Program Schedule

Keynote Speaker

Maria van Pelt
Northeastern University Bouvé College of Health Sciences, USA
Title: Nurses at the Sharp End of Care: Lessons Learned on How to Provide a Safe Working Environment

Biography: Dr. van Pelt’s research interest is the aftermath of perioperative catastrophes and the impact on patient safety and provider wellness. She has been lecturing extensively and has been recognized nationally in the United States of America for her work within this research domain for the past decade. She is a 2012 American Association of Nurse Anesthetists (AANA) Foundation Doctoral Fellow and a 2014 American Hospital Association / National Patient Safety Foundation Patient Safety/Leadership Fellow who co-developed and implemented the Massachusetts General Hospital Department of Anesthesia Clinician Peer Support Program.

Abstract: Goverment, accreditation agencies and professional organizations have established patient safety as a national priority. Standards have been promulgated and regulations enacted to ensure that healthcare administrators and clinicians take appropriate actions to promote safe patient care practices and prevent adverse events. Moreover, systematic analyses of root causes associated with adverse events are recommended to ensure that healthcare system leaders and clinicians learn from actual mishap events and near-misses to reduce risks of further untoward events. While systems and human-focused prevention strategies are critical to proactive risk reduction of adverse events and errors, patient safety initiatives are only now beginning to address the emotional consequences and the impact on clinicians involved in unanticipated adverse events or errors. Adverse events not only affect patients and the healthcare system, but also have negative consequences on the healthcare providers involved in such events. This lecture will increase awareness and knowledge surrounding the impact of the aftermath of adverse events on health care provides and provide best practices related to providing a safe environment for nurses at the sharp end of care.

Keynote Speaker

María de los Ángeles Ordóñez
Florida Atlantic University, USA
Title: Interprofessional Practice and Education at an Academic Nurse-led Memory Disorder Clinic

Biography: Dr. Ordóñez is a doctoral prepared Gerontological and Psychiatric Mental Health Nurse Practitioner, and a Fellow of the American Academy of Nursing. She is an Associate Professor at Florida Atlantic University’s College of Nursing, engaged in administration, clinical practice, teaching, research, health policy, and community service. Dr. Ordóñez is the Director of the Louis and Anne Green Memory and Wellness Center, a nurse-led, State-designated Memory Disorder Clinic (MDC) under the State of Florida's Alzheimer's Disease Initiative providing services to over 10,000 individuals and their families/caregivers each year. Her practice encompasses skilled nursing, post-acute, long-term care, MDCs, and diverse community settings. She has presented locally, nationally, regionally, and internationally.

Abstract: Introduction:Third year Medical students were invited to join the interprofessional team of the Louis and Anne Green Memory and Wellness Center (MWC) of the Christine E. Lynn College of Nursing at Florida Atlantic University in developing an innovative curriculumusing the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)framework.During their immersion, the students learned about the team approach to addressing complex needs of vulnerable patients and families living with cognitive impairment that is developed, practiced, and researched at the MWC. The students played an active role in co-creating this interprofessional team practice experience and providedquantitative feedback through pre and post-training surveys using the Readiness for Interprofessional Learning Scale (A. K. McFadyen et al., 2005), as well asqualitative feedback verbally during their visits, and in short essays after completing the experience. Steps in project/Methods:An online module reviewing the TeamSTEPPS-framework and introducing the project was provided to the students prior to starting the program. The students spent two half-days participating in interprofessional clinical activities coordinated throughout the MWC. During the first visit at the MWC, the project coordinator reviewed the core competencies from the Interprofessional Collaborative Practice Competencies evidence-based TeamSTEPPS training and provided an orientation to the site. The students then joined the Center’s staff and students from other disciplines in this elective community-based rotation to participate in the care-team modelwith Advance Practice Registered Nurses (Geriatrics, Family, and Psychiatric Mental Health), Registered Nurses, Nursing Students (Graduate and Undergraduate), Social Workers and Interns, Clinical Psychologists and Interns, Health Administration Professionals and Students, Speech Pathologists, Language Arts Students, Occupational Therapists, Physical Therapists, and others. Students engaged in the team activities,providing team-based care to medically complex patients living with cognitive impairment. The activities included: huddles, debriefs, interprofessional care coordination conferences, caregiver support groups, facilitating communication, developing plans of care, home visits, and providing educational interventions. Results: Eleventhirdyear medical students participated in the program in its first year and all reported increased knowledge and appreciation toward interprofessional team-based healthcare delivery models. They also acknowledged that to best meet the complex needs of the patients and families living with cognitive impairment and to ensure safety of all giving and receiving care, they would have to actively work with the others members of the care team to identify any potential barriers and hazards such as fatigue or complacency. Discussion: The students were encouraged to keep an open mind to learn from the MWC team, including clinicians, other learners, as well as patients and families they cared for. They learned that key to a successful experience and future practice were seamless and honest communication, flexibility to work in ever-changing healthcare environments with professionals from various disciplines, and taking initiative to be active learners.

Keynote Speaker

Linda Wauben
Rotterdam University of Applied Sciences Rochussenstraat, The Netherlands
Title: Design4Care

Biography: Linda Wauben, PhD, MSc is a professor Technical Innovations in Healthcare at Research Centre Innovations in Care at Rotterdam University of Applied Sciences (the Netherlands). Besides her work at the Rotterdam University she is also a researcher at Delft University of Technology. In all her work, she focusses on studying health challenges and problems by means of applied research, designing innovative solutions together work health workers, patients, family and client (by means of user-centred co-design) and actually producing and implementing these innovative solutions. The aim is to make lives healthier and happier.

Abstract: We are a research group from Rotterdam University of Applied Sciences and Erasmus Medical Center. We perform applied research in the field of healthcare and technology. Three years ago, we developed the Design4Care program to help solve practical problems e.g. nurses encounter during their work. In co-creation with students from different educational backgrounds (e.g. nursing, occupational therapy, physiotherapy, speech therapy, industrial product design, electrical engineering, healthcare technology, creative media technology and ICT) nurses, care assistants and doctors are challenged to find technical solutions for their problem. These solutions will then be tested in practice, and some of these solutions are even commercialized. During the conference, we will show our approach: how we study, design and implement our solutions. We only show and demonstrate the (conceptual) solutions as well as the solutions which are already used in Erasmus Medical Center.

