Madridge Journal of Nursing

ISSN: 2638-1605

5th International Nursing Conference

Oct 23-25, 2019, Rome, Italy
Accepted Abstracts
DOI: 10.18689/2638-1605.a4.004

The Relationship between Perceived Social Support and Childbirth Fear of Turkish Adolescent Pregnants

Aysu Buldum* and Tuba GunerEmul

Mersin University, Turkey

Background: The importance of social support in coping with childbirth fear has been emphasized in many studies conducted with pregnant adults.

Aim: This study was conducted to determinate the relationship between perceived social support and childbirth fear in pregnant adolescents.

Method: The study sample consisted of 100 adolescent pregnant women who applied to the obstetric clinic of a public hospital in Mersin between November 6, 2017 and April 27, 2018, who have met the inclusion criteria. The data of the study were collected using a Personal Information Form, which included questions to determine the socio-demographic and obstetric characteristics of the adolescents and applying the answers to the Multidimensional Perceived Social Support Scale and the Wijma Birth Expectancy/Experience Scale Version A. For the statistical data analysis, the SPSS 20.0 Statistics program was used. Analysis of descriptive statistics and the Pearson correlation coefficient was used to determine the relationship between the Scales.

Findings: There was a significant negative correlation between the mean scores of the Multidimensional Perceived Social Support Scale and the Wijma Birth Expectancy/Experience ScaleVersion A (p < 0.01, r = -0.345).

Conclusion: In light of the study results, it may be suggested that social support factors are important in adolescent pregnancies and that these factors should be integrated into prenatal care.

Aysu Buldum was born on January 7th, 1991. She graduated from Akdeniz University Nursing Faculty in 2013. After graduated, she started to work as an Intensive Care Nurse in Akdeniz University Hospital. When she was working, she was doing master degree in Akdeniz University Institue of Health Sciences. In 2016, she started to Mersin University Nursing Faculty as a research assistant. Also she is still educate doctorate programme in Mersin University. She has been working there since 2016. She is married and has a kid.

Is Yoga an Effective Treatment for Anxiety and Depression?

Cori Bailey

Massachusetts College of Pharmacy and Health Sciences University, USA

Objectives: The primary objective of this scholarly project was to identify if yoga is an effective intervention for the treatment of anxiety and depression.

Background: Anxiety and depression are very common mental health disorders seen in the United States and worldwide. Currently western medicine focuses on treating these illnesses with pharmacotherapy and behavioral therapy. There are questions regarding the efficacy of pharmacotherapy and whether or not it is a good long-term treatment option. Yoga is a practice that focuses on breathing and physical exercises that originated in ancient India. Yoga is used for wellness in many parts of the world and there is a recent interest in incorporating yoga as a therapy in healthcare.

Methods: An integrative review of the literature was completed. Various online databases were searched using the search terms yoga, anxiety, depression and alternative therapies. Abstracts were reviewed and studies were chosen if their purpose aligned with that of this integrative review. Both quantitative and qualitative studies were included. Data was extracted and analyzed on all of the studies included in this review.

Results: Twelve studies were selected and reviewed. The majority of the articles were quantitative studies, with one qualitative and one mixed-methods study. Overall, the studies indicated that yoga can benefit patients with anxiety and depression. Most studies showed decreased self-reporting of anxiety and depression symptoms with yoga practice.

Conclusions: Significant support exists for yoga as a treatment for anxiety and depression. However, there is a lack of standardization in yoga as a treatment for these illnesses and this requires further investigation.

Cori Bailey is a nurse from Woodstock, Connecticut. She graduated from Keene State College with her Bachelor of Science in nursing in 2015. She will graduate with her Master of Science in nursing from the Family Nurse Practitioner program in May of 2019. She has experience in medical-surgical and urgent-care nursing. She has also worked as a nurse-consultant for a childcare center. She is interested in incorporating alternative therapies into her future practice as a nurse practitioner.

Ethical Conflicts Experienced by Intensive Care Unit (ICU) Health Care Professionals in a Regional Hospital, Limpopo Province, South Africa

Ramathuba Dorah Ursula* and Hulisani Malelelo

University of Venda, South Africa

Background: Conflicts arise when healthcare providers disagrees about providing optimal care to critically ill patients where resources are constrained and services are constrained.

Purpose: The study investigated ethical conflicts experienced by ICU health care professionals working in a regional hospital, Limpopo Province of South Africa.

Methodology: The study adopted a qualitative, exploratory, descriptive design. The target population comprised of health professionals working in an intensive care unit of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch`s method of data analysis was used. Ethical considerations were adhered to.

Results: Patients care needs were compromised due to the unavailability of beds and high technology equipment, such as well-functioning ventilators. Infection control practices were overlooked and “use once” pieces of equipment were re-used. Conflicting values between nurses, patients and family of patients exist.

Conclusion: Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.

A professional nurse, nurse educator and administrator focus on integrated nursing science and management in nursing.

Into the Blue: Development and Implementation of Nursing Study Abroad Blue Zone Experiences in Sardinia, Italy and Ikaria, Greece

Jessica Naber

Murray State University, USA

Background and Objectives: Blue Zones are areas of the world where, according to studies performed by National Geographic and other experts, people live measurably longer, happier lives with lower rates of chronic disease and a higher quality of life than they do in the United States. There are five identified Blue Zones and there are nine common characteristics among these five locations, the Power 9. These common characteristics include information pertaining to diet, exercise, relationships and spirituality.

Methods: A nursing professor, along with nursing students, traveled to Sardinia, Italy in May, 2017 and Ikaria, Greece in May, 2019 to explore the culture, lifestyles and ultimately the Power 9 at work. In both locations, students visited and interviewed centenarians in their homes, visited local markets and stores, met with longevity experts, visited wineries and olive oil mills, participated in a cooking class and visited Blue Zone villages. They experienced typical celebrations, meals and social activities. The professor would like to share the experience as well as development of the program and course.

Results: The overall aim of these visits was to research the Blue Zones and draw conclusions about the Power 9 characteristics by interviewing, observing and analyzing. Students immersed themselves in the cultures and brought back information to the local university community and community as a whole. The plan is to implement Blue Zone ideals locally and potentially to implement the Blue Zone Project with the help of the Blue Zone experts.

Conclusions: Visiting the Blue Zones was extremely valuable for nursing students in bringing health promotion ideals back to the community and to patients in a variety of settings. Also, this was an important introduction to qualitative research techniques such as interviewing and qualitative analysis.

Jessica Naber, RN, PhD, has been teaching at Murray State University in Murray, Kentucky for 13 years. She graduated from Murray State in 2002 with her BSN. She then moved to Louisville where she worked at Jewish Hospital in Critical Care while she attended Bellarmine University. In 2007 she received her MSN in Education from Bellarmine. She worked in home health until she began teaching at Murray State in 2007. She graduated from University of Tennessee, Knoxville with a PhD in Nursing in 2011. She teaches Fundamentals of Nursing and clinical, as well as Philosophy of Science, Theory and Research at the doctoral level. Her research areas of interest include nursing education, critical thinking, writing in nursing courses, Blue Zones and health promotion and legal and ethical issues in nursing. She lives in Murray, Kentucky with her husband and three children, Sydney (14), Aubrey (11), and Collin (8).

