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The purpose of this action research project was to explore the perceptions, practices, and roles that a team of six (6) preservice teachers developed regarding make-based learning and teaching students with emotional and behavioral disabilities. During the course of the study, participants enrolled in a seminar course that involved weekly clinical visits to the makerspace inside a separate public school for students with exceptional emotional and behavioral needs. They also spent one afternoon per month designing and carrying out projects in a university makerspace. Data collection included observation forms that participants completed after the clinical school visits, written assignments, and individual interviews. Narrative analysis and structural coding were used to analyze data. Three beliefs emerged across participants: (1) making can benefit students with emotional and behavioral disabilities, (2) evidence-based practices have limited value in a classroom, (3) instructional time in a makerspace should be used for making.
While research on the ethical decision-making process in counseling continues to evolve, ethical violations committed by counselors persist, evidenced by an increase in the number of adverse incidents resulting in closed insurance claims and millions of dollars paid to the public on behalf of counselors (Healthcare Providers Service Organization, 2019). Knowledge of ethical codes and legal statutes, along with available decision-making models have been insufficient in guiding counselors’ ethical decision-making (Burns, 2019; Burns & Cruikshanks, 2019; Lambie et al., 2010; Lambie et al., 2011). Other factors must be considered to better understand this complex process. The purpose of this study was to examine how spiritual intelligence, meditation practice, clinical experience, and ethical climate were related to moral and ethical reflectivity among counselors in North Carolina. A simultaneous multiple linear regression was utilized to examine the role of counselors’ (n = 700) spiritual intelligence, meditation practice, clinical experience, and quality of the ethical climate to predict their moral and ethical reflection. Results indicated that spiritual intelligence, meditation, and ethical climate were significantly positively correlated with moral and ethical reflectivity. Additionally, the model accounted for 12% of the variance in moral and ethical reflection. Implications for the field of counseling are discussed.
Over the last two decades, general aviation pilots in the US, especially those who fly light fixed-wing aircraft, have portrayed high rates of vulnerability to weather-related accidents. This high vulnerability rate is in stark contrast to the increased availability of weather forecasts, which has vastly improved given the wide variety of weather guidance now available online and in the cockpit. VFR into IMC flights is the leading cause of fatal weather-related accidents. A common contributor to these fatal accidents is the pilot’s inability to definitively assess the hazard prior to departure from the relevant weather guidance. Therefore, it is hypothesized in this research that the lack of sufficient weather reports and forecasts are not a core problem, but instead the primary contributing factor is an inaccurate or incomplete weather assessment by pilots before a flight. In this light, it has become apparent that pilots need a well-integrated route-based application that simplifies and organizes weather guidance in a way that requires less technical interpretation and gives time-based options to minimize a pilot’s exposure to adverse weather. Consequently, this presents the opportunity for a targeted software application that will eliminate or significantly reduce weather-related accident risk especially for pilots planning VFR flights.
The Institute of Medicine’s report “To Err is Human” remains relevant two decades later: medical error is the fourth leading cause of death in the United States and 40% of hospitalized children experience medical error. One obstacle to safer care is lack of error reporting. That omission denies the opportunity to learn from those events. Safety Culture describes a work environment conducive to reporting, and its properties are measurable using the Safety of Patients Survey (SOPS 1.0 TM). On a pediatric acute care unit in a children’s hospital in southeastern U. S., SOPS 1.0TM scores and error reporting fell well below agency benchmarks. The purpose of this quality improvement project was to improve error reporting and SOPS 1.0TM scores specific to reporting through a Safety Huddle Intervention. Marshall Ganz’s Change through Public Narrative Framework provided the theoretical design for this project: a story of self, a story of us, a story of now. The SOPS 1.0 TM was implemented before and after the six-week intervention on the project unit and a comparison unit and monthly error reporting was tracked before and after the intervention on those same units. The 5 composites of SOPS 1.0 TM purported to measure reporting culture showed no statistically significant differences after the intervention, or between the project and comparison units. Error reporting increased after the intervention on the project unit (p=0.0121) but not the comparison unit. Of note, this quality improvement project took place during the COVid 19 pandemic, and survey results revealed a preoccupation with staffing as an overriding concern for patient safety.
