1Associate Professor, College of Nursing, Univ. of Missour-St. Louis, USA
2Study Coordinator/Research Instructor, University of Washington AIDS Clinical Trials Unit, USA
3Senior Instructor, School of Nursing, National Cheng Kung University, Taiwan
4Professor and Assoc. Dean for Research, College of Nursing, Univ. of Missouri-St. Louis, USA
Older African-American adults aged 50 + living with HIV (OAAA-LWH) have unique social care needs, giving challenges related to their HIV status, poverty and poor mental health. This pilot survey with 35 OAAA-LWH (24 males and 11 females), who are patients of anuniversity medical center was to assess 1) relevance selected benchmark measures –self-efficacy, psychological distress, medication adherence, perceived discrimination, and received practical social care –, and 2) identify other potential factorsfor model testing in the subsequent phase of this study. The unique protocol, using audio, computer-assisted self-interviewing along with medical chart review, appeared to be viable and efficient, with less than 1% missing data. While participantshad a mean age of 54.3, theyhad managed HIV for over 18years. As expected, the majorityhad less than a college degree and reported being unemployed, with 88% on disability. Self-efficacy significantly correlated with psychological distress (r = -.64), poor medication adherence (r = -.37) and received practical social care (r = -.39). Pilot data suggest that assessing HIV-related stigma as a risk factor for perceived discrimination and depression would help further identify social care needs. And including their CD 4 counts in future analysisas a psychological distress bio-markerwould help identify how it may affect and be affected by the above-mentioned variables t in this population.
Biography:
Kuei-Hsiang Hsueh is a Associate Professor, College of Nursing, Univ. of Missour-St. Louis, USA. She has published many articles in different journals.
University of Kansas, USA
Historically leadership courses developed for undergraduate nursing education programs have focused on identifying personal skills deemed essential for students. These skills primarily relate to personal traits and qualities that identify studentsʼ self-knowledge, communication skills, risk taking, and delegation. What is lacking is the concept and components of system leadership. Growing talent of nurse leaders from within the organizational and microsystem level is important in meeting the IOM report on the Future of Nursing. Knowledge of system leaadership helps nurses identify the structures, processes, and outcomes present in a clinical microsystem. Strong clinical microsystems are the precursor of a healthy work environment.
In a clinical microsystem leadership course, there are three main concepts. Those are leadership, microsystem, and healthy work environment. Leadership is the ability to motivate others to accomplish goals. The concept of a microsystem is the combination of small groups of people working together to provide care to specific subpopulation of patient (Nelson et al. 2007). Healthy work environments recognize the ability to achieve positive patient outcomes through the use of skill communication, meaningful recognition, authentic leadership, true collaboration, effective decision making and appropriate staffing (AACN Standard for Excellence, 2005). It is through the integration of these concepts that students become aware of the importance of understanding their work environment and their role in that environment.
“The microsystem is the structural unit responsible for delivering care to specific patient populations or frontline places where patient, families and care teams meet” (2008 AACN Essentials, p. 38). Clinical microsystems are the basic building blocks of all healthcare systems. It is a combination of a small groups of people who work together on a regular basis to provide care and the subpopulation of patients who receive that care (Nelson, Batalden, & Godfrey. 2007). This is the environment where the nurse participates in a broad mixture of direct and indirect patient care delivery processes. Within this environment nurses are expected to demonstrate leadership skills. This presentation will provide the participants with the beginning concepts and content needed to present a system leadership course in undergraduate nursing curriculums.
Purpose: The purpose of this presentation is to demonstrate how a School of Nursing transformed the traditional leadership curricula in nursing education by integrating the principles of system leadership and elements of a healthy work environment. This presentation will also explore how the course was design using the Donabedian framework.
Target Audience: Target audience for this presentation will include nursing educators from both academic and clinical institution, nursing administrators and academic administrators.
Target Group(s): Clinical, Academic, Administrative
Keywords: Leadership, Microsystem and Undergraduate Education
University of South Dakota, USA
Sources of nursing student anxiety during simulation activities.
Major healthcare and accrediting bodies are calling for reform and innovation in nursing education. Implementation of new or popular strategies should not ignore that some methodologies may generate a level of anxiety in individual students that hinders learning and attainment of course outcomes. Simulation activities in particular may generate a level of anxiety in students that inhibits learning.
This presentation will describe the results of an exploratory, sequential, mixed-methods study that explored the amount and sources of nursing student anxiety associated with simulation learning activities. The Westside Simulation Anxiety Survey and Elements of Simulation Tool were used to describe the amount and causes of anxiety for the study population. Findings of this study reveal that simulation produces a high normal level of anxiety for learners and the level of anxiety did not change from first and final semesters in the nursing program although sources of anxiety do change. Extremely high levels of anxiety were associated with being assigned the primary nurse title or role. Summary recommendations to address student anxiety during simulation support the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards. Because the time and resources needed for simulation activities can be significant, it is imperative that faculty understand the processes that can both positively and negatively impact learning with this learning strategy.
Biography:
Jean Yockey is an Assistant Professor of Nursing at the University of South Dakota, USA. She received a PhD in Nursing Education from the University of Northern Colorado with her research focused on simulation, a Masterʼs of Science in Nursing (Family Nurse Practitioner) from Idaho State University, a Bachelorʼs Degree in Nursing from Lewis & Clark State College, Idaho and an Associate Degree of Nursing from Brigham Young University, Utah. Her research interests include determinants of nursing student learning success and simulation.
McGill University, Australia
Following the launch by the World Health Organization of the Baby Friendly Initiative (BFI) to promote and support breastfeeding, many countries have engaged in implementing this model of care. While we know that BFI is associated to increase in breastfeeding rates, we do not know how mothers exposed to this model of care experience breastfeeding promotion and support services as well as the embodied experience of breastfeeding itself in a social context were it does not constitute the cultural norm. This study analyzed the experience of mothers using breastfeeding promotion and support services with varying degrees of BFI implementation. Focus groups were conducted with 52 breastfeeding mothers that used health services identified as having either high or low levels of BFI implementation. Thematic content analysis was done to compare mothers using high versus low BFI services. Most mothers using services with low BFI did not meet their breastfeeding goal and faced numerous barriers to support. Most mothers using services with high level of BFI breastfed for the planned duration and mentioned feeling comfortable with the embodiment of breastfeeding while feeling empowered to face the sexualizing gaze of others. Data suggests that high BFI services helped mothers attain their breastfeeding goals, changed their embodied experience of breastfeeding, enhanced their empowerment to change their social environment. This conference will discuss how this was all made possible.