Infertile womenʼs Nursing needs for Convergent Nursingcare

Jummi Park1*, Hwayeun Cho2, Eunjung Jeon3, HeawonKim4 and Nayeon Shin5

1Namseoul University, Korea
2,3CHA Fertility center Seoul station, Korea
4,5Gangnam CHA hospital, Korea

The objective of this study is to investigate the patientsʼ needs for integrated supportive service programs for the women who had infertility. The 249 participants in this study were women who had abortions in 5 infertility hospitals. Data were collected using a structure of self-report questionnaire including medical treatment and nursing after abortion, symptom recognition and sexual problems after abortion, management in daily care after abortion and supportive system after abortion. Participants had an average score 3.54 for the need of medical treatment and nursing after infertility diagnosis, 3.50 for the need of symptom recognition and sexual problems of infertility, 3.27 for the need of management in daily care after infertility and 3.28 for the need of supportive system for infertility. In order to effectively conduct integrated supportive service programs for the women who had infertility, it is necessary to understand appropriate post-infertility care for women.

Jummi Park has her expertise in evaluation and passion in improving the womanʼs health and wellbeing. Her open and contextual evaluation model based on responsive constructivists creates new pathways for improving womanʼs healthcare. She has built womanʼs health for 30 years of experience in research, evaluation, teaching and administration both in hospital and education institutions. This research was funded by 2018 Korea Research Foundation.

At Risk Patients for Weight Regain Post Bariatric Surgery: How to Prevent

Katelynne Kelley

Massachusetts College of Pharmacy and Health Sciences, USA

Obesity affects 650 million people worldwide (WHO, 2018). In the United States an estimated 228,000 patients underwent bariatric surgery (BS) in 2017 (ASMBS, 2018). Endevelt et al. (2013) reports that greater than 20 percent of patients who undergo BS will regain a large portion of the weight they lost from surgery. Excessive weight regain is defined by Cooper et al. (2015) as weight regain being greater than 25% of nadir weight. Weight regain can lead to return of an obese state with return of obesity related co-morbidities (Maleckas et al., 2016). An analysis of the literature was done to answer the question, “Are there strategies a primary care provider can use to assist patients in weight loss maintenance status post bariatric surgery?” Studies in this integrative review identify younger age and lower pre-BS BMI as having better weight loss outcomes (Aguera et al., 2015; Dilektasli et al., 2017; Marek et al., 2017; Robinson et al., 2014; Still et al., 2013). Psychiatric factors such as disordered eating behaviors affected weight loss outcomes (Brandao et al., 2015; Conceicao et al., 2014; Marek et al., 2017; Robinson et al., 2014). Himes et al. (2015) and Galle et al. (2017) showed that cognitive behavioral therapy and dialectical therapy decreased BMI in patients with weight regain and patients that had a diagnosis of borderline personality disorder. Physical activity greater than 150 minutes contributed to increased weight loss post-BS (Herring et al., 2017; Mundi et al., 2013). Endevelt et al. (2013) showed increased BMI reduction when visiting a dietician more than once post-BS. Although, more research needs to be done regarding weight regain post-BS. Primary care providers may utilize this information to assist their patients in maintaining their weight loss and assist in preventing weight regain.

Katelynne Kelley has been working as a nurse in the Emergency Department in a community hospital for the past five years. Prior to that, she had worked on a medical-surgical floor for five years. She is currently a student at Massachusetts College of Pharmacy and Health Sciences and completing her masterʼs degree in nursing to be a family nurse practitioner this Spring of 2019.

Student Evaluation of a Care Planning Conference as a Strategy to Improve Knowledge and Understanding of the Care Planning Process

Marion Hinds

Middlesex University, UK

The emergence of the nursing process within the United Kingdom (UK) began in the 1970ʼs. The concept of care planning was quickly adopted by nurse educators as a method of teaching the nursing process in theory. This adoption was much slower in practice, but eventually became the main way of documenting patient care. Recently there have been a number of challenges to this practice.

Care planning is the documentation of the nursing process. This includes a systematic and comprehensive assessment of the patient/client, identification of problems/nursing diagnosis, formulation of goals, a plan of evidence based practices to achieve the goals, implementation of the plan and finally evaluation. Today, the writing of the care plans appear to have been preserved as an educational task that some have debated has little in common to the realities of health care delivery. The formulation of a care plan, if done correctly should develop critical analysis and clinical reasoning; synthesis of nursing and medical knowledge and the application and enhancement of physical and behavioural sciences. All are core characteristics of a professional nurse.

The author and another colleague have developed a recurrent bi-annual Care Planning Conference for undergraduate student nurses in order to develop their knowledge and understanding of the care planning process. During the Conference students were exposed to a variety of scenarios and were facilitated to develop and present a nursing care plan. Students were asked to complete 2 evaluation forms both during and after the Conference. Evaluating the effectiveness of this process as an educational strategy has proved to be a positive one. Overwhelmingly, students agreed that participation at the conference had increased their understanding of care planning and that they felt more confident with using the process in clinical practice.

Marion Hinds (RN, DN, RNT, Diploma in Nursing Studies, MSc, PGCHE) is a Senior Lecturer in Adult Nursing at Middlesex University with a clinical background in Critical and High Dependency nursing practice. She is the Lead for a Year 3 Complex Needs of the Adult Patient module and also teaches on a number of other undergraduate and post graduate nursing modules. Marion is a Fellow of the Higher Education Academy. Her particular interests are in acute and complex patient care, student learning strategies and transcultural nursing practice.

Physical Restraint in Nursing Homes: Focusing on Nursesʼ Decision-Making Process

Martina Debiasi, Federica Canzan, Luigina Mortari, Elisa Ambrosi, Luisa Saiani and Anna Brugnolli

University of Verona, Italy

Background: The use of physical restraint (PR) in nursing homes is still very common in Italy. The residential care facilities are popular setting were elderly and people with cognitive impairment (dementia, Alzheimer disease and/ or people with behavioural disorders) lived. Currently, an ethical and political debate is underway regarding PR.

Aim: To explore the experience of nursesʼ decision - making about restraint or not-restraint.

Methods: Qualitative study based on a phenomenological approach; face-to-face interviews were conducted to collect data focusing on the reality of residential nurses' experience.

Settings: This study was conducted in ten nursing home in different cities in the North of Italy.

Participants: the participants were nurses working in residential care facilities. A purposive sampling of 100 nurses who worked more than 1 year in the same context.

Methods: The data were collected by using semi-structured interviews. Data were analysed by using Giorgiʼs seven-step phenomenological method.