ABSTRACT
ANDREW GARDNER. DACA Recipients Narratives: Pursuing Noncredit Occupational Training. (Under the direction of DR. MARK D’AMICO)
This adapted in-depth qualitative interview study explored and documented the lived experiences of four DACA recipients that pursued noncredit occupational training opportunities at a community college in North Carolina. The purpose was to understand what experiences led DACA recipients to enroll in noncredit occupational education in the community college setting, insight about their educational experiences in higher education, and how they used the education they gained through noncredit occupational education. Participant interviews styled after Seidman (2019) served as the primary means of data collection. Following Seidman (2019) protocols for an adapted in-depth qualitative interview, participants put their life into context, provided detailed accounts of certain critical life experiences, and reconstructed their experience within the framework of the study. Upon completion of all interviews and transcription, a detailed six phase thematic analysis guided by Braun and Clarke (2006) was completed. Though their experiences varied, four major themes were identified during the analysis process. Themes generated spoke to the personal, professional, and social experiences that shaped their journey and aspirations. The findings provided insight about each participant’s desperate path to pursue higher education and how noncredit occupational training provided them a “hidden” opportunity. Family played the greatest role in motivating and supporting participants during their journey. A high level of determination and perseverance was displayed. Participants combated obstacle after obstacle to enroll in postsecondary education and successfully leveraged it to embark on their professional career. Three conclusions were reached: (1) policies influence DACA students; (2) DACA students receive a lack of guidance; (3) DACA students leverage credentials.
Introduction: A high-functioning interdisciplinary team is needed to achieve optimal team and patient outcomes in the provision of care for intensive care patients. The difference between a high functioning and suboptimal interdisciplinary team manifest as variations in team outputs. Identification of key characteristics of high functioning teams can be used to assess and evaluate current interdisciplinary teams for potential areas of optimization. Methods: This study is a quality improvement needs assessment of the current interdisciplinary team performance in the neuroscience intensive care unit (NSICU) at a large academic medical center. This project employed a mixed method design, using quantitative methods for collected survey data and qualitative methods for thematic analysis of open-ended responses. Results: The survey had a 59.5% response rate, with 84 team members completing the survey. The majority of participants were registered nurses (n=51), followed by providers (n=21), and then other therapist members (n=12). Five themes were identified from open-ended responses regarding strengths and barriers to team effectiveness: structure, roles, the rounding processes, engagement, and team interactions. Within these themes, the needs of the team included: a shared decision-making model, improved engagement of staff members, improved team stability, clearly defined roles, interventions to improve the rounding process, and further evaluation of team interactions. Discussion: Assessment and diagnosis are the first steps in approaching optimization of the interdisciplinary team. Each interdisciplinary team is unique. Understanding the needs of the team is essential to creating a high functioning team. Key words: Interdisciplinary, Multidisciplinary, Team, Quality improvement, Team processes
Despite the strong appeal of iconic brands, research on how consumers form attachments and loyalty to them has been limited. To fill this knowledge gap, this research is aimed at identifying factors that can determine consumers’ emotional attachment and ensuing loyalty toward iconic brands, focused on brand personality, cultural disposition, and social media activity as influencing factors. To accomplish this, a survey was implemented on Amazon Mechanical Turn (Mturk) (n=759). Empirical results from multi-level linear regression model indicate that brand personality, cultural disposition and social media activity influence both loyalty and attachment in iconic brands. Detailed findings are presented. Lastly, theoretical and managerial implications, limitations, and future research directions are discussed.
Background: Work in palliative care can be a rewarding experience in helping those suffering with complicated illnesses, it can also expose those involved to significant work stress, potentially leading to burnout. Palliative medicine is a medical specialty wherein clinicians provide care for the medical, psychosocial and spiritual needs of seriously ill patients, and facilitate their understanding and coping skills through the illness progression. These clinicians are especially vulnerable to frequent exposure to traumatic situations due to the high density of complicated patients under their care, placing them at risk for burnout.