Al-Quds University, Switzerland
Health Research System (HRS) is the bedrock of health systems, to improve the population health and responsiveness and equity, and use the knowledge towards a sustainable development. Based on the term 10/90 gap, particularly in developing countries, Palestine HRS has a remarkable case; due to unstable environment. The study seeks to realize PHRS by investigating its governance and policy, stakeholder, challenges and conclude best recommendations for system development.
The study conducted in Palestine, from January to July 2015. A contemporary observational situation analysis design was used by qualitative methods. The institutions from three sectors were targeted; academic public health faculties, MoH units and NGOs and international agencies. Policy makers, academicians, researchers and representatives were selected purposively, through peerreview; some of participants invited for eighteen in-depth interviews (IDI), the rest for three sectorial focus group discussions (FGDs), with literature and documents review. Data were analysed thematically using manual matrices analysis, Word, and Excel programs.
Despite instable circumstances, PHRS is promising. Eleven academic institutions and nearly forty local private, NGOs and international agencies, are remarkably producing health research, but probably without regulated national policies. Governance is not well-organized in managing HRS functions, which its activities are most likely scattered and institutionally or individually driven. The financing is significantly very timid, it does not essentially itemized in budgets. Three main HRS stakeholders involved; academic faculties as a producer, private, NGOs and international agencies as a producer or funder simultaneously, and MoH as a user or MoF as a funder. The international agencies role is inconspicuous although of some successful initiatives. Interestingly, the environmental factors were the most significant gaps, mostly political, as well as the system shortcomings. The human resources and facilities are scarce with poor incentives. PHRS priorities are inconsistent and efforts are uncoordinated with poor multidisciplinarity. Dissemination and research application are questionable. Health research culture is not sufficiently-promoted, and the commitment is not politically-endorsed. The study generated best strategies to strengthen PHRS synergistically.
Palestine is a fertile place for health research; it could become a successful model regionally, despite conflict. Palestinian HRS is a nascent with uncertain structure and inactive organizing body, even political commitment support. PHRS actions do not reached the hoped level yet. Sectorial intervention should be taken, through reactivating a unified representative body and national HRS policy cooperatively, to be regulated appropriately, bridging the gaps and affording resources adequately, and to produce and utilise the research effectively.
Seton Hall University, USA
Objective: An educational wellness program was created and implemented at a local facility for socioeconomically disadvantaged individuals who are experiencing both psychiatric and physical illnesses and was the DNP project for this author. The facility includes psychosocial rehabilitation as well as primary care for acute and chronic physical conditions.
Significance: Cardiovascular disease is greater in those with mental illness (SAMHSA, 2012). African-American men and women have an increased incidence of hypertension (www.heart.org). Priority populations that are receiving poor health care are racial and ethnic minorities, low income populations and individuals with chronic conditions (www.ahrq.gov).
Method/Description: The program focus was to inspire healthy behaviors through the provision of a wellness program aimed at the physical conditions frequently seen in this diverse population. The theoretical framework for the project is Self-Efficacy theory which originated from Social Cognitive Theory by Albert Bandura. The belief that one has the power to produce any given task is related to the ability to complete it. Self-efficacy is believed to be the most important pre-condition for behavior change (Bandura, 1977). Manuals were created to support the staff and clients. The clients were provided educational material in teaching sessions. Follow-up occurred at the primary clinic to assess the impact of the teaching sessions and for continual wellness and motivation.
This project considered factors that are consistent with the Eight Dimensions of Wellness of the Substance Abuse and Mental Health Service Administration and incorporate the efforts of the National Million Hearts Initiative (www.millionhearts.hhs.gov). The SAMHSA Wellness Initiative supports actions to work toward improving quality of life, cardiovascular health and decreased mortality rates (SAMHSA, 2012). Screening, pre and posttests during educational sessions and evaluation was the utilized methodology.
Findings: 77 clients participated. 87.5% of individuals screened returned for follow-up. 68.85% of group participants opted for screening. Two individuals required immediate intervention. All individuals screened reported an increase in communication confidence.
Conclusion: Elimination of health disparities in the U.S. will not occur without the involvement of nurses, other health professionals and communities at large. This project addressed health disparitiesby empowering individuals to improve their self-efficacy, cardiovascular health and thus their overall wellness.
Biography:
Patricia Clark Pappas is a holds a Doctor of Nursing Practice degree from Seton Hall University. Her DNP project focused on addressing health disparities in a vulnerable population. Dr. Pappas Master of Science Degree in Nursing from Columbia University was as a Critical Care Clinical Nurse Specialist. Her area of expertise is adult medical surgical oncology patients. She holds multiple certifications including: Certified Nurse Educator from the National League for Nursing, Clinical Nurse Leader from the American Association of Colleges of Nursing and Acute/Critical Care Adult Knowledge Professional from the American Association of Critical-Care Nurses.
University of Dammam, Saudi Arabia
An exploratory descriptive study was conducted at faculty of nursing, university of Alexandria, Egypt, to explore adolescentʼs utilization of web-sites as a source of information about their reproductive health. The study sample consisted of all nursing students enrolled in the first academic year 2008-2009 who accepted toparticipate in the study (200students). First year students were chosen because they are still in the late adolescence period (17-21). A questionnaire sheet was developed after reviewing of the relevant Literature it comprises the following parts: Part1: Socio-demographic data such as gender, age, etc. Part2: Media available at home e.g radio, television, computer…etc. Part3:Reproductive health related topics accessed by the study subject e.g, puberty, menstruation, pregnancy, nutrition, drugs, cancer, violence, parenting…. etc.