Results: Three point of interest were identified: phenomenology based on facts (what happens, reasons for using restraint, monitoring and surveillance); mental phenomenology (feelings of family, feelings of patients, experience and feelings of nurses, judgments on restraint and conceptualizations); phenomenology of alternative actions (actionable actions, and desirable actionsgood for future policies).

Conclusion: Although the prescription of restraint is a medical act, nurses play a key role in decision-making processes regarding PR, they are primarily involved in the use of it. The decision-making process on the use of PR is a result of a complex trajectory, for ethical implications and integration with other professionals. Nurses often do not use the restraints as a first option but evaluate and activate other alternative strategies. The factors influencing the decision-making process of nurses concern the characteristics of patients, nurses themselves and context variables.

Martina Debiasiis a PhD candidate at the University of Verona. She is a nurse working in a Cardiology Department and an expert in qualitative research and in geriatric care.

Adolescents with Type 1 Diabetes and their Parent's Perceptions of Motivation, Self-Efficacy and Family Responsibility About Diabetic Self-Care And Diabetic Control

Nahla Mansour Al-Ali* and Khalid Samer Yaseen

Jordan University of Science and Technology, Jordan

Background: Type 1 Diabetes Mellitus (T1DM) is insulin dependent and lifelong chronic disease that requires a high level of care. It is the most incident and prevalent illnesses in childhood and adolescence — adolescents with T1DM encounter a significant challenge to keep healthy through adherence to diabetic self-care and diabetic control. The evidence proved that motivation, self-efficacy and family responsibility have a substantial effect on diabetes management. However, there is no such kind of studies conducted in Jordan.

Aim: This study aimed to assess perceptions of adolescents with T1DM and their parents of motivation, self-efficacy and family responsibility about diabetic self-care and diabetic control (HbA1c levels).

Methods: A cross-sectional, correlational design was used for this study. A purposive sample of 111 adolescents, aged 12–18 years and 102 parents attending the diabetes clinic at the National Center for Diabetes, Endocrinology and Genetics, completed the questionnaire. Statistical analysis, including descriptive statistics, t-test, Pearson correlation coefficient test and multiple linear regressions were used. Results: In this study, adolescents see themselves motivated, have high self-efficacy and see their parents more responsible for their health. Parents see their children motivated, have high self-efficacy and are responsible for diabetes management. Diabetic control (HbA1c) was best predicted by the adolescentsʼ perception of selfefficacy and parentsʼ perception of motivation. Diabetic self-care is best predicted by the adolescentsʼ perception of self-efficacy, adolescentsʼ gender and parentsʼ perception of responsibility. As adolescents get older, they perceived less family responsibility, less diabetic self-care and as parents get older, they perceive more responsibility about their diabetic children. Years since diagnosed with diabetes,was significantly negatively associated with adolescents self-care. There was a significant difference in fathers and mothers perceptions of adolescents confident aboutʼ self-efficacy, mothers were more likely than fathers to feel confident about their children. There was a statistically significant difference between gender of adolescents and parentsʼ perceptions of motivation; parents feel more confident about their female adolescents than males toward adherence to diabetic self-care.

Conclusion: Adolescentsʼ perceptions of self-efficacy, parentsʼ perception of motivation, parentsʼ perception of family responsibility and adolescentsʼ gender were significantly associated with diabetic control and diabetic self-care. Improving selfefficacy, sharing responsibility, family teaching about diabetes and gender-related education may improve diabetes management in adolescents with T1DM.

Nahla Al Ali is associate professor of community health nursing at Jordan University of Science and Technology, Jordan. Her Ph.D. issued from Queenʼs University Belfast in Northern Ireland, UK. She received her BS in Nursing and her MSN in Community Health Nursing from Jordan University of Science and Technology. Nahla is currently teaching advanced community courses for graduate students in the Faculty of Nursing at Jordan University of Science and Technology. She is ahead of a committee of the community health licensure exam, Jordanian Nursing Council. She is certified as A HOME CARE NURSE from Case Western Reserve University/ Frances Payne Bolton School of Nursing/Ohio /USA, certified VALIDATION WORKER (Level 1) from The Validation Training Institute/USA and CERTIFIED PROFESSIONAL TRAINER (TTT) from Lead Academy and Jordan University of Science and Technology. Her research interests are health promotion and disease prevention, NCDs, school health issues and adolescentʼs health. She has published more than 20 papers in reputed journals and one book and chapter in the book. She has been serving as an editorial board member of many reputable journals.

The Lived Experience of Women with Breast Cancer during the Surveillance Phase of Recovery: A Liminal Process to Healing and Recovery

Patricia K Amado

University of Miami, USA

Purpose: The purpose of this presentation is premised upon my hermeneutical phenomenological study on breast cancer survivors. The method of hermeneutics enables all disciplines to understand the narrative inquiry approach to research; what it is from a therapeutic lens; what uniqueness it provides in dealing with coping and making- meaning out of a chronic illness such as breast cancer and the art of story-telling as a venue for communication and a method to facilitate healing body, mind and spirit while battling a chronic illness.

Method: Through the use of narrative inquiry as a research method in nursing will introduce an innovative way to understand phenomena (illness) in order to understand the lived experiences of woman diagnosed with breast cancer and also those living in fear of the recurrence of the disease. It is important as healthcare professionals and laypersons realize the experience of what happens for women in the transition from health to facing a life- threatening disease. Narrative inquiry represents a better perspective on the story of illness that at times may be difficult to voice. A cognitive engagement of discourse in an open semi- structured format may give voice to the person within the context of their own journey through illness. With semistructured interviews, the investigator will have a set of questions on an interview schedule, but the interview will be guided by the participants rather than be dictated hence the advantages of this method is as follows:

Objectives: Differentiate how the phenomenon of breast cancer and transition can be viewed from various paradigms: for education, practice and research

Understand the phenomenon of surveillance

Provide all practitioners an innovative method to address long term survivor needs

To introduce the concept of a liminal pathway which will contribute to the development and the body of knowledge in nursing

• There is an attempt to establish rapport with the patient which allows a richer relationship to gather personal experiences of illness

• The ordering of questions is less important as in gathering information in a history and physical (less empirical approach)

• The interviewer is freer to probe interesting areas that arise.

• The interview can follow the respondentʼs interests or concerns. It is a creative method of healing as someone is faced with a chronic and sometimes terminal journey.

Results /Conclusion/Findings

Quality of life is a multi- dimensional facet of oneʼs social, spiritual and physical, emotional well- being. Breast cancer survivors face many fears, whether it is fear of recurrence loss of health and fear of dying. In order to treat each person holistically the healthcare provider needs to acknowledge alternative ways of healing for the breast cancer patient. Through introducing narrative therapy as a therapeutic way to express feelings one can make sense of this malady through the art of dialogue and may introduce new ways of learning how one builds resiliency in this specific population. It is an innovative method to help people transition to a better quality of life. A Liminal pathway through transilience, transition and acceptance with authentic reflection on illness was discovered. This has been an important tool in moving forward in life and accepting a higher quality of being.