Integrating Nursing Education

Session Introduction

Paula Foran
Education Officer – Australian College of Operating Room Nurses, Australia
Title: The value of guided operating room experience for surgical ward nurses


Abstract: Purpose of the research Since the removal of perioperative nursing from the core undergraduate curriculum questions have been raised regarding the acquisition of surgical knowledge to support best patient care outcomes. This national research project investigated this issue in Australia. Method Methodology for this doctoral research was a fixed mixed methods paradigm incorporating a triangulated/convergent parallel design. Qualitative data was collected from across Australia investigating undergraduate nursing students’ comment about their time in the operating suite or lack thereof; transferable skills learned in the OR that may assist them in surgical nursing, and their attitudes towards possible future employment in the operating suite. Quantitative data was collected concurrently from students who participated in differing models of OR education. Knowledge testing was undertaken on areas surrounding pre and post-operative surgical ward nursing. Participants’ results were compared to the model of OR education students’ had participated in to determine if there was a correlation between their OR education and students’ knowledge of surgical ward nursing. Findings Findings revealed undergraduates nurses receiving guided operating theatre experience had a 76%pass rate on surgical nursing questions compared to 56% with non-guided or no experience (p < 0.001)(1). Graduate nurses were re-tested after their first year of nursing to see if their undergraduate deficits had been rectified. Graduate nurses with guidedoperating theatre experience as undergraduates or graduate nurses achieved a 100% pass rate comparedto 53% with non-guided or no experience (p < 0.001)(1).The research informs us that undergraduate nurses achieve greater learning about surgical wardnursing via guided operating room experience as opposed to surgical ward nursing experience alone. Implications These results support the belief that OR experience supports greater knowledge of surgical nursing care. Transferable skills learned via OR experience included pain management, patient education, pre and post-operative care and asepsis(2). Recruitment of nurses can be fostered during guided experience and retention of current staff increased. 1. Foran P. Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis. Nurse Education in Practice, 2016;16(1):217-24. 2. Foran P. Effects of Guided Undergraduate Perioperative Education on Recruiting Novice RN's and Retaining Experienced RN's. AORN Journal, 2015;102(3):254-61.

Amanda i Bulette Coakley
Massachusetts General hospital, USA
Title: Pet Therapy program at MGH


Abstract: At Massachusetts, General Hospital (MGH), the pet therapy program is a collaborative program between the Volunteer Department and the Department of Nursing and has been in place for fourteen years. During that time, there have been over 82,284 recorded visits with patients and countless visits with visitors and staff. The benefits of pet therapy visits with hospitalized patients include reported improved levels of pain and energy and visitors and staff reports of feeling more calm, relaxed engaged and “cheered up” (Coakley & Mahoney, 2009). In an initial pilot evaluation, after implementation of the Pet Therapy program at MGH, Coakley & Somerville, (1993) reported that patients on general care units reported feeling happy, comforted, satisfied, relaxed, attached, and peaceful after a dog visit. One dog handler noted that “patients started to smile as soon as I enter the hospital with a dog” (Evans, personal communication, 2003). Purpose:Although there is research to supportpet therapy, there continues to be a gap in the research on formal pet therapy programs and the effect pet visits have on patients, staff and pet handlers. Method: This study employed a descriptive non-experimental design and a convenience sample to: 1. Quantitatively explore through a pre-post design the effect of the pet therapy visit on patients as measured by blood pressure, pulse, completion of the Spielberger State anxiety index, visual analog scales for level of comfort, well- being and salivary cortisol levels. 2. Explore using an inductive qualitative content design, the experience pet therapy visits have on the staff and dog handlers. To meet the aims of question one, the sample included patients on four inpatient surgical units. Measures included: vital signs, visual analog scale (VAS) of comfort and well-being, the Spielberger state anxiety and salivary cortisol levels pre and post a pet therapy visit. To meet the aims of question two, focus groups were conducted. The sample included 4 focus groups of 8-10 nurses each and 2 focus groups with 6 pet handlers at each meeting. Results/Findings: Quantitative: significant reduction in pulse, blood pressure and respiratory rate p<.05, improved levels of comfort and wellbeing p<.000, improved levels of anxiety p<.000, non-significant results-salivary cortisol p=.769. Qualitative: Three themes were identified: (1) Pet therapy visits promoted relaxation, comfort and decreased stress for nurses, (2) Handlers report satisfaction knowing their pet visits provided patients with a connection to the outside world, reduced stress and enhanced comfort, (3) Nurses and handlers identified the pet therapy program as catalyst to promoting a healing environment for patients and staff. Discussion/conclusion: A pet therapy program in the hospital setting promotes positive feeling in nurses and handlers and patients. This contributes to a healing environment for patients and staff alike.

Dayna L.Herrera
California Baptist University, USA
Title: Education Strategies for Health Promotion on the Global Level

Biography: Dr. Dayna Herrera has been employed as a full-time tenure-track faculty member at California Baptist University, College of Nursing for nearly 10 years. She has been in nursing education for 12 years. Dayna has been a registered nurse for over 29 years with a primary focus in areas of pediatrics, oncology, informatics, simulation, and leadership. Dr. Herrera structured her doctoral project to the direct benefit of patients outcomes; she focused her efforts toward the effective provision of interprofessional education (IPE), envisioning and formulation; Called2Collaborate. Called2Collaborate faculty champions engage, educate and mentor faculty to integrate interprofessional curricula, learning experiences and learning assessments across health-related disciplines at California Baptist University and in the community. She has been instrumental to through professional presentations in showcasing the university and healthcare at the national level as a nursing leader in IPE and simulation. Dayna demonstrates global service by leading interprofessional healthcare teams to South Asia, Africa, and the UK.
Rebecca L. Meyer PICU/CVICU nurse for over 20 years, been a nurse for over 30 years. Member of ECMO Team, Transport Team, IRB Committee, Preceptor, Charge Nurse, and Manager. Master’s education and Doctoral work focused on End-of-life care. Became full-time faculty in 2010, accepted MSN Program Director position in 2011. Wrote FNP curriculum, co-authored curriculum revisions in the MSN Program co-authored the DNP Program. Teach in all 5 nursing programs in a variety of courses. Train with/lead teams of students for 3-week international service projects. Participate/volunteer in professional boards and community activities.
Dr. Lisa Bursch has been a nurse for 25 years and a pediatric nurse practitioner for 20 years. She finished her BSN at University of Texas Health and Science Center in Houston, her MSN as a pediatric nurse practitioner at California State University Long Beach, and her DNP at Rush University Chicago in Systems Leadership. Dr. Bursch’ s doctoral project focused on access to health care for the vulnerable population in Riverside County and partnered with Riverside Life Services to develop a nurse-managed health clinic to help increase access to after-hours primary care. Dr. Bursch is also Board Chair for Health to Hope clinic and has experience in working in mobile health clinics and parish nursing. During the last 3 years, Dr. Bursch has collaborated with nursing, behavioral science, dietitian, and athletic training faculty to develop IPE scenarios.