The participants were asked to select the ones on which they have ever sought for information, preferred topics, other sources of their information e.g parents, radio, TV or printed materials…etc and their perception about the health information on the internet. The study revealed that they preferred using the internet instead of other sources, because it ensures privacy and easiness of accessing relevant valid information. It concluded that, the internet is a source of reproductive health information commonly used by adolescents
Biography:
Dr.shadia has completed his Ph.D from Alexandria University and postdoctoral studies from the same University. She has published a lot of papers in different scientific journals.
School of Nursing, St. Louis University, Philippines
Aims: To unveil the lived experiences of chronically ill prisoners and to know the impact of their illness to them.
Methods: Hermeneutic Phenomenological qualitative study was utilized to unveil the experiences of prisoners with chronic illness. The concept of saturation was used wherein 11 participants were obtained through referral method. Unstructured interview was used and all data gathered were placed in a transcript file. Analysis and data interpretation were done through Collaizzi method.
Results: Prisoners with chronic illness have various experiences inside the jail. From these experiences, the impact of chronic illness to prisoners were found to be their struggles, coping, and insights. Their struggles were identified to beexacerbation of existing condition, having repulsive control of activities of daily livingby jail personnel, inadequate health resources and services, financial insufficiency to address illness, unconducive jail set-up, and development of negative feelings. As a response, they made a way to cope by dealing with jail system, developing renewed optimism, striving for diet modification, engaging to physical activities, and practicing complimentary therapy. And in the process of coping, insights were gained which are being grateful despite being imprisoned, gaining widened source of support system, and having a strengthened faith towards God. These helped the participants accept their condition, adjust to the new environment they were imposed to live in, and think optimistically of the future.
Conclusions: Prisoners with chronic illnesshave varied struggles while inside the prison. Consequently, they are ought to adjust and cope up with their current situation. In addition to this, they were able to gain insights, while in the process of coping, that have helped them gain new reason to move ahead and keep them believing that one day, they will be free from bastille without their chronic illness taking its toll.
İstinye University, Turkey
Background: Various instructional methods and environments are used in nursing education to develop studentsʼ psychomotor and communication skills, reduce their anxiety levels, and enhance their satisfaction.
Objectives: To examine the effect of three different instructional environments on the development of the studentsʼ psychomotor and communication skills and their levels of anxiety and satisfaction.
Design: A prospective study design was used.
Methods: The sample of the study consisted of 60 nursing students. Before the implementation of the study, the studentsʼ cognitive skills and trait anxiety levels were evaluated. The students were divided into five groups and five nursing activities (Leopoldʼs maneuvers, teaching breastfeeding, family planning education, teaching vulvar self-examination and teaching breast selfexamination) were specified for each group. They implemented these nursing activities under the supervision of a faculty member in the nursing skills laboratory, standardized patient laboratory and clinical practice environment respectively. In each instructional environment, the studentsʼ psychomotor and communication skills, state anxiety levels and satisfactions were evaluated.
Results: The median scores for psychomotor skills [Nursing Skills Laboratory=73.1; Standardized Patient Laboratory=81.5; Clinical Practice Environment=88.6] and communication skills [Nursing Skills Laboratory=64.9; Standardized Patient Laboratory=71.6; Clinical Practice Environment=79.0] were found to increase as the students went on practicing in a more complicated environment (p<0.05). Similarly, it was determined that the studentsʼ anxiety levels decreased as they were practicing incrementally [Nursing Skills Laboratory=33.0; Standardized Patient Laboratory=32.0; Clinical Practice Environment=31.0]. As the instructional environments were getting more similar to the reality, the studentsʼ satisfaction levels were found to become higher.
Conclusions: Students who deliberately practice in the instructional environments until they are competent develop their psychomotor skills while reducing their anxiety levels, and enhancing their communication skills and satisfaction. For that reason, the development of studentsʼ competency areas is thought to be effective for the enhancement of patients and healthcare workers safety.
Keywords: Nursing education, clinical practice, nursing skills laboratory, standardized patient, psychomotor skill, communication, anxiety, satisfaction
Biography:
She graduated in first place from Hacettepe University in 1989. She won the İhsanDogramacı Superior Merit Award and Science Incentive Award. She earned her pilotʼs license from Republic of Turkey Ministry of Transport. She studied about counseling on assisted reproductive techniques at Liverpool Womens Hospital Reproductive Medicine Unit in United Kingdom on the British Council Research Scholarship. She earned a certificate in management and leadership in nursing. She is an active member of Thematic Network leadership work group. She studied as a research scholar at Kent State University College of Nursing in 2006 for 3 months. In 2007, she worked on a project named “Development of Leadership Skills in Nursing Doctoral Students” at University of Michigan Faculty of Nursing on an international research scholarship which was supported by International Network for Doctoral Education in Nursing (INDEN) and Sigma Theta Tau and provided to only three people around the world every year. She worked as a research assistant at Hacettepe University School of Nursing in the Maternity and Womenʼs Health Nursing Division from 1990 to 1997. She was promoted to assistant professor in 1998, associate professor in 2006 and professor in 2012. She worked as a Co-Head of Nursing Department, Erasmus Department Coordinator, Head of Strategic Planning Group and board member of Hacettepe University Womenʼs Research and Implementation Center (HUWRICH) between 2009 and 2011. Her interest subjects are sexuality and reproductive health and management and leadership. She is member of national and international nurseʼs organizations such as INDEN and Sigma Theta Tau. She has been working as a Director of Nursing Services at Hacettepe University Hospitals since September 2012 and Founding Dean of Faculty of Nursing between 2012- 2013. She has published more than 50 papers, 15 grant projects, eight books as an editor and author, and 90 presentation in the national and international congress. She is also invited speaker more than 60 congress and symposium. She is working as a dean in a Faculty of Health Science in İstinye University, İstanbul since 2016.