Yoga as an Adjunct Therapy for Chronic Low Back Pain

Robert A. Shertick

Massachusetts College of Pharmacy and Health Science, USA

It is estimated that 84% of adults will have low back pain during their lifetime (Knight et al., 2018). Current treatment for chronic back pain in adults involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the first line in pharmacological therapy (Shipton, 2018). Physical therapy is the current physical intervention for the treatment of chronic low back pain (Qaseem et al., 2017; Saper et al., 2017; Shipton, 2018). There may be other alternative physical inventions patients could try to help with their chronic low back pain, including ones that could be done at home. An analysis of the literature aimed at answering the question “In the adult primary care setting, does the addition of yoga to the plan of care for chronic low back pain provide improved relief when compared to traditional non-steroidal anti-inflammatory drug (NSAID) treatments?” Kolcabaʼs Comfort theory was used as framework to help guide research and analysis for using yoga as an intervention for chronic low back pain. This integrative review assessed current literature for the use of yoga as an intervention for chronic low back pain. Studies included yoga alongside physical therapy, education and other alternative therapies for chronic low back pain. Literature also suggested other psychological benefits of using yoga as a treatment method for chronic low back pain. Yoga as an intervention for chronic low back pain has some evidence to support its use, but needs continued research before being promoted as an evidence-based intervention for the treatment of chronic low back pain.

The Effect of Motivation Program on Stroke Rehabilitation Motivation in Older Patients with Stroke

Siriluk Phomkhao*, Narirat Jitramontree and Virapun Wirojratana

Mahidol University, Thailand

This quasi-experimental two-group study aimed at studying the effect of a motivation program (MP) on stroke rehabilitation motivation in 44 older stroke patients admitted to two tertiary hospitals. The Self-Determination Theory was used as a conceptual framework. The subjects were selected by inclusion criteria, age match-paired and divided into an experimental group and a control group of 22 subjects each. The experimental group received routine care with the rehabilitation motivation program for two weeks, while the control group received only routine care. The motivation of subjects were measured before the experiment, one week and two weeks after completion of the MP. Data were collected using the Demographic Data interview form and the Stroke Rehabilitation Motivation Scale. Data were analyzed with the Mann-Whitney U Test and Repeated Measure one-way ANOVA.

The findings revealed that the rehabilitation motivation in the experimental and the control groups at Week 2 after completion of the MP was different with a statistical significance at .05. Furthermore, comparing the rehabilitation motivation in the experimental group between that of before the experiment and at Week 1, the motivation was different with a statistical significance at .05, whereas the rehabilitation motivation at Weeks 1 and 2 was not different. This MP could enhance the rehabilitation motivation among older patients with stroke. Nurses should apply the rehabilitation motivation program in caring of older stroke survivors.

Siriluk Phomkhao cared for stroke survivors in the hospital for 4 years. She expected patients can do rehabilitation and recover to their normal lives. Her project entitled “The Effect of Motivation Program on Stroke Rehabilitation Motivation in Older Patients with Stroke” was selected to get a scholarship from the Nurses' Association of Thailand. She completed a master gerontological program at the age of 28 and has been teaching for 2 years in the department of fundamental nursing, Faculty of Nursing, Mahidol University, Thailand. Her area of expertise is gerontological nursing. She serves as a consultant for a Senior Citizen Club.

The Addition of Coffee in the Treatment Regimen for MTX Intolerance Increases the MTX Compliance in RA Patients

Sadhana Singh Baghel*, Thakran R, MessiC and Yadav V

Indian Spinal Injuries Centre Super Specialty Hospital, India

Background: Methotrexate (MTX) is ‘anchor drug’ in the management of Rheumatoid Arthritis (RA). It is usually administered orally or subcutaneously in once weekly doses. MTX intolerance is common cause of non–compliance in patients so it is the cause of poor disease control. The addition of coffee for MTX intolerance increases the itscompliance.

Objectives: To assess the effect of coffee on MTX intolerance in RA.

Methods: 800 RA patients willing to participate were enrolled in this study. The patients with MTX intolerance were asked to take weekly MTX dose along with coffee as per schedule. The coffee schedule advised was as follows: 2 strong cups of coffee early in the morning on the day of the week on which the MTX was schedule. This was repeated in the late evening 1 hour before the dose of MTX. A 3rd dose of 2 cups of strong coffee was repeated the next morning this schedule was repeated every week synchronized with the weekly dose of MTX. All the patients were counseled and explain to follow the coffee schedule. All the information collected pre-designed form.

Results: 800 patients treated with the weekly dose of MTX. Among of them 385 (48.1%) patients did not have any MTX intolerance, 415 (51.87%) had MTX intolerance, 200 (48.2%) patients had minimal intolerance not requiring any intervention. The remaining 215 (51.80%) patients had moderate or severe MTX intolerance were added coffee.

Result after coffee intervention:

• 152 (70.7%) complete relief of symptoms

• 17 (7.90%) partial relief of symptoms with antiemetic.

• 14 (6.5%) minimally better but managing.

• 14 (6.5%) no relief.

• 18 (8.4%) donʼt like it.

The patient was advised to discontinue coffee unless the patient liked coffee and preferred to continue taking it.

Conclusion: By the intense and regular counseling by the specialist rheumatology nurses about coffee treatment in MTX intolerance helps the decreasing intolerance and increases its compliance in patients.

Sadhana Singh Baghel has completed her B.Sc. Nursing at the age of 26 years from Jiwaji University and Advance Rheumatology Course from American College of Rheumatology. She is working as a Senior Rheumatology Nurse Counselor at Indian Spinal Injuries Centre. She presented research papers as oral and poster in reputed national and international conferences. She has co-author in various published papers in reputed national and international journals.

Effects of Saffron and Crocin on the Human's Health: A Review Article Study

Nasrin Mehdipour* and Shahriyar Ghanbari

Shiraz university of Medical Sciences, Iran

Many nations have used saffron to cure numerous diseases for centuries. Saffron activities include anti-convulsive, anti-ischemic, anti-genotoxic, antidote, anti-Alzheimer, hypolipidemic, anti-inflammatory and antioxidant effect. Saffron also offers protective effects against cardiovascular diseases, diabetes, Parkinsonʼs disease, depression, cancer and tumor activity, atherosclerosis and other diseases.

The anticancer effects of saffron are mainly due to crocin. Escribano et al showed that crocin in comparison with crocetin, picrocrocin and safranal has more anticancer potency and is able to induce apoptosis in human cancer cells in vitro. Crocin and crocetin have significant anticancer activities in breast, lung, pancreatic and leukemic cells.

Methods: A search was carried out using Scopus, MEDLINE and Web of Science databases and local references without date restriction. The keywords for the search were: Crocus sativus, saffron, crocin, crocetin, cardiovascular, women health and immune system.