Objective: The objective of this quality improvement project was to better understand burnout levels in palliative nurse practitioners and nurses in a large inpatient, academic hospital system and to determine the feasibility and effectiveness of implementing mindfulness meditation to reduce burnout levels.
Design: The Maslach Burnout Inventory (MBI) was used to assess burnout pre and post implementation of a brief, self-guided mindfulness intervention via smartphone application. The intervention was performed individually, remotely, and asynchronously with volunteers.
Setting/participants: A total of 12 palliative care nurse practitioners and nurses volunteered from an inpatient palliative care group within a large healthcare system in North Carolina. Results: MBI domains analysis revealed a statistically significant decrease in emotional exhaustion (Pre: 2.2; Post: 1.5; p=.016). The depersonalization domain (emotional disconnect) score did not show a statistically significant decrease in the post-intervention score, but a numerical decrease was reported (Pre: 0.82; Post: 0.65). The personal accomplishment domain score did not show any significant change (Pre: 4.6; Post: 4.5). The reflective questions indicated that many participants felt the mindfulness exercise was feasible, tended to feel calmer, were more relaxed, and were satisfied with the intervention. This correlates to the statistically significant result on the emotional exhaustion subscale, leading to the conclusion that the mindfulness intervention was valuable to those who participated and had efficacious results.
Conclusion: The information gained from this project is vital to better understanding burnout in palliative clinicians given its consequences are detrimental to healthcare systems, patient care and clinicians themselves. By developing evidence-based interventions and training, burnout could be prevented, thereby promoting longevity and satisfaction of clinicians in palliative care. If burnout can be eased, seasoned clinicians can be retained, leading to reduced financial burden on the healthcare system and improved patient care and satisfaction.
Though North Carolina is home to the 9th largest Indigenous population in America, as well as to the largest Tribe East of the Mississippi, North Carolina curriculum and schools often erode Indigenous histories from the classroom. Indigenous people are presented as forever constrained within antiquity, as savage, as docile, as stoic, and at worst – as nonexistent. This study centers Native students who traverse through these systems that perpetuate stereotypes of Indigenous barbarism, passivity, and erasure, with a focus on Native students living in urban areas of North Carolina. Similarly, non-Native teachers were interviewed for this study to discuss their role in this system as well as what they are doing to challenge it. Themes include problematic curriculum, anti-Indigeneity, erasure, White supremacy, and resistance and resilience.
More than 760,000 people have died from an opioid overdose since 1999. The opioid epidemic claimed more than 70,000 lives with over 1.6 million having an opioid use disorder in 2019. Literature suggests an association between increased opioid prescribing and increased opioid addiction and by limiting the number of opioid prescriptions written may reduce opioid addiction. There is variation in opioid prescribing practices among acute care providers and opioid prescribing education has been proven to be an effective strategy to optimize prescribing in the acute care setting. This quality improvement project sought to minimize the use of opioids for chronic non-cancer pain by adhering to the Centers for Disease Control Guideline for Prescribing Opioids for Chronic Pain.
Twenty-five acute-care providers including medical doctors, nurse practitioners, and physician assistants participated. This project included a pre-test to measure providers baseline pain management knowledge, an educational module, and then a post-test. Retrospective chart audits were performed on records of patients discharged from the acute care setting from July 2020 to August 2020 with an opioid for chronic non-cancer pain prior to implementation of educational intervention and again January 2021 to February 2021 post-implementation.
Comparison of the pre-and-post-test surveys revealed learning in several areas. Though not statistically significant, (Pre: 40.4; Post: 41.3, p=.276), efficacy of the educational session was evident by improved test scores, pre-test (M = 40.4, SD = 3.5) and post-test (M = 41.3, SD = 4.7). The average number of opioid prescriptions by provider decreased significantly in the post-intervention period (Pre: 3.4; Post: .24, p<.000). Results suggest that implementing opioid-prescribing guidelines can reduce sub-optimal opioid prescribing in the acute care setting, therefore reducing the number of available opioids in the community for diversion and abuse.