University of South Africa, South Africa
Purpose: To explore and describe the lived experiences of student teachers currently registered for the Bachelor of Curationis (BCUR) studying in an ODL university. The degree comprises nursing education and management and the students had attended the teaching practice workshop, a component of nursing education programme.
Method and Design: An explorative, descriptive, interpretative and qualitative design was conducted to explore student teachers experiences of the teaching practice workshop they have attended. Purposive sampling which is based on the belief that the researcherʼs knowledge about the population can be used to hand pick sample elements was used. Students who were willing to participate were requested to sign the consent form. Data was collected through written narratives and a Collaizʼs method of data analysis was followed.
Results: The majority of the students indicated that the workshop period of five days is too short compromising face to face learning and makes teaching and learning to take place underduress. They also expressed fear of the unknown and anxiety as they had never taught before. Others felt it was real experience situation, where they practiced peer assessmentand had an opportunity of socializing with fellow students.
Conclusions: Student teachers indicated that the one day orientation done beginning of the year should be extended to five days to facilitate maximum guidance by lecturers and to ensure proper preparation of lesson plans. This should be followed by another five days for the teaching practice workshop. Audio visual teachings and recording was suggested as a form of assessment. Use of latest technology such as power point presentation should be used instead of overhead projectors and posters
Keywords: Experiential learning, ODL, student teachers, teaching practice.
Biography:
Dr Masango is holding a D Phil Nursing Education (2002), M Cur Nursing Education (1998), B Cur Hons Nursing Education (1993), Diploma in nursing administration (1995), BCur Education and Community Health Nursing (1991), Certificate in Clinical HIV/AIDS management for nurses (2008).
Dr Masango is currently working as a senior lecturer in the Department of Health Studies at the University of South Africa (UNISA). She has previously worked as a professional nurse at Ngwelezane hospital in KwaZulu Natal Province (1982-1985), as a lecturer and senior lecturer at the University of Zulu Land (1995- 2007), Provincial coordinator for the University Research Cooperation (2007-2009) and Campus manager at Net Care Education (2009-2010). She is and has been involved in the supervision of post-graduate students (M&D) some of which have completed their theses and dissertations.
Dr Masango has published quite extensively in accredited journals both nationally and internationally. And has a very strong interest in nursing education, philosophy of education, research and TB/HIV/AIDS.
Senior Charge nurse, Head of Nursing Education, Department of Nursing, AHS/SEHA, UAE
Vaccination against childhood communicable diseases through the Expanded Program on Immunization (EPI) is one of the most cost-effective public health interventions available. Most causes of vaccine preventable illness among children are relatively uncommon due to high rates of vaccination and very effective vaccines.
Adult vaccination is one of the most important tool for reducing morbidity and mortality not just in the elderly but in other members of the society by increasing herd immunity, reducing severe clinical outcome and helping in eradication of the disease.
The immunization program overall has been very successful with kids. So is there is a problem? Yes, there is. Weʼre not doing so well with adults.
Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations.
Although provider recommendation is a key predictor of vaccination, more often clients report not receiving vaccine recommendations at healthcare provider visits. Other barriers to vaccinating adults, including the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, we introduced a number of strategies which have been demonstrated to substantially improve adult vaccine coverage. Providers are encouraged to incorporate routine assessment of their adult patientsʼ vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.
Indiana Wesleyan University, USA
The purpose of this study was to analyze the effects of mentoring of nursing faculty and job satisfaction with intent of nursing faculty to stay at their current academic institution. A quantitative, descriptive design was used with a convenience sampling of baccalaureate nursing faculty from three mid-central schools of nursing in the United States. A revision of Faganʼs Career Development Questionnaire was distributed via Survey Monkey to professional e-mail addresses of 172 baccalaureate level nursing faculty, both online and onsite, who did not teach in a clinical laboratory or clinical settings. The total number of returned surveys was 54. A result of the study was that a significant amount of participants (n=35) responded that they did not have a mentor or special person who took an interest in their teaching career. Participants (n=19) who had experience with a mentor continued to answer specific questions regarding their mentoring experiences. Results indicated that participants who had a mentor were likely to remain at their school of nursing for the next year and possibly for the next five years. Participants with a mentor (n = 19) reported their mentor did not influence their decision to stay or leave their current position in academia. An almost equal number of participants (n = 11) with a mentor reported their mentor influenced their decision to remain in academia as a nurse educator. The results of this study indicated nursing programs that utilized experienced faculty as mentors may have an increase in job satisfaction and retention of nursing faculty in their baccalaureate nursing programs.
Biography:
I live in Winnsboro, Louisiana, which is located in the Northeast area of Louisiana. I graduated from Cameron University, Lawton, Oklahoma, in 1990 with my ADN, Southwestern Oklahoma State University, Weatherford, Oklahoma, in the first RNBSN weekend program in the Southwest United States, my MSN from the University of Phoenix, in 2005, and my M.Ed from Intercontinental University in 2009. My PhD is from Capella University, Minneapolis, Minnesota. My clinical background of 20 years is Critical Care and Radiology Nursing. I completed my doctoral dissertation, Nurse faculty Mentoring: Job satifaction and mentoring of nurse educators in a baccalaureate nursing program in October, 2014. I am an Assistant Professor with the School of Nursing, Indiana Wesleyan University, and a mentor for Thomas Edison State University, Trenton, New Jersey, with the School of Nursing, and an adjunct online faculty in Health Care Administration for the University of Phoenix, Phoenix, Arizona.
I have been full-time online nurse educator for the past six years with Indiana Wesleyan University.
Senior Charge nurse, Head of Nursing Education, Department of Nursing, AHS/SEHA, UAE
Introduction: Vaccine-preventable infectious diseases are responsible for significant maternal, neonatal, and young infant morbidity and mortality. Changes in the immune response in pregnant women – which are thought to occur in order to allow the woman to tolerate the semi-allogeneic foetus – may interfere with the development of the specific immune response to pathogens. These immunological changes may alter the susceptibility of the woman and the foetus to certain infectious diseases and increase the risk of more serious outcomes. This paper discuss the benefits and challenges of immunization of pregnant women.
