International Public Health

This chapter presents glocalisation as a new global phenomenon in providing sustainable business solutions and preserving durability of the business environment in the tourism and hospitality industry. The chapter reveals that the ‘one strategy fits all' (universalism) deficiency of globalization brought glocalisation into the limelight as the best alternative strategic approach in sustaining global business relevance and promoting environmental sustainability in the 21st century business era. The strategic mix of globalization and localisation inherent in glocalisation promotes unprecedented economic growth and the development of developing and emerging economies through promotion of their cultural heritage and historical values. The chapter further discloses that prevalent of global warming giving rise to climate change in the tourism and hospitality industry which can be significantly controlled through strategic implementation of a glocal strategy. It is concluded that gloca...

This chapter presents glocalisation as a new global phenomenon in providing sustainable business solutions and preserving durability of the business environment in the tourism and hospitality industry. The chapter reveals that the 'one strategy fits all' (universalism) deficiency of globalization brought glocalisation into the limelight as the best alternative strategic approach in sustaining global business relevance and promoting environmental sustainability in the 21st century business era. The strategic mix of globalization and localisation inherent in glocalisation promotes unprecedented economic growth and the development of developing and emerging economies through promotion of their cultural heritage and historical values. The chapter further discloses that prevalent of global warming giving rise to climate change in the tourism and hospitality industry which can be significantly controlled through strategic implementation of a glocal strategy. It is concluded that glocalisation serves a dual-purpose of providing sustainable business solutions and preserving the business environment.

BACKGROUND: This study is an assessment of the knowledge and attitude of elderly patients towards hospice and palliative care. It assesses what modalities of elderly care are accessible, affordable, socially acceptable and practiced within the study population.

BACKGROUND: This study is an assessment of the knowledge and attitude of elderly patients towards hospice and palliative care. It assesses what modalities of elderly care are accessible, affordable, socially acceptable and practiced within  the study population.

OBJECTIVE: This study assesses the knowledge, attitude and practice of hospice and palliative care among elderly patients in Nnamdi Azikiwe University Teaching Hospital, ( NAUTH), Nnewi, Anambra State. It also assesses what factors determine the mode of elderly care, within  the study population.

METHODOLOGY: This descriptive cross-sectional survey involved elderly patients in  the wards and clinics of this facility.

RESULTS: The study involved 194 respondents. The mean age of respondents in this descriptive cross-sectional survey was 72.8 ± 1.3 years, with a range of 65-89 years. 58.2% (111) of the study population were females, while 42.8% (83) were males. 71.1% (136) of the respondents were married in monogamous family settings while 29.9% (58) were married in polygamous family settings. 82.5% (164) of the highest level of their formal education fell within the primary and post- primary bracket. 55.6% (108) of the study respondents were dependents who had either retired from active public service, or were experiencing illness- related morbidity. 90.7% (176) of the respondents were Christians while 9.3% (18) were adherents of the African traditional religion (ATR). 74 (38.1%) respondents in the entire study population had a knowledge of hospice and palliative care. Of the 74 respondents with a knowledge of hospice and palliative care, only 17 (22.9%) of them admitted the willingness to be cared for in a hospice centre, if given the opportunity, while 63.5% (47)  were of the opinion that  pain relief is best in hospice, but that it would not improve the actual quality of life. 90.5% (67) preferred care at home to institutionalised hospice centres and 77% (57) were in favour of the establishment of hospice services in every Nigerian community. 19% (36) of entire study population had a history of practice of hospice and palliative care, the rest of the study population, had no history of hospice practice. Of the 36  respondents with a history of hospice care practice, no one admitted to the patronisation of institutionalised hospice centres, 66.7% (24) practiced inpatient care in this facility, 44.4% (16) practiced home based care, and 77.8% (28) of them, reported that they were satisfied with the form of care given either at home or at the hospital.

CONCLUSION: Most of the patients had no adequate knowledge of  hospice/ palliative care, and the different care options available for geriatric patients. This low level of practice of hospice and palliative care is quite expected, as there were no standard hospice care services available within the study population. However, patients who had some knowledge of the subject, expressed the desire of seeing hospice being established in every Nigerian community, while some maintained that a focused home based care would be the best option. The major factor influencing patients’ choices as revealed by this study was the desire to promote healing or achieve a better quality of life during illness. Also, some geriatrics who had a history of hospice and palliative care practice had initially commenced practice based on family decision, but were not satisfied, and could not continue due to the high cost of health care services. These factors are paramount and should be considered, when administering care to them.