Abstract: Purpose Cultural and ethnic diversity around the globe generates a challenge fornurses providing culturally competent (CC) care. Nurse educators play a significant role in assisting nurses to meet cultural competencies, which includes concepts such as cultural awareness and cultural sensitivity. Nurse educators can provide culturally relevant and specific patient scenarios, which are customized to fit the patient's own cultural values, beliefs, traditions, practices, and lifestyles. Literature According to the literature, evidence based strategies for health promotion are key in nursing education. Transcultural nursing education is important to achieve a holistic, caring, and compassionate perspective in nursing care. Transcultural nursing refers to the actions and decisions nurses make in their care in order to promote health for all patients. Patient outcomes are improved when nurses develop excellent assessment and cross-cultural skills, and follow a process to deliver culturally sensitive care that is congruent with a patient’s cultural values and beliefs. Methods Clinical simulation is an effective evidence-based educational tool in nursing education which can be used to master the principles of cultural competence. The use of simulation can support cultural nursing care by providing a safe environment to conduct a cultural assessment, elicit students' attitudes toward cross-cultural situations, improve communication, and increase critical thinking. With these skills, participants can recognize cross-cultural issues in interacting and communicating with patients from diverse ethnic and cultural backgrounds. The authors have created cultural simulations for students in a global health course so they will be exposed to culture, traditions, beliefs, and lifestyles that impact individual and community health outcomes. Findings During the structured debriefing process an increased cultural awareness was identified by the students who participated and they were significantly impacted.Students were able to verbalize that culture includes ethnicity, language, spirituality, religion, socioeconomic status, and education. They were able to articulate their thoughts and feelings about the experience, as well as potential bias they may have had prior to the simulation. Students reported an increased awareness of the socially transmitted behavior patterns, arts, beliefs, values, and customs of those people from other cultures and ways to make changes in their personal nursing practice. Implications Professional nurses need to be aware of differing worldviews and cultures in order to provide the best possible care to patients, families, and communities. Health disparities faced by those who may not have the resources to access care is a continuing discussion at the national and international level. This simulation demonstrated the effectiveness of using creative, evidence-based simulation strategies to address health disparities, vulnerable populations, increase cultural awareness in nursing students, and could be replicated in other nursing programs. By using structured debriefing in a psychologically safe environment the students felt free to explore anxieties, personal values and beliefs. Future research could focus on the long-term benefits of such training in minimizing stereotyping and prejudice in nursing care so that nurses can make a difference for patients from all cultures.

Theresa Tarrant
School of Nursing Touro University, USA
Title: Mentoring novice faculty for academic skill acquisition and organizational impact

Biography: Dr. Tarrant is the Director of the Touro University Nevada School of Nursing, overseeing RN-to-BSN, Master of Science in Nursing, and Doctor of Nursing Practice programs. Dr. Tarrant has 30 years’ nursing experience, ranging from direct patient care to hospital Chief Nursing Officer.

Abstract: One challenge academic nursing leaders are facing today is how to best mentor novice faculty members. These new faculty may be expert nurse clinicians, yet in the academic realm these professionals are novices [1]. The literature has clearly shown that mentoring new faculty is essential to a successful transition from clinical practice to the academic role [2, 3, 4]. While developing a new Master of Science in Nursing (MSN) degree program, the goals of the mentoring relationship extended to creating a foundation for programmatic success beyond the mentor and mentee as individual professionals. Therefore, the mentoring relationship had to set outcomes based upon both the School of Nursing’s goals and the mentee’s career development goals. This presentation illustrates how one nursing academic leadership team planned and facilitated mentoring relationships with novice faculty based on Benner’s use of the Dreyfus model of skill acquisition [5]. The outcome of the mentoring process included the novice faculty members’ successful socialization to the academic triumvirate: teaching, scholarship, and service.

Catherine Chung
School of Nursing Touro University, USA
Title: Mentoring novice faculty for academic skill acquisition and organizational impact

Biography: Dr. Chung is the Director of Graduate Nursing Programs at Touro University Nevada, overseeing curriculum for the MSN and DNP programs.

Abstract: One challenge academic nursing leaders are facing today is how to best mentor novice faculty members. These new faculty may be expert nurse clinicians, yet in the academic realm these professionals are novices [1]. The literature has clearly shown that mentoring new faculty is essential to a successful transition from clinical practice to the academic role [2, 3, 4]. While developing a new Master of Science in Nursing (MSN) degree program, the goals of the mentoring relationship extended to creating a foundation for programmatic success beyond the mentor and mentee as individual professionals. Therefore, the mentoring relationship had to set outcomes based upon both the School of Nursing’s goals and the mentee’s career development goals. This presentation illustrates how one nursing academic leadership team planned and facilitated mentoring relationships with novice faculty based on Benner’s use of the Dreyfus model of skill acquisition [5]. The outcome of the mentoring process included the novice faculty members’ successful socialization to the academic triumvirate: teaching, scholarship, and service.

Bloo Gerrit
Radboud University Medical Center, Netherlands
Title: Perioperative Safety for Ethnic Patient Groups. An Explorative Case Study in a Dutch Hospital The Professionals’ Perspective

Biography: Gerrit Bloo is working as a recovery nurse and nurse scientist. He is a promovendus and published (10.1002/bjs.9609) a review and meta analysis on differences in health outcomes between non-Western minority and Western majority patients. This study is part of a thesis he is working on. He also studied the perspective of patients on perioperative safety

Abstract: Abstract Background In a previous study conducted in a 600 bed Dutch teaching hospital, surprisingly better perioperative safety, in terms of clinical outcomes (fewer complications) was found for non-western ethnic minority patients compared to Dutch majority patients, in high risk surgery (mortality risk >1%). In this study, we explore the health care professionals’ perspective on the factors that may contribute to safe perioperative care for non-western patients. Participants and Methods Qualitative study in which four nurses and two physicians who deliver perioperative care to both non-western ethnic minority and Dutch majority patients were interviewed. After analyzing the interviews, a member check was scheduled with three of the interviewees and three members of the research group. The results of the interviews were explored in detail. Results Results show that various factors may influence the conditions for safe perioperative care delivery. These factors could be grouped into categories relating to (1) staff (e.g. educated, experienced motivated staff, willing to bridge a language barrier etc.) (2) organization of care ( e.g. patient centred care, accredited, minimalizing handovers etc.) and (3) patients (e.g. patient and family awareness of safety restrictions etc.). Results show that ethnic origin is less important than a language barrier in optimal patient preparation before surgery and anesthesia. Potential problems can be avoided if professionals and patients fully understand each other, regardless of the ethnic origin. Conclusions We hypothesize that perioperative safety for non-western ethnic minority patients as well as for Dutch majority patients can be improved by taking into account factors such as assessment and recognition of limited language proficiency and health literacy, bridging of a language barrier, family involvement, and awareness of safety restrictions and rules. Future research should focus on how professionals can improve patients’ perioperative health literacy. Ethnicity seems to be subordinate to language comprehension. The management of patients with limited language and health literacy is important for safe perioperative care. Professionals should focus on creative solutions to overcome language barriers so that all patients will be optimal prepared for anaesthesia and surgery.

Anita Johansson and Anna Kjellsdotter
Skaraborg Hospital, Sweden
Title: The Clinical Nursing IntroductionProgram at Skaraborg Hospital

Biography: Anita Johansson and Anna Kjellsdotter, are Research Managers at Research and Development Centre, Skaraborg Hospital, Sweden

Abstract: Background Nurses at the start of their professional career may be in need of practicing their hands-on skills, as well as their theoretical knowledge. The Clinical Nursing Introduction Program, during one year, is an investment made in newly graduated nurses. The program aims to offer the nurses a good start in their professional careers and to create opportunities for them to progress in their profession. Objective The purpose of The Clinical Nursing Introduction Program is to create a safe and supportiveenvironment where the newly graduated nurse is given the opportunity to progress into the profession through education, clinical supervision and critical reflection. Method The Clinical Nursing Introduction Program include: • an employment until further notice as a registered nurse at Skaraborg Hospital • working under one’s own responsibility as a registered nurse • two placings in a clinical setting at different care units • simulation and practice of hands-on skills in a safe and supportive environment • process-oriented reflective supervision in nursing and theoretical education on current topics • specific introduction for the minimum of four weeks at each care unit • the opportunity to auscultate at an additional care unit Having completed The Clinical Nursing Introduction Program the nurse is offered a permanent placing based on the nurse’s own wishes and the needs of the care unit. The Clinical Nursing Introduction Program starts up twice a year with an introduction week prior to introduction at each care unit respectively. Results Process-oriented reflective supervision in nursing is perceived as a central component and is valued highly regarding the development of self-confidencein one’s professional role as a nurse. It is also an arena for exchanging experiences and to share and acquire new knowledge. The placings at different care units provide professional competence as well as an understanding of the organization of the hospital as a whole. Conclusion The Clinical Nursing Introduction Program has put focus on the need for support and development ofself-confidence in the newly graduated nurse, to enable development of competence in one’s profession.