Results: Saffron displayed a dose-dependent repressive effect only against human malignant cells in in vitro colony-forming test system. All isolated carotenoid ingredients of saffron demonstrated cytotoxic activity against in vitro tumor cells.

In Iranian traditional medicine, saffron can improve complexion and can be used for the treatment of erysipelas. In Greek traditional medicine, it can refresh facial skin and is used to relieve liver from the dominance of bile and to cure acne, skin diseases and wounds. Also, it can make the body look more youthful and brighter.

Several studies indicate that saffron's constituents have been proven to be effective against a wide range of common disorders including coronary artery disease, stomach disorders, hypertension, learning and memory impairment, dysmenorrhea and premenstrual syndrome (PMS). Furthermore, saffron or its main constituents have shown remarkable activity against some neurodegenerative diseases that nowadays affect significant percentages of the general population such as Alzheimer's disease (AD), Parkinson's disease (PD) depression and schizophrenia. Saffron neutralizes gastric acid, cleanses the stomach, increases digestion of food, strengthens liver and stomach and decreases appetite.

Conclusion: Recent studied show that many of the positive effects of saffron have been established using in vitro or in vivo animal studies. The specified mechanisms of anticancer effects of saffron are not clear, but it seems that carotenoids exhibit biological activities as antioxidants, modulation of sigma-1 receptors, affect cell growth regulation, inhibition of topoisomerase II and modulate gene expression and immune response.

Further clinical research to elucidate the potential benefits or detrimental effects of saffron or crocin in humans is recommended.

Toxicity Effect of Environmental Chemicals and Pollution on Womenʼs Health: A Review Article Study

Shahriyar Ghanbari

Shiraz University, Iran

Introduction: Today, women are exposed to many Environmental chemicals or pollutants compounds over lifetime. Knowing mechanism and effect of these compounds help us to identify the higher risk of various health problems. There are a few known mechanisms for carcinogenicity of aromatic rings, aromatic amines, N-nitrosamine and halogenated compounds in quantum chemistry.

Materials and Methods: A search was carried out using Scopus, MEDLINE and Web of Science databases and local references without date restriction. In this research, quantumbiology, cancer biology and medical publications have been used. According to Polmanʼs theory, a carcinogenic compound has an active site with a high density of electrons and π-bond order. The existence of such high electron density regions increases the reactivity of molecules. In another theory, the reactivity is due to its resulting metabolite. Such products attach to the DNA. Modern food- production methods have opened exposure to environment carcinogens in women. For example, addition of nitrate and nitrite to food products, as preservatives can increase the cancer risk in two ways.

One of the initial studies published in 1999 reported a link between OCPs and breast cancer risk using a human breast cancer screening model to study toxaphene, also known as Camphechlor which was a replacement for DDT and two of its congeners. Toxaphene was used heavily as an agricultural insecticide in the US and its concentrations is abnormally high in regions of the northern hemisphere such as the Canadian Arctic and the Great Lakes.

Results: Preservative chemicals found in analysis of some breast tumors indicate high concentrations of parahydroxybenzoicacids (parabens) are used by women in many cosmetic and some food. Parabenes can mimic the hormone estrogen effect, which is known to play a role in the development of breast cancer.

New studies that targeted toxicologically relevant chemicals and captured biological hypotheses about genetic variants or windows of breast susceptibility added to evidence of links between environmental chemicals and breast cancer. However, many biologically relevant chemicals, including current-use consumer product chemicals, have not been adequately studied in humans. Studies are challenged to reconstruct exposures that occurred decades before diagnosis or access biological samples stored that long. Other problems include measuring rapidly metabolized chemicals and evaluating exposure to mixtures

Conclusion: Exposure is an important risk factor for health and can lead to increased risk of a variety of diseases. It is believed that about seventy percent of cancers have environmental origins. Here, the term environment refers to life style, diet, exposure to infection, average age of menstruation period and the age of menopause, number of children or overlay chemical and cultural environment that is much more important in the case of womenʼs health.

Registered Nursesʼ Lived Experiences of Peer-To-Peer Incivility in the Workplace

Susan Rux

Chamberlain University, USA

Incivility negatively interferes with patient care delivery, nursing retention, as well as medical costs. Disregard for anotherʼs knowledge and skills through rude and discourteous actions that prevent others from thriving is an actual depiction of an uncivil workplace. The purpose of this qualitative study was to explore registered nursesʼ lived experiences of peer-to-peer incivility in the workplace. An aim of this study was to understand the participantsʼ experiences of peer-to-peer incivility in the workplace, its effect on patient safety and nursing job satisfaction and retention. Descriptive phenomenology was used for this study on the lived experience of being a registered nurse who has encountered peer-to-peer incivility in the workplace. Participants were enrolled using a combination of purposive and snowball sampling. Semi- structured interviews were audiotaped and conducted with participants who had experience with peer-to-peer incivility in the workplace. Data were collected until saturation was achieved. The audiotapes were transcribed and analyzed for common themes that represented the participantsʼ experiences with peer-to-peer incivility. Based on the findings of this study, suggestions are offered for further research and required actions to elevate the work atmosphere of the nurse from uncivil to a healthy and professional workplace.

Dr. Susan Rux is an award winning nurse educator and administrator with greater than 20 years of diverse nursing experience. Dr. Ruxʼs work on promoting civility in the nursing workplace has brought international attention to the divisive concerns of peer-to-peer incivility in academic and work environments. Her thoughtful assessments offer best practice strategies, to craft healthy workplaces by preventing and addressing uncivil behavior.
Currently, Dr. Rux is the Chief Academic Officer and Dean of Academic Affairs with Chamberlain University – North Brunswick, New Jersey campus. Additionally, she serves as the Founder and CEO of SR Strategic Solutions. Previous professional roles have included: Chief Nursing Officer – Consultant/Strategic Advisor, Program Director of Nursing, Associate Professor and Nursing Education Consultant.
Dr. Rux was elected as the Vice President of Communications for the New Jersey State Nurses Association (NJSNA), Region 4 and Secretary of the Forum of Nurses in Advanced Practice. She has served as a member of the task force for the American Nurses Association Professional Panel for Incivility, Bullying and Workplace Violence. She holds numerous professional memberships and certifications spanning the administrative, education and practice fields of nursing.

Salivary Cortisol, Subjective Stress and Quality of Sleep among Female Healthcare Professionals

Wegdan Bani-Issa*, HadiaRadwan, Farah Al Marzooq, Shamsa Al Awar, Arwa M Al-Shujairi and Ab Rani Samsudin

University of Sharjah, UAE

Stress in the workplace is globally recognized as a risk factor impacting workersʼ health and workplace safety. Women healthcare professionals are at risk for considerable stress given the demanding nature of their jobs and working conditions in hospitals. This study assesses levels of stress among the female healthcare professional workforce according to measures of their cortisol levels, subjective stress and quality of sleep.