Immunization of pregnant women can protect them directly against vaccine-preventable infections, and in so doing potentially protect the foetus. It can also directly protect the foetus and infant via specific antibodies transferred from the mother during the pregnancy.
Pregnant women and their babies are at increased risk for influenza-related complications, including premature labour and preterm birth. Additionally, pertussis outbreaks continue to occur with infants at highest risk of severe illness and death. However, immunization coverage among pregnant women is suboptimal. Clients report concerns for the safety of vaccines and not receiving vaccine recommendations at healthcare provider visits.
Department of Health and Human services recommendation includes Assess the immunization status of each patient, Recommend the indicated vaccines to each patient, Administerany necessary vaccines or, if you do not stock the vaccine, refer the patient to a provider or location that can vaccinate the patient, Document the vaccinations that your patient is given, ideally in your state or local immunization registry.
Conclusion: Health care providers play a crucial role in helping keep pregnant women and their new born healthy. Assuring our patients are protected by recommended vaccines is key.
St. Lukeʼs Medical Center, Philliphines
Introduction: The Medical Center in 2014 has been experiencing a steady increase in medication error rates higher than the set threshold of 0.30 per thousand patient days. In search of an answer to manage medication errors, the nursing care group adopted a framework to integrate evidence based practice and performance improvement principles. Evidence Based Practice has its origin from Medicine. The term was first used by Gordon Gyatt in 1992. It was a new approach to providing medical care, the essence of this paradigm, using research evidence as the best evidence to guide professional decision making, has spread to other professions both within and outside the healthcare arena. So as evidence becomes crucial in practice setting and particularly in patient care, medication errors can be reduced using evidences in the literature. Medication Safety strategies and initiatives evidently can reduce errors before reaching patients (Paparella, 2008). Evidence Based Practice in Nursing was an offshoot of the medical practice EBP. The difference was mainly the shift from one on one clinical question to a question about a group. This becomes now a huge difference in approach, one that takes place in an organizational system. The desire to adopt a framework that is both evidence-laden and process driven where nurses can apply simplicity and practicality was premised in Da Vinciʼs “simplicity is the ultimate sophistication”. The EBPI Framework gives clear direction on how to develop, implement, and evaluate innovations aimed at improving healthcare. The use of the model also helps avoid the dissemination of practice changes on a large scale before the processes needed for successful implementation have been tested and refined. Also important is the opportunity to determine who will implement these practice changes and to assess the knowledge they will need to do so.
Methodology: The EBPI being systematic avoids hospital wide implementation of practices that have little or no evidence of its usefulness. A small test of change is the hallmark of the framework. The model integrates performance improvements utilizing the Plan Do Study Act (PDSA) Model in an identified Evidence Based Nursing Practice. One disadvantage of the model noted by some who have utilized it was the length of time it may take to systematically apply such a disciplined approach to improvements. (as our experience taught us in Medication Management System, a successful project may take anywhere from 6 to 18 months to implement.) In the long run, however, taking the time to follow the EBPI model as described can save precious resources, both human and financial, because the chance of reaching desired outcomes is greater than when implementing change on a whim, opinion, or little quality evidence. The model becomes useful both in Quality Assurance and Quality Improvements. Data we gather becomes useful in developing consistent performance improvements which can eventually be translated to large scale improvements. The thought of the medication box as an individual patient supply came about when the error in 2014 have soared high. A medication error rate was recorded at 0.396 of which omission error was recorded at 0.128. The need to address this increasing error as to omission was necessary. Evidences in the literature pointed out a considerable reduction in medication error with the use of an individual patient medication supply. The Medication box is an individual patient medication supply that has grade B in EBP. A moderate support that warrants consideration of application was recommended. This suggests that this can reduce the omission error rate considerably.
Results: A Correlation Statistics between time spent, use of medication box and Medication Error was made. It revealed a no correlation between the time spent handing off, the use of the medication box and Medication error. This suggests that Med error may have been reduced as omission error have declined. Another small test of change was conducted for the second pilot test of the medication box. This time a compliance variable was measured as the work flow was enhanced based on the results of the first pilot test. Work flow process and protocol compliance were utilized as test variables. Compliance was measured using test protocol steps completion. Medication error rate, excess medicines of discharged patients and discontinued drugs that were properly turned in were measured as to rate of occurrence. Satisfaction Survey of the users was also utilized to determine: usefulness of the medication box, turning in of discontinued and batched medicines of discharged patients. There was 98.25% compliance to the work flow process of medication box usage. There was 0.425 medication error rate for the months of July to September 2014 compared to the 0.448 medication error rate of 2013. Medication error rates were noted to have been committed in the following: reconciliation, dispensing, encoding and administration. Highest error rate was noted in administration (0.42) and lowest were dispensing and encoding with similar rating of 0.14. There were no reported errors as to missed, over and under dosage. There was a negative high correlation (r=-0.98) between medication error rates and work flow compliance rate of nurses as to medication box utilization suggesting that the error committed is not related to the use of medication box.
Conclusion: The use of the Medication Box as an Individual Patient Medication Supply System had prevented the occurrence of the errors related to missed, over and under dosage. This had contributed significantly to the total medication error rates of the third quarter of 2014. The zero reported errors related to the missed, over and under dosage were attributable to the individual patient medication supply. The batched medicines delivered and safely kept in the patientʼs room may have prevented other nurses in the unit to borrow medicines from the Breurʼs Cart which is a unit patient medication storage resulting to missing a dose. The role of the Clinical Unit Based Educator in the validation of the medicines to be administered by the Bedside Nurse had contributed further to the zero incidence of error of missed, under and over dosage since four eyes check becomes operational. The medication error reduction of nursing care group particularly on omission errors had created an overwhelming impact in the medical center over all medication error rates. A notable decrease in the omission error was observed after a year when the medication boxes were installed in almost 50% of nursing units. (2014: 0.161 and 2015: 0.121). As of 2015, overall medication error rates across the medical center as to omission was recorded at 0.130 from the 2014 rate of 0.182.