Marika Morelli
University of Verona, Italy
Title: The importance of mothers’ well-being in the audiologic habilitation process of children with cochlear implant

Biography: Marika Morelli is a psychologist and a Ph.D. student in Human Science at the University of Verona. She has collaborated to qualitative and quantitative international research (observation of the interaction between adults and children and children with peers, study of the well-being of parents and children at hospital). She studies children with typical and atypical development, focusing on children with cochlear implants. Her area of interest is the interaction between individual and environmental factors in the linguistic and social development of children, for prevention and intervention.

Abstract: Many studies have shown that mothers of children with cochlear implants (CIs) could display distress [1], negative emotions [2] and dysfunctional communication with their children [3]. However, few studies have investigated the relationship between mothers' well-being and communication and language development of children with CIs. The aim of this study is to assess, using a multi-method approach (qualitative and quantitative), the relationship between mothers' well-being (stress and feelings), mothers’ communication strategies and children’s language development, before surgery and three months after CI activation. Twenty mothers along with their deaf children were recruited at ‘Guglielmo da Saliceto’ Hospital in Piacenza. Each mother was interviewed before CI surgery to investigate the emotions related to the diagnosis of deafness of her child. Moreover, before surgery and after CI activation, the mother-child interaction was observed, following the guidelines of the Assessing Linguistic Behavior [4], to analyze the mother’s linguistic input [5], and two questionnaires were administered in order to assess the mother’s stress and child language development, respectively, Parenting Stress Index [6] and Italian version of MacArthur Communicative Development Inventories [7]. Preliminary results have shown that the emotional experience of the mother related to the diagnosis of the child is complex, and involves positive and negative emotions. Moreover, the data have highlighted that the mother’s distress, perception of a difficult child and parent-child dysfunctional interaction were positively correlated with a higher use of prohibitive phrases of the mother during interaction with her child and negatively correlated to the child’s lexical development. To sum up, the preliminary findings have shown the mother’s feeling could affect motherchild interactions and consequently the child’s language development. For this reason, it’s important to assess mothers’ well-being in the audiologic habilitation process of children with CI. In particular, these data could contribute to implement supportive programmes for mothers before children’s surgery and after CI activation, focused on mothers’ emotions and on the direct observation of the mother-child interaction.

Dr. Friyal Al Qahtani
College of Nursing, IAU Dammam KSA
Title: Development of Forensic Nursing in Saudi Arabia: Leading a Specialized Nursing Profession in the Kingdom


Abstract: The purpose of this article is to present a comprehensive synopsis of the history and background of forensic nursing in Saudi Arabia. The authors explain how it was introduced and developed as a nursing specialty in conjunction with the significant advancement of Saudi forensic medicine as a component of the Kingdom's Vision 2030. Saudi society has welcomed new criminal laws against violence, abuse and harassment which have been enacted to protect its citizens and expatriates. Saudi nurses belong to a large group of service providers who embrace an agenda of health promotion and early intervention to improve the health status of Saudi communities. Regardless of the advancements in forensic services and the availability of forensic physicians, personnel resources are insufficient to meet the needs of caring for victims of human violence. The introduction of forensic nursing through an educational framework for violence prevention and intervention will enhance collaboration within the forensic medical community, professional nurses, crime laboratory analysts, and the Commission for Investigation and Public Prosecution (CIPP) in Saudi Arabia. A multidisciplinary collaboration can lead to an expansion of forensic services by forensic nurse examiners in the future where justice calls for greater commitment to the benefit of Saudi society. Forensic nurses play a pivotal role in the hospital and community settings assisting people of all ages who are victims of crime related trauma, abuse or maltreatment, sexual assault, and catastrophic disasters, among other categories of intentional and unintentional harm. Within a collaborative practice model, forensic nurses utilize specialized knowledge and clinical skills to provide holistic care for patients with crime related trauma. As an emergent discipline, forensic nursing assumes a mutual responsibility with the forensic medical sciences and legal authorities in concern for the loss of life and function due to human violence, sociocultural crimes, and liability related issues.

Bodo C. Melnik
University of Osnabrück, Germany
Title: Breast milk exosomes: key components for postnatal growth and lifelong epigenetic programming are deficient in infant formula

Biography: Medical School University of Münster, promotion 1982. Visiting scientist 1982-1984 at the Cardiovascular Research Institute, School of Medicine, University of California San Francisco. Dermatology training as resident with Professor Dr. Gerd Plewig at the Department of Dermatology, Heinrich-Heine-University, Düsseldorf 1984-1990. Venia legendi in dermatology and Felix Hoppe Seyler Price awardee of the German Society for Laboratory Medicine 1989. Since 1991 senior lecturer at the Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück; Since 1994 Associate Professor at the University of Osnabrück. Member of the European Society for Dermatological Research. Major research interests: acne, sebaceous and epidermal lipid metabolism, milk signaling, milk exosomes, milk microRNA-mediated signal transduction, epigenetics of milk microRNA in health and disease.

Abstract: In recent years, the scientific perception of milk has changed dramatically from a simple feeding system to a most sophisticated signaling network of mammalian evolution. To fulfill its signaling functions, milk provides a hardware composed of adequate amounts of essential amino acids that activate the nutrient-sensitive kinase mTORC1 and transfers an ingenious software composed of extracellular, virus-like vesicles (exosomes) that contain most important gene-regulatory microRNAs. This system is under tight control of the highly conserved human lactation genome, which allows the optimal and timely secretion of all regulatory compounds that are of critical importance for lifelong epigenetic programming of the infant. The awkward perception of pediatrics in the 1930s that “milk is just food” was apparently the biggest mistake in recent medical history, promoting uncontrolled artificial formula feeding, which is not under surveillance of the human lactation genome, provides inappropriate amounts of regulatory amino acids and does not transfer bioactive microRNAs that play pivotal roles for correct postnatal epigenetic imprinting of the infant. Formula-related early postnatal deficiencies in epigenetic programming apparently promote the early onset of diseases of Western civilization some decades later in life. Milk is the earliest nutritional and functional environment of all mammals including humans that via epigenetic mechanisms allows adequate maturation of the immune system as well as optimized organ development. The great pioneer of pediatrics Sir Truby King was absolutely right when he in early 1900 stated “breast milk is the birthright of the newborn”. Modern lactation research just agrees: “Breast is best”.

