australasian Journal of Early Childhood, 42(2), 4–11. https://doi.org/10.23965/ajec.42.2.01 Faas, S., Wu, S.-C., & Geiger, S. (2017). The Importance of Play in Early Childhood Education: A Critical Perspective on Current Policies and Practices in Germany and Hong Kong. Global Education Review, 4(2), 75–91. Fesseha, E., & Pyle, A. (2016). Conceptualising play-based learning from kindergarten teachers’ perspectives. International Journal of Early Years Education, 24(3), 361–377. https://doi.org/10.1080/09669760.2016.1174105 Finch, C. R., Frantz, N. R., Mooney, M., & Aneke, N. O. (1997). Designing the Thematic Curriculum: An All Aspects Approach MDS-956. 97. Gess, A. H. (2019). STEAM Education. STEAM Education, November, 2011–2014. https://doi.org/10.1007/978-3-030-04003-1 Gronlund, G. (n.d.). “ Addressing Standards through Play-Based Learning in Preschool and Kindergarten .” Gronlund, G. (2015). Planning for Play-Based Curriculum Based on Individualized Goals to Help Each Child Thrive in Preschool and Kindergarten Gaye Gronlund. Gull, C., Bogunovich, J., Goldstein, S. L., & Rosengarten, T. (2019). Definitions of Loose Parts in Early Childhood Outdoor Classrooms: A Scoping Review. The International Journal of Early Childhood Education, 6(3), 37–52. Hapidin, Pujianti, Y., Hartati, S., Nurani, Y., & Dhieni, N. (2020). The continuous professional development for early childhood teachers through lesson study in implementing play based curriculum (case study in Jakarta, Indonesia). International Journal of Innovation, Creativity and Change, 12(10), 17–25. Hennessey, P. (2016). Full – Day Kindergarten Play-Based Learning : Promoting a Common Understanding. Education and Early Childhood Development, April, 1–76. gov.nl.ca/edu Henriksen, D. (2017). Creating STEAM with Design Thinking: Beyond STEM and Arts Integration. Steam, 3(1), 1–11. https://doi.org/10.5642/steam.20170301.11 Inglese, P., Barbera, G., La Mantia, T., On, P., Presentation, T., Reid, R., Vasa, S. F., Maag, J. W., Wright, G., Irsyadi, F. Y. Al, Nugroho, Y. S., Cutter-Mackenzie, A., Edwards, S., Moore, D., Boyd, W., Miller, E., Almon, J., Cramer, S. C., Wilkes-Gillan, S., … Halperin, J. M. (2014). Young Children’s Play and Environmental Education in Early Childhood Education. PLoS ONE, 2(3), 9–25. https://doi.org/10.1586/ern.12.106 Jacman, H. (2012). Early Education Curriculum. Pedagogical Development Unit, FEBRUARY 2011, 163. https://www.eursc.eu/Syllabuses/2011-01-D-15-en-4.pdf Jay, J. A., & Knaus, M. (2018). 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Diarrhoea accounts for one in five deaths amongst children in Nigeria. In home management of childhood diarrhoea, cultural diversity exists in people’s perceptions of appropriate feeding practices during and after diarrhoeal episodes. This study examined factors that influenced people’s perceptions of feeding practices in home management of childhood diarrhoea in Ibadan North East Local Government Area of Oyo state, using Weberian social action theory. The study design was exploratory using qualitative techniques. Sixteen (16) In-depth interviews (IDIs) for mothers of under-five children, six (6) Key Informant Interviews (KIIs) for Community leaders, Herbalist and Nurses in public health institutions, and four (4) Focus Group Discussions were conducted. Teething, poor sanitation and consumption of some foods were perceived as responsible for high prevalence of diarrhoea amongst children. Mothers’ perceptions of type of food to be served to children, and number of feeding times, during and after diarrhoeal episodes varied according to their social status and food culture of their local environment. The study concluded that mothers’ perceptions of feeding practices in home management of childhood diarrhoea were influenced by culture, religion and socio-demographic factors. Injurious beliefs should therefore be dropped towards enhancing success of primary health care (PHC) programme