Methods: Using a cross-sectional research design, data on stress was collected from 335 apparently healthy adult women healthcare professionals. Eligible women were asked to provide morning and bedtime saliva samples for analysis of their cortisol levels. Perceived Stress Scale, Stress Symptoms Scale, Brief Coping Scale and Pittsburgh Sleep Quality Index were used to assess perceived stress level, symptoms of stress, strategies for coping with stress and sleep quality consecutively.

Results: One third of the women evaluated had below-average morning cortisol levels. Around 57% of women reported moderate levels of perceived stress, with more frequent reporting of symptoms of stress related to vital signs, including heart rate, rapid breathing and back and/or neck pain symptoms. Poor sleep quality was reported by around 60% of study participants. Religion, spiritual beliefs, prayer and meditation were reported to be sources of comfort and relief from symptoms of stress. Participantsʼ physical activity was found to be a predictor of levels of both morning and bedtime cortisol levels.

Conclusion: Evaluating cortisol levels and subjective perceptions of stress could help to identify groups with impaired response to stress and elevated morning cortisol levels. These findings can serve to encourage decision makers to assess and seek to reduce workplace stress among women healthcare professionals to promote their health and productivity and maintain workplace safety.

Wegdan Bani-issa is a PhD prepared nurse faculty. Dr. Wegdan finished her Masters in nursing from the University of Windsor/Ontario Canada and her PhD studies from the University of Kansas Medical Center, USA. Her main specialization is in diabetes care and management as well as nursing education. She is currently working as an associate professor at the University of Sharjah and conducted several research in the area of diabetes. Additionally, she is interested in using electronic health records and womenʼs health.

Student Nursesʼ Intercultural Communication Experiences in Clinical Practice

Joy Shao

Northumbria University, UK

The Black and Minority Ethnic (BME) population has increased significantly over the last three decades (Office of National Statistics, 2011). Many of these people may require healthcare that is responsive and sensitive to their diverse cultural needs and religious beliefs. However, many research reported that intercultural practice in healthcare services is inadequate, with likely negative consequences for the health and wellbeing of patients from BME backgrounds. There has been a significant increase in BME communities in the UK and pre-registration nursing education has moved to an all-degree model, with the aim of underpinning the level of practice needed for the future. In light of this change, a qualitative study was carried out to find out whether current British nursing students feel better prepared for their intercultural care encounters.

Research Questions

To achieve this, the following research question and sub-questions were raised:

In practice, how do student nurses communicate with people who they perceive as having a cultural background different to their own?

• What challenges do they encounter?

• How do they manage these challenges?

• How effective were their management strategies?

Research Approach

A qualitative research approach was chosen to explore the rich experience of intercultural encounters from the perspective of student nurses. Following ethical approval, 43 pre-registration nursing students took part in one-to-one semi-structured interviews. Thematic analysis was used to analyse the data generated from these interviews.

Key Findings

When a shared language was missing, student nurses had concerns about the quality of care they delivered. White British students experienced more frustrations than those from BME backgrounds.

• Even though the student nurses valued the importance of accessing accredited interpreter services, they found that qualified nurses were less keen to use interpreters

• The relatives of patients were common facilitators of communication with non-English-speaking patients. However, concerns were raised about using family members as interpreters on the grounds that they lacked clinical knowledge, comprised patientʼs confidentiality and had difficulties in their availability.

• Bilingual health professionals were praised for their temporary resolutions for patients when accredited interpreters or family interpreters were not available.

• Student nurses from BME backgrounds perceived that they were viewed negatively by colleagues in their placements and this made BME students feel under-valued, doubted and emotionally hurt. Some even considered leaving the course.

1) University academics

• To include more cultural related information and discussion in the pre-registration nursing curriculum.

• To invite former patients and staff from BME backgrounds to talk about their intercultural care experience in clinical practice.

• To facilitate nursing students to share experiences of intercultural encounters during placement.

• To encourage students from BME backgrounds to inform and discuss unfair treatment with their mentors and academic staff.

• To investigate, liaise and take action with placement managers when BME student nurses encounter discrimination and racism on placement.

2) Service providers

• To provide further training to develop staff awareness, sensitivity and competence in intercultural care and unconscious bias.

• To address the importance of accredited interpreters and encourage the use of a variety of interpreting facilities to assist intercultural communication.

• To provide effective audio / visual materials and apps for staff and students caring for patients who require linguistic support.

• To raise awareness of the vulnerability of student nurses from BME backgrounds and promote the sensitive working environment.

After providing a variety of critical care services in China and the UK for a number of years, Joy Shao became a Senior Lecturer at Northumbria in 2007. In this role, she teaches, assesses and facilitates studentsʼ learning, helping pre-registration nursing and operating department practitioner (ODP) students work towards their professional registration. In addition, she teaches on the franchised overseas nursing programme, providing teaching and support for staff and students, as well as programme development. Joy is also a Programme Leader for campus-based international nursing programmes, including MSc Nursing, MSc Nursing Leadership and BSc (Hons) Nursing Science and Dissertation module lead for these programmes. Her clinical and educational background and expertise inspired her to research on student nursesʼ perception and experience on the transcultural aspect of nursing care. The research findings are useful to further develop nursing curricular and clinical service provision and consequently increase patient safety and satisfaction.

Putting Nursing Students at the HeLM of Health Literacy: Effect of a Health Literacy Module (HeLM) on the Health Literacy Knowledge, Skills and Attitudes of Nursing Students

Joy Borrero

The Graduate Center, City University of New York, USA

Background: Effective communication is a foundation of high-quality, patient-centered health care. Understanding health literacy is an essential attribute that health care professionals need to possess in order to promote effective partnerships with patients and their significant others. Nurses, especially, need to be involved in addressing the epidemic problem of low health literacy in the United States because they are responsible for the majority of patient, caregiver and community health education and communication. Nurses play a key role in providing health care information to individuals, families and groups in a variety of settings and therefore should be educated about the essentials of health literacy, its prevalence in society and its relationship to health outcomes. There are currently no standards for including health literacy training in the undergraduate nursing curriculum. Few studies have been conducted to assess nursing studentsʼ knowledge, practice and attitudes or perceptions of health literacy which are also components of the Quality Safe Education for Nurses (QSEN) initiative (QSEN, 2014).

Purpose: The purpose of this study was to evaluate the effectiveness of the Borrero Health Literacy Module (HeLM) on health literacy knowledge, skills and attitudes of nursing students using a pretest and posttest.

Method: Pre-licensure baccalaureate nursing students (n = 180) were invited to participate in this quasi-experimental study, which consisted of a 2 hour classroom session. Students completed the health literacy questionnaire: The Health Literacy Knowledge and Experience Survey (HL-KES) as both a pretest and a post test. The classroom session included the components of the HeLM which was designed by the researcher and validated by two experts in the field of higher education and health literacy.