Marcia Jones
Bronx Community College, USA
Title: The Perceptions of Teamwork among Inter-professional teams on International Humanitarian Missions in the Caribbean

Biography: Marcia Jones, RN, CNM, MSN, DNP has 37 years of nursing experience inclusive of 25 years of experience as a Nurse Educator. She has planned and participated in over twenty humanitarian medical missions to Africa, India and the Caribbean.

Abstract: Each year many healthcare professionals participate in international humanitarian healthcare missions; and on these medical missions, nurses play a crucial role in providing care and working alongside clinical and non-clinical groups. The survey explored i mission participants’ attitudes to collaborative working. Methods: A TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ), survey was electronically emailed to 105 individuals, representing multiple professions and roles. These individuals participated in international humanitarian healthcare missions during 2012-2017. The survey was distributed, and the data were collected using the online survey engine Survey Monkey. TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) was used to assess attitudes toward the core components of teamwork. This study explored the perception of nurses and other healthcare members who participated in humanitarian missions to the Caribbean. Results/Findings: Team structure, Leadership, Situational Monitoring and Communication were identified as the most important concepts in promoting successfully humanitarian missions.

Gholamzadeh Sakineh
Shiraz University of Medical Sciences, Iran
Title: The effect of need based education on level of anxiety and satisfaction of family with traumatic brain injury patients admitted in intensive care units in Shiraz hospitals

Biography: Gholamzadeh S obtained her PhD Degree in Gerontology at 2013 from University Putra Malaysia (UPM). She is working as faculty member of Shiraz University of Medical Sciences (SUMS) for more than 20 years. She published several papers and three books and participated in many congresses. She is also research assistance of community based psychiatric care research center in Shiraz-Iran.

Abstract: This study was conducted to determine the effectiveness of a needs-based educational intervention on level of anxiety and satisfaction of family of traumatic brain injury patients admitted in intensive care units of hospitals affiliated to Shiraz University of Medical Sciences in Iran. In this quasi-experimental design study 60 patient family members selected with a convenience sampling method. They were assigned either to an experimental p or control group (control n=30 and experimental n=30).To determine the level of anxiety the Spielberger Anxiety Inventory was applied and for investigation of family needs and satisfaction, the Critical Care Family Need Inventory were used. After the pre-test, each family member in the experimental group was received some education sessions, on Day 2 and Day 3 after admission. The content and frequency of the educational sessions was formulated based on the results of the needs assessment at the pre-test time. Post test was performed for both groups after education on day 4 after admission. Based on the results, more important needs of the family members were needs for assurance and information. after educational intervention, family members in experimental group, reported low level of state anxiety and high level of satisfaction than control group (p-value<0.05). In control group, the level of anxiety was same in both pretest and post test (p-value>0.05) and the level of satisfaction was lower than pre test (p-value<0.05). In conclusion, needs base education programme can decrease level of family anxiety and increase level of satisfaction.

Pilar Llauradó Dalmau
Title: Teaching project in surgical instrumentation of Lumbar Arthrodesis Multilevel by Clinical Simulation


Abstract: Objective through the Clinical Simulation we intend to favor the acquisition of nursing competences in surgical instrumentation necessary in the real practice and to reduce the incidence of stress in the surgical area in the novel personnel. This learning has as a priority the safety of the patient, in the globality of the term. Design: randomized experimental study, control group pre-test open and parallel post-test, analyzing a sample of 30 students (novice surgical nurses), 15 of which will perform simulated sessions plus a subsequent debriefing session and 15 will not perform any type of simulation. Both groups will attend the formative classes regulated by the educational center. The main variables will be acquisition of the necessary skills in ALM instrumentation, anxiety, stress. The variables will be analyzed using the Demand-Control (DC) model scale from Karasek in the stress assessment and competency questionnaire. The collected data will be exported to the Epinfo 7.2 program for further analysis. KEY WORDS: stress, simulation, competences, learning

Taipei City Hospital Heping-Fuyou Branch, Taiwan
Title: Improve Health Literacy of Primary School Students on Seasonal Flu


Abstract: This study, refers to the CDC epidemic prevention materials as the content and test questions, is to promote influenza and epidemic prevention for primary and secondary school students. The study was divided into several stages: First, a pre-test with 10 yes-no questions was given to the students. It then followed with 30minutes of teaching and coaching. A pos-teaching test was performed afterward. To expel doubts and enhance understanding of influenza, step-by-step explanation of each question was provided with prizes to encourage student interaction at the end of post-teaching test. On January 4, 2018, a total of 90 questionnaires were sent to sixth graders in the northern region. 80 copies of which, counting 42 male and 38 female students, were recovered. The recovery rate was 85.1% with 53% males and 48% females. The average age of those students is 11.33 years old. The analysis, performed according to the 21st edition of SPSS, showed that students' awareness of influenza can be significantly improved through prevention education (p<0.05) with an overall knowledge improvement rate of 17.2%. Through the pre- and post-teaching tests, four questions related to the knowledge in this influenza awareness study showed statistically significant differences (P<0.05): (1) The most effective way to prevent influenza is vaccination. (2) Which of the followings are the complications that may occur after being infected by influenza virus? (3) How long is the incubation period of the flu? (4) Which type of mask should you wear if you show symptoms such as having a fever, coughing and sneezing or when you are visiting a patient? Biography(100 Words) Seasonal influenza is a type of respiratory diseases caused by human influenza virus. Its occurrence appears to be cyclical in most countries. Currently, seasonal influenza, seasonal flu in short, refers to infectious disease caused by influenza A virus of H1N1 and H3N2 and/or the influenza B virus. The flu is most likely to occur every year in winter, from November to March, particularly on campus where a lot of people gather. Therefore, it is crucial to implement personal hygiene. Wash hands properly to protect one’s health, cover nose and mouth when coughing or sneezing, adhere to the principle of not going to class or work by staying home to rest when ill.

Su-Ya Huang
Chi Mei Medical Center, Taiwan
Title: Exploring the Big Five Personality Traits of Clinical Nursing Preceptors

Biography: Su-Ya Huang works for Organization and Department: CHI MEI Medical Center, Department of Nursing. Education: B.S.1999 -- Chang Jung Christian University, Tainan, Taiwan -- Health Care Administration M.S.2016 -- Chang Jung Christian University, Tainan, Taiwan – Nursing Experience:Patient Safety of health care, Management of Nursing Quality, Nursing Education.

Abstract: Clinical nursing preceptors were an important person for new nurses, which can to help new nurses through the process of learning, orientation, and socialization to their working environment. They facilitate the development of knowledge, professional skills, and professional attitudes in nursing through supervision, role modeling, and personal development of the Preceptorship Program. To provide familiar for new nurses to reduce reality shock, decrease early burnout, and helps nurses become functioning members of the healthcare system. Currently, few studies have examined the factors of personality traits and teaching willingness in Clinical nursing preceptors. The main objective of this study were to understand the statuses of the big five personality traits in clinical nursing preceptors. This study method applied a cross-sectional design using structured questionnaires, including demographic characteristics, and the Big Five personality traits evaluation. A total of 200 questionnaires were distributed and 185 questionnaires were returned, with the recovery rate of 92.5%. there were 172 participants were recruited from a medical center and a regional hospital in south Taiwan through a convenient sampling procedure. Data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, and Pearson’s correlations. There are 60 items in the Big Five personality traits scale that includes five dimensions of Openness, Conscientiousness, Extraversion, Agreeableness and Neuroticism, with 12 questions in each dimension., the results of this study showed that clinical nursing preceptors that Big Five personality traits score from the highest to lowest was Conscientiousness, Agreeableness, Extraversion, Openness and Neuroticism. Personal characteristics job titles had significant difference with Conscientiousness. Years of teaching experience had significant positive relationships with the “Agreeableness” (r =.174), and the significant negative relationships with the “Neuroticism” (r = -.313). Age had significant negative relationships with the “Neuroticism” (r = -.269). The results of this study can be provide reference to talent selecting of clinical nursing preceptor for clinical nursing managers.