Keywords: Hospice care, Palliative care, Geriatrics
Conflict of interest: None

In Nigeria, there has been a strain on the existing healthcare
infrastructure. To tackle this nonetheless, the government has made
remarkable efforts in the provision of more healthcare facilities through
effective collaboration with other stakeholders in private and non governmental organisations. (Obansa, S. A. 2013). This has evidently led to a revamp in, and an availability of, healthcare facilities. However, so much more still needs to be done to fully achieve the SDG 3 (Abosede, O. A. Et al, 2014).

.  Data from the Kenya health demographic survey of 2014 indicates a grim picture with 7.22 million under-five children of which nearly 1.9 million are stunted and 4% attire wasted notwithstanding this, there are varying social demographic differences in malnutrition (Bandura. A, 1986)occurrence among various counties. for example,, out of the 47 counties,, 9 reported a 30%prevalence of stunting, categorized as severe and of public health importance.  the annual costs for malnutrition related to health, education, and labor productivity are estimated between 1.9 and 16.5% of GDP. Nutrition-specific interventions aimed at improving nutrient intake and diet practices are independently responsible for nutritional reductions even when delivered at a high scale and with high coverage. Over the recent years, interest is developing in testing and developing, and evaluating multisectoral and integrated approaches to tackle the underlying determinants of child nutrition (nutrition-sensitive approaches. fecal pathogens are implicated in various studies of chronic and asymptomatic infections that lead to stunting. Wash has been proven as the best mitigation to enteric diseases caused by lack of clean water, poor hygiene, and sanitation facilities, of which in their absence children are at risk of stunting due to repeated and extended occurrences of diarrhea and soil-transmitted helminths including asymptomatic infections which in themselves leads to environmental enteric dysfunction, a chronic condition which impairs the absorption of nutrients. The effectiveness of wash on child growth is limited in most studies (Bhutta et al, 2013).

Introduction
Assessment of students learning is a debatable issue and has proved to be a challenge in many educational institutions. The challenge is compounded when it comes to the assessment of students learning in clinical practice. Mahara (1998) points out that, clinical evaluation is intended to provide feedback to students and teachers on what learning has taken place and what is required to improve the teaching-learning process, thereafter allowing the teachers to make a definitive judgment whether the students’ practice meets the professional or the academic requirements. The effectiveness of learning in the clinical setting can be evaluated by students’ achievement of clinical competences.
Competence has been defined in different ways. ICN Framework of Competences for the Nurse Specialist(2005) described competence as application of a combination of knowledge, skill and judgment demonstrated by an individual in daily practice or job performance [6]. In agreement to this the Australian National Competence. Standards for Nurses in General Practice (2005) defined Competence as the ability to perform tasks and duties to
the standard expected in employment. Furthermore, Cowan et al. (2005) suggested having a holistic definition of competence that should include knowledge, skills, performance, attitudes and values. From the three definitions above it can be seen that there is an agreement in the definitions that competence reflects the holistic nature of nursing roles. Such student nurses to be certified fit to practice need to demonstrate that they have acquired the competences. Therefore, there is need to have effective means of assessing students competencies.
Many clinical assessment strategies are based on direct observations. While (1991) asserts that the main challenge to clinical evaluation lies in the subjectivity of the observational process . He states that human observation is noted to have an inherent bias and is a subjective process. Chapman (1999) also supports this view arguing that it is difficult to overcome subjectivity as assessments are based on a value judgement, which varies from person to person . A major challenge in any assessment process is to ensure that objective measurement is used and to guarantee objectivity is particularly difficult in the assessment of clinical competence.
Furthermore, the clinical evaluation should be based upon a constant one in one observation period with a student . Clinical teachers or ward nurses are usually required to accommodate a varying number of students in their clinical supervision teaching schedule so that assessments of individual students’ performance are usually based upon a sample of the students’ total experience in the placement. The forgoing discussion reflects some of the challenges in the assessment of students’ clinical competence and it is possible to overcome some of these challenges with OSCE.teaching.
In kenya Skillslabs were established in 24 colleges under the Kenya Medical Training Colleges. Curricula and learning materials were developed and reviewed to support the use of those facilities, and many activities to enhance staff capacity took place. All activities in the projects took place to achieve their overall aim: to improve and keep up the level of clinical competence of the health professionals in Kenya with respect to clinical skills.The curricula for nurses and clinical officers  were reviewed and the Skillslab methodology is continuously being applied. The trainees now develop their practical skills before they meet the real patients, by using dummies or manikins and “simulated patients”.
On the level of training and integration, quite a lot has been achieved. Skillslab training is integrated in the curricula for nurses and clinical officers. Students have access to additional learning materials (procedure manuals, learning guides, and logbooks) and mechanisms to acquire those have been put in place. Mastery of skills is assessed in OSCEs (objective structured clinical examination) after training in Skill slab and the practical examination systems are harmonized.  (Kmtc, journal 2016)