Findings: The results of the HL-KES pretest and post-test analyses showed statistical significant differences in the average literacy score change of +4.97, the 5-unit difference is statistically significant (p < .001) at the .1 level of significance. The questions of the HL-KES were grouped according to five content areas and the statistical analysis of the pre-test and posttest scores resulted in statistically significant differences in each content area. Statistical analysis supports that the Borrero HeLM made a statistically significant difference in the health literacy knowledge, skills and attitudes of nursing students who participated in this study.

Effect of Continuous Care in Patients with Inflammatory Bowel Disease: A Systematic Review

Gu Zijun*, Lin Zheng, Shang Xingchen, Gu Fangchen and Zhou Meijing

Nanjing Medical University, China

Objective: To evaluate the effect of continuous care in patients with inflammatory bowel disease.

Methods: The related literature were retrieved from PUBMED, CINNAL, Web of Science. The Cochrane Library EMBASE, VIP, Wan Fang Data and CNKI databases by computer from the establishment of the library until March 2019 and two evaluators independently screened literature, extracted data according to inclusion and exclusion criteria and evaluated the risk of bias in the included literature and cross-checked. RevMan5.3 software was used for statistical analysis.

Result: 12 literatures including 1921 patients were included, 983 patients in intervention group and 938 patients in control group. Two literatures were evaluated as A grade and the others were rated as B grade. Different dimensions can be improved in patients with inflammatory bowel disease through continuous care. The patientsʼ vitality [MD = 3.38, 95% CI (2.70, 4.06), P < 0.00001], role-physical [MD = 1.26, 95% CI (0.72, 1.79), P < 0.0001], social functioning [MD = 2.35, 95% CI (1.94, 2.77), P < 0.0001], role-emotional [MD = 1.14, 95% CI (0.57, 1.70), P < 0.0001] and mental health [MD = 4.56, 95% CI (3.18, 5.95), P < 0.0001] can also be improved by the continuous care in SF36 scale. The evaluation result of IBDQ scores showed that the overall quality of life of the intervention group was better than that of the control group [SMD = 0.39, 95% CI (0.08, 0.69), P = 0.01]. However, the subgroup analysis of the results indicated that nationality had affected the effect of continuous care.

Conclusion: Continuous care education can significantly improve the quality of life of patients with inflammatory bowel disease in different aspects and telemedicine has been applicated and developed in the continuous care of the IBD patients. In addition, it can also improve patients' satisfaction with clinical care. Nonetheless, the contrary results due to nationality need more high-quality studies to further verify the effect of continuous care education on patients with inflammatory bowel disease.

Gu zijun, currently studying in the department of gastroenterology, school of nursing, Nanjing Medical University, China. Her major research direction is inflammatory bowel disease. She has great interest in the psychological status and family care of patients with inflammatory bowel disease and actively engaged in these studies. At the same time, She is also a very positive and sunny girl, like travel and food.

Health Benefits of Mindfulness - Based Interventions for Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Meijing Zhou

Nanjing Medical University, China

Introduction: Given that there is no cure for inflammatory bowel disease (IBD), psychosocial interventions have been recommended as an important component of complementary alternative therapies. Mindfulness-based interventions, a burgeoning psychological interventions are increasingly used to reduce stress, alleviate psychological concerns and improve overall well-being in patients with other chronic disease. However, there is a lack of consensus regarding the effectiveness of mindfulness-based interventions in patients with IBD.

Objectives: We collected data to explore the efficacy of mindfulness-based interventions compared to treatment as usual in treating psychosocial symptoms associated with IBD.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials. We included interventions focused on mindfulness-based stress reduction, mindfulness-based cognitive therapy, dialectical behavior therapy and acceptance and commitment therapy with no restrictions on participants' age and disease severity. We searched the following electronic databases: MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, China Biology Medicine, Chinese National Knowledge infrastructure, Wan Fang Data. The review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: We included six studies in the meta-analysis, with 400 patients. Mindfulness-based interventions showed significant effects on depression in both the short (SMD = -0.71; 95% CI: -1.20, -0.22; P = 0.004) and long term (SMD = -0.53; 95% CI: -0.97, -0.10; P = 0.02), short term effects on anxiety (SMD = -0.58; 95% CI: -1.03, -0.14; P = 0.01), but notstatistically significant improvements in QOL (SMD = 0.18; 95% CI: -0.26, 0.61; P = 0.42) and not statistically significant effects on stress in both the short (SMD = -1.26; 95% CI: -2.99, 0.48; P = 0.15) and long term (SMD = -0.82; 95% CI: -1.70, 0.06; P = 0.07).

Conclusions: Mindfulness-based interventions are effective in alleviate depression and anxiety, but do not show an advantage in improving quality of life and reducing stress among patients with IBD. Further additional rigorously designed randomized controlled trials with larger sample size are urgently warranted to verify this conclusion.

Status and Hot Spots of Positive Psychology: A Bibliometric Analysis

Sun Caiyun1*, Lin Zheng1,2, Gu Fangchen1, Zhou Meijing1 and Gu Zijun1

1Nanjing Medical University, China
2Jiangsu Province Hospital, China

Objective: To represent the research status of positive psychology and analyze the hot spots and to provide references for clinical work and future research in this field.

Methods: Literatures related to positive psychology were retrieved in Web of Science Core Collection database from 2000 to 2019. We make a bibliometric analysis about the annual publication number, distribution of countries, funding agencies, journals of publication and research areas. Cite Space visualization software and HistCite software were used to facilitate the analysis of research hot spots and high cited references, respectively.

Results: A total of 4536 pieces of literature relevant with positive psychology were collected. The volume of published documents showed an increasing trend year by year. America had most articles which number is 1793 while China had 241 articles, ranking 6. The funding agencies and journals of publication were diverse, most of which belonged to America. The research areas mainly consisted of Psychology, accounting for 52.491%, while Nursing ranked 10, accounting for 1.984%. Top 5 strongest burst keywords were mindfulness, psychosis, association, predictor and randomized controlled trial. The highest 10 cited references mainly focused on the research of relationship between positive psychology and happiness and positive psychological intervention methods.

Conclusions: Positive psychology is at the stage of growing and developing. Core journals have not emerged yet. America is in the leading position in this field. The quantity of literature in China is small and still has a larger upside. The research hot spots include mindfulness intervention, associated therapy and design of randomized controlled trial. In future, research workers could expand and enhance positive psychology in clinical application and study for further exploration of effective intervention program.

Sun Caiyun graduated from Nanjing Medical University in June 2019. And now she is a professional master graduate student, major in Nursing at the same college. During her undergraduate period, she has achieved fist-level scholarship three times and national scholarship once. She is willing to do voluntary work to help others. As a result, she was honored as outstanding volunteer. Her internship was completed in Shanghai Tenth People Hospital from April 2018 to April 2019. She is interested in research abou tinflammatory bowel disease, which is also my teacherʼs specialism.