Jared M. Dougherty
Heart and Vascular Procedural Care, USA
Title: When Shared Governance Becomes Professional Governance

Biography: Mr. Dougherty is a graduate of York College of Pennsylvania and is currently enrolled in a dual Master of Science in Nursing-Master in Business Administration program at The University of Texas at Tyler with a graduation date of December 2019. Mr. Dougherty began his career in the Heart and Vascular Institute Critical Care Unit at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania where he became trained in caring for patients requiring advanced heart failure therapies including mechanical circulatory support devices and cardiac transplantation. He is now one of the Clinical Head Nurses for the Heart and Vascular Procedural Division and directly oversees the cardiac catheterization laboratories, electrophysiology laboratories, a pre-/post-care unit, echocardiography area, and vascular ultrasound area. In his time as a direct-care, clinical nurse, Mr. Dougherty was the chair of the Department of Nursing Quality of Work Life shared governance council. In collaboration with hospital administration, Mr. Dougherty and council representatives focused on staffing, scheduling, recruitment, and retention efforts of clinical nurses within the 548-bed academic medical center. Mr. Dougherty utilized his past knowledge of organizational shared governance and educational knowledge in order to create the multi-professional Procedural Council which has a unique structure and function in relation to all other organizational shared governance bodies.

Abstract: With a structure dating back to 1995, one academic medical center had enjoyed many years of successful shared governance within the Department of Nursing. Over the years, redundancies and inefficiencies were identified leaving many nurses frustrated with what the council structure had become. Additionally, the original structure created for the inpatient Department of Nursing did not function well within the Procedural Division. Therefore, a new structure was developed for the Procedural Division and implemented as a multi-disciplinary council in which direct care nurses, technologists, technicians, sonographers, advanced practice clinicians, and others all participate equally in decision-making. Shared governance has existed within the nursing profession for more than 40 years, having supported the establishment of an independent discipline in the healthcare realm (Clavelle, Porter O’Grady, Weston, &Verran, 2016). Clavelle, Porter O’Grady, Weston, and Verran also note that professional governance structures, which are defined as more evolved forms of shared governance, are on the rise (2016). According to the authors, these professional governance structures must address the concepts of accountability, partnership, ownership, and equity (Clavelle, Porter O’Grady, Weston, &Verran, 2016). Researchers note that interdisciplinary shared governance models have been shown to result in better outcomes for patients as individuals from different disciplines make informed decisions pertaining to patient care and the work environment (Alrwaihi, Kehyayan, & Johnson, 2018). In 2017, leaders met to begin redesigning the Department of Nursing Shared Governance structure. At that time, leaders identified the need to create a separate structure that more accurately addresses the needs of the Procedural Division. With the hire of a new Clinical Head Nurse within the Procedural Division who had extensive knowledge of the organizational shared governance model, the idea for the Procedural Council was born. In consultation with other Procedural Division leaders, the Clinical Head Nurse researched, designed, and implemented a new shared governance structure for the division in which nurses, technologists, technicians, sonographers, and others all participated equally in decision-making. In order to best leverage the use of committees and councils within the Procedural Division, it was determined that the Procedural Council would adopt the tenants of Staff Practice, Staff Education, Healthy Work Environment, and Patient Experience. Whereas the Department of Nursing structure also includes Patient Quality Outcomes as a main tenant of shared governance, this would remain a tenant of the existing Procedural Division Accountable Care Team group. Staff anecdotally report a greater level of satisfaction within the Procedural Division following the implementation of the Procedural Council. Council members have been able to directly enhance accountability, partnership, ownership, and equity across disciplines within the Procedural Division. Additionally, use of authentic leadership practices has greatly enhanced leadership presence within the division. Multidisciplinary participation within the Procedural Division has led to greater transparency, enhanced communication, and standardization of practices. Additionally, this group is responsible for the development of the Excellence in Procedural Care Award which recognizes the achievements of allied health professionals within the Procedural Division.

Bashar Ahmed (1) and Marissa I. Molina (2)
University of the Incarnate Word, USA (1)
UT Health San Antonio (2)

Title: Integrating Nursing Education

Biography: Bashar Ahmed MSF, MBA, is an Adjunct Professor at School of Professional Studies, University of the Incarnate Word, USA and Marissa I. Molina, MSN, RN, is an Assistant Professor/Clinical UT Health San Antonio School of Nursing, USA

Abstract: The purpose of this study was to explore the importance of the use of the coordinated assessment tools and its impact on a local, regional, and national homeless population. This study aimed to examine the homeless population service that the federal government through its Department of Housing and Urban Development delivers. This study encourages the homeless service providers to use one single system that could be used to provide an immediate shelter services for those who need it the most. The importance of Coordinated Assessment is to pave the way for more efficient homeless assistance systems by; helping people move through the system faster (by reducing the amount of time people spend moving from program to program before finding the right match), effective coordinating entry program that would improve the process for the continuum of care providers within large communities, reducing new entries into homelessness (by consistently offering prevention and diversion resources upfront, reducing the number of people entering the system unnecessarily); and Improving data collection and quality as well as providing accurate information on what kind of assistance consumers need. . This study recommends training programs involving local communities to better prepare for serving the homeless population and reaching the ultimate goal of ending homeless in the United States.

Academic hospital of Suru-Léré Cotonou, Africa
Title: Prevention of surgical site infection : an approach technique

Biography: Blaise KOVOHOUANDE is Senior Technician in Surgery, manager of operating theatre in Academic hospital of Suru-Léré, in Cotonou, in Benin in Africa. I am operating room nurse since 2011. I am in the 3rd year as English student at university. I manage an English club I created in my hospital. In September,28th , 2017 I organized a training in my hospital to help health workers to know the importance of English language because our facility is well attended by English-Speaking patients due to its location. I took part at the 31st congress of AFISO in Belgium on March, 2017 as orator. I exhibited a topic on a technique I developed to reduce the surgical site infection (available on I have created a nonprofit organization (NGO) called OPS/Bénin. Every year I organize a scientific day. The second edition took place on Thursday,23rd November , 2017 in Cotonou

Abstract: Every time, more than one million persons suffer of nosocomial infections. Between 5 to 10 percent patients attending modern hospital in developed countries are reached by one or many nosocomial infections. Researchers has reported that in an undeveloped country, the risk to do nosocomial infection is multiplicated by from 2 to 20. A bad cleaning of the surgical site can cause surgical site infection. Most of the germs that cause the surgical site infection are located on the skin of patient. Also, the World Health Organization has said not to go over 3 percent concerning nosocomial infection. Unfortunately, any country is able to keep his rate at that level. Both developed countries as well as underdeveloped countries are concerned. The surgical site infection has heavy consequences (social, economic till the death). In my professional life I have been charged to take care once of a patient having surgical site infection and I recognize that it is not easy at all, neither for the patient nor for the health worker. Because of the location of the germs, I have developed one technique called “MANUAL,METHODIC AND SYSTEMATIC TECHNIQUE OF CLEANING SURGICAL SITE”. That technique demonstrates the different four steps to prepare the surgical site in the operating room.