Recommendations: The medication box as an individual medication supply system was proven to have considerably decreased medication errors. The utilization of the medication box in all nursing units is highly recommended. As to this time, the individual medication supply or the medication box was installed in all patient rooms.
University of South Africa, South Africa
Introduction: South Africa is one of the few developing countries with a national confidential inquiry into maternal deaths. The establishment of the Confidential Enquiry into Maternal Deaths in South Africa was to allow the country to determine at what level there is a breakdown in the health system and in turn this will allow for remedial action. The information for “saving Mothers” comes from an analysis of data on women who died in South Africa during pregnancy, pregnancy, labour or the puerperium in the four quadrium and were reported to the National Committee on Confidential Enquiries into Maternal Deaths (NccEMD).
Problem statement: All the reports from the inception of NccEMD made recommendations, but poor review and report on what the country has achieved with regards to maternal mortality.
Purpose: To establish progress made in South Africa with regards to maternal mortality.
Objectives: To assess the levels of maternal morbidity and morbidity in South Africa; and to report findings and make recommendations.
Research design: A retrospective, comparative study to assess all the NccEMD reports from 1998 to 2012.
Conclusion: The death of a woman who leaves behind a young family has devastating consequences for these survivors, with increased chances of disadvantage, illness and premature death, especially in poorer societies.
1Assistant Professor, Department of Graduate Nursing, Alcorn State University, USA
2Professor, Capstone College of Nursing, The University of Alabama, USA
Purpose: Implement an evidence-based exercise protocol based on participantʼs level of comorbid conditions to guide interdisciplinary healthcare professionals in the prescribing of appropriate exercise regimens for patients living with type 2 diabetes in primary care.
Data Sources: The evidence utilized to create this protocol was based on a substant overview of the literature first focusing on randomized control trials then expert opinions. CINHAL 1987-2016 and PUBMED 1986-2016 databases were searched to uncover pertinent literature; specific attention was also given to literature which explicated Penders Health Promotion Model (HPM).
Conclusions: Application of portions of Penders HPM as a guide when implementing a diabetes exercise protocol into practice has potential to avoid additional diabetes related complications and safely direct interdisciplinary healthcare professionals in prescribing appropriate exercise regimes in primary care.
Implications for Practice: The obesity epidemic is directly associated with the increase intype 2 diabetes. Obesity coupled with type 2 diabetes serves to further complicate the patients metabolic profile and risk for further complications. Diabetes exercise protocolsneed to be individualized and based on the patients current level of complications. Having a protocol algorithm can be of assistance in this area as it is a cost-effective tool that can be utilized for improving the health outcomes of patients with type 2 diabetes through safely directing exercise related behavior change in primary care.
Biography:
Doctor of Nursing Practice that encompasses the ability to provide leadership and practice proficiency that engenders the delivery of quality of healthcare services to all individuals for the attainment of favorable health outcomes. Owns a primary care practice, Quality Health Care Services, PA in Jackson, MS and serves as a nurse educator for Alcorn State University, Natchez, MS. Received Doctor of Nursing Practice from University of Alabama at Birmingham, Birmingham, AL; Master of Science in Nursing (Family Nurse Practitioner) at Alcorn State University, Natchez, MS; and Bachelor of Science in Nursing from the University of Mississippi Medical Center, Jackson, MS.
University of Bahrain, Bahrain
Home health care is a health care services that can be given at home for an illness or injury. Home health care is more convenient, and just as effective as care you get in a hospital or health centre. The main goal of home health care is to treat an illness or injury. Home health care helps client get better, regain independence, and become as self-sufficient as possible.
Home health care services in Bahrain started many years. The main goal of this home health care is to provide curative, preventive, and other supportive services at home. Community health Care Nurses provide medical and personal care to individuals who are chronically ill, disabled or suffering from cognitive impairments.
The community health nurse contributes to quality nursing practice. Community health nurse utilizes appropriate resources to plan and provide nursing services that are safe and effective.
Because home care is vital to a new approach for health care, the existing demand for home care nursing is expected to increase dramatically. Barriers to practicing to full scope were identified, at individual, organization, and systemic levels.
This paper presents the home health care system in Bahrain, the development, trends, issues and opportunities, standards of practice and standards of professional performance for community health nurse. In addition this paper will discuss the barriers for effective home health care practice and recommendations.
Biography:
Nadia Adbahi, Head of Community Health Nursing program. Nadia earned a master degree in clinical nursing specialist in community health nursing from University of Texas, Austin. Member in Health Promotion and Community Partnership Committee. She is a member in Ministerial Child Protection Team, Ministerial Health Education Committee, Sigma Theta Tau International honor Society of Nursing, Epsilon theta chapter, Texas Committee to Prevent Child Abuse.
Senior lecturer at college of Health Sciences University of Bahrain
Since 1960, the government of Bahrain has provided comprehensive health care that is in line with the World Health Organization global objectives to the whole population via a network of 22 health centers, and one secondary and tertiary care hospital, one psychiatric hospital, one geriatric hospital and four maternity hospitals distributed throughout the Kingdomʼs four Governorates.
Bahrainʼs maternal and child health care has a long history dating back to the start of medical services in the kingdom. Maternal and child health care aims to offer an integrated and preventive health care to mothers and children through pregnancy and after birth. Antenatal care is provided through a network of multi-purpose health centres throughout the country. Antenatal care services in Bahrain can be described as a success in achieving and improving maternal, perinatal and neonatal outcomes. Bahrain provides an illustration of antenatal care system with virtually all care provided by qualified midwives, who maintain a complex, reliable and well regarded primary care system and who keep the load on the secondary system at a low and workable level. ANC in Bahrain has reached almost all pregnant women with reported increase in the coverage of the recommended four ANC visits and increases in the coverage of a first trimester ANC visits. The backbone of the early detection and referral system that controls maternal mortality is in the hands of midwives who are trained to serve their women clients with professionalism and compassion.