Early Recognition of Depression in Children

Rosemarie Zorola

Massachusetts College of Pharmacy and Health Science, USA

Background and Purpose: Early diagnosis of depression in children, ages seven to 11 years old, can be challenging as some early symptoms may be confused with normal cognitive, emotional and physical manifestations of children at various developmental stages. The purpose of this project is to conduct an integrative review of primary research relevant to childhood depression and synthesize the findings with the goal of determining what is currently understood about early symptoms of depression in children ages seven to 11 years old.

Methodology: A comprehensive review of the literature was conducted to answer the research question, “How does the primary care provider identify depression in children ages seven to 11 years old?” The framework of this paper is based on Dorothy Johnsonʼs Behavioral System Model as these theoretical assumptions are compatible with a medical, as well as nursing, perspective.

Results: The studies in this integrative review have identified anxiety and somatic symptoms such as headaches and abdominal symptoms as potential early signs of depression in young children. The studies also yielded environmental factors that are associated with childhood depression such as parental depression and peer relationship.

Conclusion: With the information gather from this integrative review, advance practice nurses will be more aware about the issue on depression in children ages seven to 11 years old and the importance of early identification. This review provided information on the early identification of possible markers of depression with the hopes that this information will help advance practice nurses in the management of childhood depression and prevent the disorder from progressing to a depressive disorder.

Rosemarie has completed her Bachelors of Science in Nursing at the age of 21 years from Silliman University and is now finishing her Masters in Nursing. She is specializing in Family Nurse Practice. She is currently working as an oncology nurse at the University of Massachusetts Medical Center.

Gut Feelings: The Impact of Probiotics on Mental Health Outcomes

Julia Mackler

Massachusetts College of Pharmacy and Health Sciences, USA

Past studies on anxiety and depression have focused on genetic, neurological, behavioral and environmental aspects of these diseases (Jiang et al., 2015). Newest research on this topic has shifted towards the impact of the bodyʼs own gut microbiome, emphasizing the profound effects that the gut may have on mood and behavior (Foster, Rinaman, Cryan, 2017). The concept of gut-brain communication and interrelationship can be used as a new paradigm to study mental health disorders. An analysis of the literature was completed to answer the question, “What is the effect of probiotic use on mental health outcomes for the adult population in a primary care setting?” Martha Rogerʼs 1990 Science of Unitary Human Beings was used as a framework to conceptualize mental health disorders as disequilibrium of energy and the importance of treating the patient in a holistic manner (Papathanasiou, Sklavou & Kourkouta, 2013). Studies in this systematic literature review implemented several methods to investigate the bidirectional communication and relationship between the brain and gut microbiome. Measures of anxiety, depression, fecal microbiota, cortisol and other signaling molecules were investigated. Synthesis of the literature demonstrated that probiotic supplementation overall improved mental health outcomes. Considering the multitude of different probiotic strains, study lengths and measurement tools utilized, specific probiotics cannot be recommended for treatment of anxiety and depression at this time. This literature review supports and encourages further research into the use of probiotics for treatment of mental health disorders.

Julie graduated from the University of Maryland with a BS in Psychology and a minor in Spanish. She Jumped right into nursing school at Georgetown in an accelerated BSN track and started her career at MedStar Washington Hospital Center in the Surgical Oncology department. After 3 years, she moved to Labor and Delivery, where she loves the excitement, teamwork and challenging cases as she works towards becoming a Family Nurse Practitioner. She is an active member of a collaborative, interdisciplinary health care team at Washington Hospital Center.

Barriers to Accessing Primary Care for Developmentally Disabled Compared to Non-Developmentally Disabled Adults

Jessica Dias

Massachusetts College of Pharmacy and Health Sciences, USA

Developmentally disabled (DD) patients often have problems with accessing primary care services when compared to adults without developmental disabilities. Penchansky and Thomasʼ (1981) Theory of Access was used as the framework in this review to describe how the requirements in healthcare and how these directions play a pivotal role to accessing primary care. After researching the literature related to DD patientsʼ access to primary care, this paper will highlight their impediments to receiving primary care services in comparison to non-developmentally disabled patients. Studies in this review have identified key components as poor communication, lack of training and anxiety and mistrust of the patient. The future of primary care is focused on improving the relationship between patients and general practitioners (GPs) to improve patient outcomes; therefore, it is important to address the challenges facing DD patients.

Jessica Dias completed her LPN in 2002, and her Associateʼs in Nursing in 2014 from Quincy College and a Bachelorʼs inthe Science of Nursing in 2016 from Southern New Hampshire University. She will complete her Masterʼs in 2019 in Nursing specializing in the Family Nurse Practitioner track. She specializes in Developmental Disabilities working with this vulnerable population for over 17 years it has been her mission to improve the quality care they receive. This is especially personal with her own son struggling to receive quality care with a diagnosis of Autism and DD.

Rehabilitation for a Case with High-level Spinal Cord Injury and Multiple Trauma Yu-Ling Lai Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan

Purpose: Road traffic accidents may lead to devastating injuries and high-level spinal cord injury (SCI) induces paralysis of the breathing muscles, predisposing to ineffective cardiopulmonary function. Concurrent trauma to the extremities also causes further functional disability. A case of spine injury and long-bone fractures was reported.

Method: This was a 30-year-old victim of motor vehicle accident in which C3-4 vertebral fracture with spinal cord injury developed, in addition to bilateral femur shaft fracture, right tibia shaft fracture and right distal radius fracture. The patient underwent decompression and fusion, along with open reduction and internal fixation for bilateral femur fracture, right tibia shaft fracture and right distal radius fracture. Tracheostomy was performed due to mechanical ventilation dependence and respiratory training was commenced at the intensive care unit. Aggressive chest care was provided and pain control was achieved with medication and relaxation technique. Gradual active joint movement and muscle strengthening were started 6 weeks after surgery.

Results: Crackled breathing sound, nasal flaring and moderate amount of sputum with 93-95% oxygen saturation was found initially. After 2.5 months of rehabilitation, the respiratory rate improved from 22-30 to 14-22 times/minute. Successful weaning was achieved 1 month later and tracheostomy decannulation was performed 2 months later. The patient finally developed symmetrical breathing pattern despite of compromised vital capacity. Pain during movement reduced from 8 to 3 out of 10. He could transfer to wheelchair by himself and practice walking with a gait trainer. He was discharged home after 3 months of hospitalization.

Conclusion: For patients with spinal cord injury and multiple long bone fracture, early rehabilitation is mandatory to minimize complications, shorten the duration of ventilator support and improve mobility. Comprehensive evaluation and management ensures maintenance of function for those suffer from polytrauma.

Yu-Ling Lai graduated from Medical College of Central Taiwan University of Science and Technology in 2003 and has received full clinical nursing practice training at Taipei Tzu Chi Hospital. She has continued pursuing her master degree at the Institute of Nursing, Taipei Medical University since 2016 and is currently working at Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation as the head nurse of nursing department, as well as the nursing clinical practice teacher.