Nursing Management

Session Introduction

Anna Gyberg
University of Gothenburg, Sweden
Title: Effects of a Nursing Intensive Care Unit -a pilot study

Biography: Anna Gyberg, RN, MS, PhD student at University of Gothenburg and works as a development manager for patient safety and quality at Sahlgrenska University hospital, Gothenburg, Sweden

Abstract: Older people who need acute care in hospital are a complex group at risk of hospital-induced complications. Calculations have shown that the hospital stay doubled for patients suffering from health damage (1). Stelfox and co-workers (2) found that patients isolated and cared for in single bed rooms were twice as likely to experience hospital-induced complications. In the very same study isolated patients more commonly reported dissatisfaction, such as negative perception of treatment, the access to the staff, cleanliness, and communication (2). Furthermore, the incidence of falls and fall-related injuries were found to be significantly higher, 2.9 fold greater incidence, in single room facilities (3). The nurse’s station in hospital is usually a place for nurses and used as a space for administration, care coordination, and consultation and has been found to be a place where nurses spend a significant amount of time (4, 5). With the aim to reduce hospital induced complication and the sense of uncertainty among the patients we constructed a care environment for three patients with advanced nursing needs and a working station for nurses in the same room, called nursing intensive care unit (NICU). Tentative results showed that hospital induced complications were few among patients who were cared for at the NICU and that they felt less uncertain to have the health care professionals nearby. The length of stay were half as long in the NICU compared to the patients treated in usual care. During the first three months of the pilot, there were no occurrences of fall accidents at the NICU when staffed, however three occurred when not being staffed. For other patients, in the usual care, 26 fall accidents were reported. No pressure ulcer was found at the NICU compared to two in usual care. One patient suffered from a pneumonia at the NICU and three patients in usual care. The average length of stay was 7.3 days at the NICU and 15.5 in usual care. The working environment was calmer than on regular nursing stations where the nurses tended to spent more time. As a clinical implication we consider that the NICU concept advantageously can be scaled up to other units around the clock as we in this project see that the occurrence of hospital induced complications in the usual care probably could have been avoided through closer attention. This study proceeds as a pilot study and continuously we plan for a full size randomized study.

Houri Dara
Al Amiri Hospital, Kuwait
Title: Safety Needs of Hospitalized Elderly Patients

Biography: Dara H obtained her Bachelor Degree in nursing at 2002 from Shiraz University of Medical Sciences (SUMS) Iran. I’m working as a registered nurse in Nuclear Medicin department of Al Amiri Hospital in Kuwait for more than 20 years. She published several papers and three books and participated in many congresses. She is also research assistance of community based psychiatric care research center in Shiraz-Iran.

Abstract: Safety is a major problem when working with older patients. One of the most important safety issue is ‘‘geriatric syndromes or medical errors,’’ which include falls, delirium, pressure ulcers and underfeeding. Geriatric syndromes are associated with high mortality. The literature identified and extended on six particular recommendations that we believe will improve the safety of geriatric care. These six recommendations consist of the detection and reporting of geriatric syndromes, identifying system failures, establishing geriatric units, improving the continuity of care, decreasing medicine adverse effects, and promotion of geriatric training programs. Elderly people seem to be a special at risk group for medical errors. Usually, errors are classified either as mistakes, lapses or slips. Mistakes or lapses come from improper choices, regularly due to inadequate knowledge, lack of experience, training, and information or decision-making based on the wrong set of rules. Misdiagnosis, wrong-site surgery, and readmission are other safety problems. A readmission is when a patient needs to come back to the hospital less than 30 days after being discharged. Other safety issues in regard to the elderly patients are restraint that can be physical, chemical, mechanical, technological and psychological which is against of patient safety in reality. Patient safety culture plays a significant role in promoting the patient safety in health care centers. When health care professional considers the significance of safety and organizes it among them, then it change into culture in the organization and perceive it as a value by any person of the organization during their work.

Mohammad Reza Foroutani
Larestan University of Medical Sciences, Iran
Title: The concept of "professional nursing" from clients opinion

Biography: M.foroutani is a academic instructor of Lar Nursing College, Larestan University of Medical Science of IRAN for 26 years also he is a student(M.S.c) of Medical Education(virtually)

Abstract: The "professional" is one of the criteria used by the standardization. This means, for most of those involved in the profession, clearly explain and understand its true meaning.But clients of services, is possible to have a different meaning. In the meantime, the nursing profession, which have their own contacts, should be more careful.Because , different interpretations of these concepts, can cause a variety of outcomes and expectations . The perspective of Some recipients of nursing care from the concept of "professional " is widen the scope and expand services. And some of them, "professional " is meaning, specialization and lessen of nursing care. sometimes Professional; defined synonymous with increased costs and reduce the level of public access.And sometimes, due to the limited scope of activities, hoping to reduce costs. However, clarify the true meaning of "professional" increase the identify and expect appropriate to the discipline and profession of nursing.

Jehanzeb Khan Yousafzai,
Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan
Title: Perceptions of patient attendant about nursing profession at public and private tertiary care hospitals of Karachi, Pakistan


Abstract: Objective: To determine patients' attendant perceptions about nursing profession at Karachi, Pakistan. Methodology: In this cross-sectional study, data were collected from patient attendants at private and tertiary care hospitals from Karachi, Pakistan from June 2014 to March 2015. Purposive sampling strategy was used to enroll 150 participants. Data collection tool was developed to collect data. Results: Majority of private hospital (96.0%) respondents thought that nursing was a respectable profession compared to government hospital (64.0%). Almost 80.0% of respondents from both government and private hospital agreed that nursing was an acceptable profession in our society. Large number of respondents from private hospital (73.0%) thought nurse services are very important in our country. Conclusion: Majority of the participants had positive perception about nursing profession. However, perceptions of patient attendants in private hospital were more positive as compared to those in public hospitals.

Providing Quality Care & Reducing Family Healthcare Costs

Session Introduction

Orawan Kaewboonchoo
Mahidol University, Thailand
Title: Polycyclic aromatic hydrocarbons (PAHs) and arterial stiffness among toll gate collectors in Bangkok, Thailand

Biography: Orawan Kaewboonchoo is Associate Professor of Nursing at the Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand. She graduated with a B.Sc. (Hons) in nursing and M.Sc. in public health from Mahidol University, Thailand. She has completed her PhD in medicine from Wakayama Medical University, Japan. She is currently the chair of the MNS in occupational health nursing. She is actively engaged in postgraduate teaching, research and service. She has published more than 20 papers in reputed journals and has been serving as an editorial board member of the Asia Pacific Journal of Public Health.