Because of its successes, its applicability as a model for other countries is worthy of consideration though many of its features may not easily be replicable elsewhere. This paper attempts to identify the operational features and the most essential factors that contribute to safe pregnancy for women in this setting, and give some indication of what would be required for these to succeed in other settings.
Biography:
Nadia Abdulhadi is a senior lecturer at college of Health Sciences, University of Bahrain since 1984. She holds MSc degree in Perinatal Nursing from University of Pennsylvania (USA) and BSc. degree in Nursing from College of Health Sciences (Kingdom of Bahrain). She is the coordinator of the Midwifery Program since 2000. She is teaching Midwifery, Research, Management and Ethics courses to undergraduate Nursing students. She is World Health Organization (WHO) consultant for Midwifery Education since 2008. She has developed and taught several short courses for midwives in Bahrain. She is an active member in several professional organization and was honored several awards and letters of appreciation for excellence in teaching and contributions to the development of midwifery profession.
Al Ain Hospital, UAE
The overall aim of this audit is to establish standard documentation process on pain assessment, reassessment and follow up, patient and family education including appropriate prescription of medications for PACU and ward Nurses that covers Acute Pain Service 24/7 in Al Ain Hospital in the management of pain. The multidisciplinary healthcare team is responsible for documenting the results of assessments, treatment plans and on-going progress notes regarding the resolution/management of the individualʼs pain.
The Joint Commission standards on pain management address the documentation of assessment and reassessment. Yet, little has been published to describe when and how nurses perform and communicate reassessment of pain.
There are 15 criteriaʼs set to which nurses need to comply in management of pain documentation that can only be answered with “yes” and “No”, with the target rate of 100% the rest are patientʼs demographics.
The audit started last May 1, 2016 and end on Aug 1, 2016. All patients that availed Acute Pain service were all recipient on this documentation review made by nurses assignedincluding the continuity of service in the ward except patients who had PCEA in Labor and delivery and those who have spinal morphine.
Biography:
Marilyn V. Parro has been in Al Ain Hospital PACU Nurse since 2009. In her 24 yrs as RN, Marilyn has worked in almost every aspect of healthcare. Early in her career she gained experienced working in Philippines prior to work overseas. Her career highlighted as Anesthesia Nurse in Military Hospitals in Saudi Arabia before joining American Hospital Dubai and Al Rahba Hospital in Abu Dhabi. Then after she concentrate in Post Anesthesia Care Unit and Pain Management.
She has a wide range of expertise in healthcare, from policy making, pharmaceutical and medical equipments commissioning requirements. She had the experienced to set up Dubai Medical Suite of DHCC as PACU In-charge. Initiate to start up as Training Manager in Sama Abu Dhabi Homecare Center prior to joined Al Ain Hospital and set up PACU unit.
She was one of the recipients of the highest award for Nurses in UAE on 2005 given by Emirates Nursing Association. She was an inducted member since 2008 of Sigma Theta Tau International Honor Society of Nursing, an affiliated member of Upsilon Eta Chapter, National University of Singapore.
Marilyn received her Masterʼs Degree in Science in Healthcare Management from Royal College of Surgeons in Ireland, Dubai Campus, Class of 2009.
Robert Gordon University, UK
Background: Contemporary birth has become frequently attuned to fear and positioned in medicalisation. Although the context of birth has changed over time and across cultures something meaningful about birth is lost and hidden in the experience when a newborn arrives.
Method: Using hermeneutic phenomenology stories from mothers, birth partners, midwives and obstetricians were interpreted.
Findings: The stories reveal an attuned-space, attuned-temporality, bodily attunement and a felt relational quality of gathering with others. The presence of others at birth are both seen and unseen, near and far and can include a sense of “holy-other”. A contextual web of social, emotional and spiritual meanings coalesces and discloses birth as meaningful beyond what is normally spoken reminding those privileged to be at birth that birth is significant and a remembrance of our shared natality. The moment of birth is thus a special time named Kairos, a sacred joyful moment in life that brings forth deep meaningful insights. Findings and conclusions are presented in a way that invokes thinking about 21st century birth revealing hidden profound meaning.
Conclusion: The findings provide new interpretations on contemporary birth practices and professional disputes across all cultures. This study calls upon everyone to honour birth and shelter something precious and profoundly meaningful. These valuable insights have implications for all those involved in and around birth from education of health care professionals, social policy makers, childbirth researchers and women and families using the maternity services.
Ethical approval: Gained through Auckland University of Technology Ethics Committee, New Zealand.
1Tehran University of Medical Sciences, Iran
2Islamic Azad University Karaj Branch, Iran
Background: Patient-centred care is both a goal in itself and a tool for enhancing health outcomes. The application of patientcentred care in health care services globally however is divers. This paper reports on a study that sought to introduce patient centred care.
Methods: The study used grounded theory method. Data were collected on five critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semi-structured interviews with 27 participants (nurses, patients and physician). Data obtained were analysed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context and process of the study.
Findings: The core category of this grounded theory is humanising care, which consisted of four interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients and patient empowerment. A core category of humanising care integrated the theory. Humanising care was an outcome and process.
Conclusion: Patient-centred care is a dynamic and multifaceted process provided according to the nurses understanding of the concept. Patient-centred care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs and preferences.
Implication for Nursing and Health Policy: Given the findings of the present study, health care providers should remember that they are the main advocates of the patients interests and should therefore plan their care programs accordingly. The findings of the present study can be implemented as a framework for improving the quality of care.
Keywords: Critical care, Grounded theory, Nursing, Patient-centred care, Quality of care
Biography:
I am assistant professor in TUMS in critical care department. I have 9 years experiences in clinical setting (Emergency, Cardiac Care Unit). My research line are Patient centered care and critical care scopes. I am member of International Nursing Organization and Iranian Cardiac Society. I published some ISI papers about my research line.
University of Sri Jayewardenepura, Sri Lanka
Background: Dengue is the most common among all the arthropod-borne viral diseases and a major public health problem in Sri Lanka. Because there is no vaccine, great emphasis is placed on control and preventive measures. The study was conducted to identify the level of knowledge and practices regarding preventive measures of dengue fever among hospitalized patients in Infectious Disease Hospital, Sri Lanka.