Growth monitoring and promotion of optimal growth are essential components of primary health care for infants, children and adolescents. Growth monitoring includes serial measurements of weight, length or height for all children, head circumference for infants and toddlers, and interpretation of those measurements relative to the growth of a large sample population of children depicted on a selected growth chart. These measures help to confirm a child's healthy growth and development, or identify early a potential nutritional or health problem. This enables health professionals and parents to initiate action before the child's nutritional status or health are seriously compromised. Over the last three decades there has been substantial discussion on which reference population to use in assessing adequacy of childhood growth. In 2004, Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada and Community Health Nurses of Canada published recommendations for use of the 2000 American growth charts from the Centers for Disease Control and Prevention. At that time, limitations of the charts were noted, including the fact that these charts were growth references, describing how a sample population of children grew, regardless of whether or not their rate of growth was optimal or not. It was also noted that the decision on which growth charts to recommend would be revisited as more appropriate data became available. Increasing evidence that growth patterns of well-fed healthy preschool children from diverse ethnic backgrounds were comparable, supported the use of a single international growth reference based on healthy, wellnourished children from different geographic and genetic origins, who had fully met their growth potential. Until recently, no such growth charts existed. In 2006, the World Health Organization (WHO), in conjunction with the United Nations Children's Fund and others, released new international growth charts depicting the growth of children from birth to age five years, who had been raised in six different countries (Brazil, Ghana, India, Norway, Oman, USA) according to recommended nutritional and health practices, including exclusive breastfeeding for the first four to six months of life. The optimal growth displayed in the WHO growth charts for infants and preschool children represents the prescribed gold standard for children's growth; hence these charts are considered growth standards. In 2007, the WHO also released charts for monitoring the growth of older children and adolescents that had been updated and improved to address the growing epidemic of childhood obesity. Dietitians of Canada, Canadian Paediatric Society, The College of Family Physicians of Canada, and Community Health Nurses of Canada make the following recommendations, intended as a practice guideline for medical practitioners and other health professionals. The desired outcome is that wide dissemination of these recommendations will promote consistent practices in monitoring growth to improve the nutritional status and health outcomes of Canadian infants, children and adolescents.

Abstract While overall neonatal mortality rates are improving in Ghana, the Ashanti Region has the highest mortality rate in the country. The clinical causes of newborn deaths are well known, yet local beliefs about illness aetiology, cause of death and care-seeking are less well understood. This exploratory qualitative study sought to understand how community members perceive and respond to neonatal illness. Researchers worked with public health nurses, community health nurses and opinion leaders in the Ashanti Region of Ghana to identify women who had lost a baby, either during pregnancy or after delivery. In-depth interviews and focus group discussions were conducted about knowledge, attitudes and beliefs regarding neonatal mortality. The transcripts were coded and analysed using NVivo 10.0. A total of 100 participants were interviewed: 24% reported a previous stillbirth; 37% reported a previous miscarriage; and 45% reported losing a baby who was born alive. Nine per cent experienced more than one type of loss. The local illness of asram – an illness with supernatural causes – was cited as a leading cause of death of newborns. Every participant reported hearing of, knowing someone, or having a child who had become ill with asram. While women gave varying information on symptoms, method of contraction and treatment, all participants agreed that asram was common and often fatal. Four overarching themes emerged: 1) asram is not a hospital sickness; 2) there is both a fear of traditional healers as a source of asram, as well as a reliance upon them to cure asram; 3) there are rural/urban differences in perceptions of asram; and 4) asram may serve as a mechanism of social control for pregnant women and new mothers. Local beliefs and practices must be better understood and incorporated into health education campaigns if neonatal mortality is to be reduced in Ghana.