Methods: A cross-sectional study was conducted through simple random sampling; and a structured questionnaire was interviewer-administered for Three hundred and six (306) hospitalized patients.
Results: More than half of the participants (52%) were presented with dengue fever. They had high (46%) level of knowledge on dengue fever and its preventive measures (Mean= 11.03, SD= 1.767). Nevertheless, a majority (88%) had poor level of practice in prevention (Mean= 10.05, SD= 2.718). Ninety percent of them could recognize that dengue is preventable. Television and radio were the predominant sources of information. Eliminating standing water collection sites was the most prevalent (96%) preventive practice. There was significant positive association between the level of knowledge and level of preventive practices (p=0.030).
Conclusion: Good knowledge about dengue fever, did not translate to adoption of preventive practices. The participants demonstrated gaps in knowledge and level of preventive practices. It indicates the value of education programmes as a tool in dengue prevention. Future campaigns should focus on educating and encouraging the community to adopt simple, inexpensive preventive methods. This would help to eliminate dengue in Sri Lanka.
Keywords: Dengue fever, prevention, knowledge, practices, Sri Lanka
Biography:
Miss Jayasinghe was a talented, smart student in her undergraduate period, who performed very well in her curricular and extra-curricular activities. Since October 2015, she is working as a demonstrator in Department of Allied Health Sciences, University of Sri Jayewardenepura. Her research interest is Community health nursing.
National University of Ireland, Ireland
Background and context: The abuse of older people is recognised internationally as a widespread problem. It is important for nurses to report suspected elder abuse and, while on clinical placement, students have the opportunity to meet older people in different settings. Therefore a student nurse may have the opportunity to recognise and respond to abuse and provide appropriate support. However studies show that healthcare professionals fail to recognise abuse. Aims of the study were to: determine the proportion of first and third year nursing students (general and psychiatric) who correctly identify elder abuse in a vignette; to identify variables associated with the correct identification of abuse and to suggest factors and strategies to increase correct identification.
Methodology: All participants were given The Caregiver Scenario Questionnaire which measures recognition of elder abuse. Ethical approval was granted by the University ethics committee. The questionnaire comprised a fictional vignette about a son who cares for his mother who has dementia, followed by a list of 14 management strategies. Respondents rated each strategy on a 6-point Likert Scale. Some strategies are abusive and some are not.
Analysis: Data analysis is currently being undertaken using IBM SPSS Statistics (Version 20) and descriptive and inferential statistics will be applied to determine correlations between demographic factors, education and experience and ability to identify elder abuse. The significance level was set up at p<0.05.
Summary: This paper will present the findings of the first study undertaken in Ireland to examine recognition of elder abuse in nursing students.
Conclusions and implications: The findings will inform changes that need to be made to undergraduate curricula at national and international levels. It is expected that curriculum content will be improved to reflect the educational needs of student nurses regarding recognition of elder abuse.
Ministry of Health, Kingdom of Bahrain
Internationally and locally the role of the school nurse has become more comprehensive in order to meet the health care needs of students(1). In comparison with other developed countries the professional role of the school nurse in the Kingdom of Bahrain is poorly understood and underdeveloped by governmental agencies. This study used a qualitative research design to explore the role of Bahraini secondary school nurses. Following ethical approval from the RCSI, MOH & MOE a sample group of ten nurses were purposefully selected Data was generated through semi-structured interviews and analyzed using Burnardʼs four-stage framework(2). Two major themes comprising of several subthemes emerged from the data: (i) The role of Bahraini secondary school nurses and the need for nursing professional programs with improved organizational structure; and (ii) Role conflicts experienced by the nurses because of a lack of professional autonomy and collaboration and also high ratio of students to nurses. The implementation of a collaborative organizational structure between the two ministries (Ministry of Health and Ministry of Education) regarding school nursesʼ roles, polices and guidelines would facilitate and greatly enhance the current service, as would professional educational programs for the nurses working in these school settings.
Biography:
Miss Hassani has completed her MSc at RCSI Bahrain and studing Nursing PhD at RCSI Dublin. The first School Nurse specialist in Bahrain and doing her PhD thesis on “INVESTIGATING THE FACTORS INFLUENCING JOB SATISFACTION AMONG SCHOOL NURSES IN BAHRAIN – A MIXED METHODS STUDY”
Centro Escolar University, Philiphines
In a complex and evolving world of health care environment today, nurse educators are being challenged to prepare the Millenial students for professional practice in nursing. Engaging students in active learning is essential to prepare them in providing nursing care and self-directed learning strategy has been found to be effective in supplying this need in active learning. But this strategy will not be effective if students are not ready for it. Self-directed Learning Readiness (SDLR) has been found to be an important factor in enhancing academic performance and perceptions of the learning environment of students. Aside from readiness for self-directed learning, considering learning preferences or styles is also essential in helping students understand their learning needs. It rationalizes their own choice of teaching strategies suitable for themselves.
This study aims to assess the level of readiness of student nurses for self-directed learning and their specific learning styles and; determine the relationship of these two factors. The study will be utilizing the descriptive correlation survey design to determine the relationship of readiness in self-directed learning and learning style. The Autonomous Learner Index of Abu-Moghli et al (2005) will assess the level of readiness in self-directed learning and the Learning Style Inventory of Kolb (2005) to assess their learning style type. Nursing students of Centro Escolar University shall be the respondents of this study.
The researcher hypothesizes a significant relationship between the level of readiness for self-directed learning and learning styles among nursing students.
Biography:
Vincent Raphael V. Manarang is a graduate of Bachelor of Science in Nursing last 2009 and a registered nurse. He is a professor in Centro Escolar University for 3 years already, teaching the subjects Primary Health Care, General Anatomy, General Physiology and General Mircoscopic Anatomy and Embryology. He is also a reviewer of one of the Top review centers in the Philippines for Nursing. He is currently taking up his degree Master of Arts in Nursing for Nursing Administration.
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