Abstract: Previous studies have reported an association of polycyclic aromatic hydrocarbons (PAHs) with cardiovascular disease. Arterial stiffness, as an intermediate endpoint to cardiovascular disease, has received much attention recently. This study aimed to investigate the association of PAHs exposure and arterial stiffness among Thai toll gate collectors. Ten PAHs were monitored in breathing zones of the collectors at six toll booths for 24 hours during morning, afternoon and night shifts. Average of total PAHs concentrations (ΣPAHs) were 6.13 ng/m3 (3.55-11.29 ng/m3). In this study, the subjects’ working year at the toll gate was used as the PAHs exposure. The arterial stiffness was evaluated by the second derivative finger photoplethysmogram (SDPTG). The subjects comprised of 92 male and 85 female toll gate collectors who were free from any diagnosed cardiovascular disease. The subjects' age ranged from 25 to 59 yr. Mean age (+/- standard deviation) were 39.9 (+/- 8.2) yr. Mean working years at toll gate was 12.2 (+/- 9.0) yr. The mean of aging index of SDPTG (SDPTG-AI) were -0.51 (+/- 0.32). Multivariable linear regression was applied to examine associations between PAHs exposure and arterial stiffness. There was significant correlation between PAHs exposure and arterial stiffness (β = 0.006, p<0.05), after controlling for sociodemographic, behavioral, dietary and biomedical factors. These results suggest that PAHs might be an important risk factor for cardiovascular diseases among the toll gate collectors. Further longitudinal studies are recommended.

Sumlee Saleekul
Bangkok Boromarajonani College of Nursing, Thailand
Title: Factors related to depression among aging agricultural workers in Thailand

Biography: Sumlee Saleekul is lecturer at Bangkok Boromarajonani College of Nursing, Thailand. She is the head department of community health nursing and is engaged in both undergraduate and postgraduate teaching, research and service. She has completed her MSc. in public health from Mahidol University, Thailand. She has published many papers related to community health nursing in peer-reviewed journals.

Abstract: Agricultural worker is the biggest group among non-informal workers in Thailand. They are faced a variety of stressors which affect to their physical and mental health. This study aimed to examine the factors related to depression among Thai agricultural workers. A total of 364 workers completed the Beck Depression Inventory II. The characteristics, sociodemographic, and working behaviors of the subjects were also collected. Logistic regression analysis was used to analyzed the factors related to depression among the workers. Results revealed that 60% of the subjects were female, 69% were married. An average age of the subject was 60±9 years. Median of the Beck score was used as cut off point to divide the subject into two groups, low or high of depression. The prevalence of high depression in male and female were 53.9% and 65.9%, respectively. Factors related to high depression among aging agricultural workers in this study were age (1.15, 95% CI: 1.11–1.20), educational level (2.35, 95% CI: 1.19–4.66), and loss of important person (7.71, 95% CI: 1.62–36.58).

Chanudda Nabkasorn
Burapha University, Thaialnd
Title: Effects of Exercise Program on Lung Capacity and Depression among Thai Female Adolescents with depressive symptoms

Biography: Chanudda Nabkasorn is Assistant Professor of nursing at the Faculty of Nursing, Burapha University, Thailand. She graduated with BSN in nursing and MSc. in educational psychology from Chulalongkorn University, Thailand. She has compleated her Ph.D. in medical science from Wakayama Medical University, Japan. She is the chair of Master of Nursing Science in mentall health nursing. She has published many papers related to mental health in peer-reviewed journals and has 2 books under her name.

Abstract: The purpose of this quasi-experimental study was to examine the effects of exercise program on lung capacity and depression among Thai female adolescents with depressive symptoms. Sixty-six high school students who met inclusion criteria were recruited and were randomly assigned into the experimental group and the control group, n=33 for each group. The experimental group received 5 sessions of aerobic exercise program for eight-weeks, each session took about 50 minutes. Thecontrol group received routine care. The Children’s Depression Inventoryand lung capacity measurement were used to collect data at pretest, posttest, and onemonth follow-up. Descriptive statistics, independent t-test, and repeated measure ANOVA with pairwise comparison using Bonferroni method were employed for data analysis. The results demonstrated that the mean scores of lung capacity and depression between the experimental group and control group at post-test and 1 month follow-up were significantly different (p< .05). In the experimental group, the mean scores of lung capacity and depression at pretest, posttest, and one-month follow-up were significantly different (p< .05). For pairwise comparison of lung capacity and depression mean scores within experimental group; pretest &post-test and pretest &one month follow-up had significantly different mean scores but posttest & one month follow-up did not have significantly different mean scores. Findings showed that this exercise program would increase lung capacity and reduce depression in high schoolfemale adolescents. Nurses and related healthcare personnel would apply this program to adolescents with depressive symptoms in order to promote their respiratory function and reduce their depression.

Mohamed Chahboune
Hassan 1st University Settat, Morocco
Title: Cardiovascular risk estimation among the consulting population at primary health care institutions (Case of the city of Settat, Morocco)

Biography: 2000-2001: Responsible nurse of the occupational medicine unit in an industrial unit in Meknes, Morocco; 2001-2002: caregiver nurse in the Department of Urology at Avicenna Military Hospital, Marrakech, Morocco; 2002-2011: Nurse Major of a health center in the Provincial Ambulatory Action Infrastructures Service, Khénifra, Morocco; 2011-2016: Technical Manager of the Food Microbiology Unit within the Regional Laboratory for Epidemiological Diagnosis and Environmental Health, Meknes, Morocco. 2016 to the present day: Professor of Higher Education: Nursing sciences, Higher Institute of Health Sciences, Hassan 1st University, Settat (Morocco)

Abstract: Short Description of what will be discussed during the presentation What we will discuss during our presentation are the results of a recent cross-sectional study that we conducted at the level of primary health facilities in the city of Settat in Morocco. The main objective of our work is to estimate the risk of occurrence of cardiovascular events (fatal or not) in the 5 years to come, in the patients who frequent these structures and to study the factors associated with this risk. This type of study is of undeniable usefulness. Indeed, the exploitation of its results makes it possible to anticipate the health problems within the studied community and makes it possible to better anticipate them by proposing adapted solutions. What will the audience take away from your presentation? The public interested in community health will be able to use what they have learned by setting up similar studies in their workplace, which will allow them to have a clear future vision of the state of the health of the population served in terms of cardiovascular disease considered as a leading cause of death in the world. This research could be used by other professors to broaden their research or teaching. This study is a decision support tool that will enable decision-makers to put in place adequate solutions to health problems in the population. Is this abstract connected to an organized session? If yes, please provide full session title. Session Name: Community nursing

Saraswati Neupane
Gaulochan International Trading Pvt. Ltd, Kathmandu, Nepal
Title: Status of Nurses in developing countries : case study of Nepal


Abstract: This study analyzes the existing status of nurses in Nepal. According to Nursing Council of Nepal (NNC), by the end of December 2018 there are 41, 729 Staff nurses, 818 foreign nurses (total) are registered. There is a challenge in the employment of these nurses in the country. Nepal currently has 0.50 nurses per 1,000/population and 0.17 doctors per 1,000/population, which is significantly less than the WHO recommendation. This study "Status of nurses in Developing Countries : the case study of Nepal " has tried and incorporated all aspects related to nursing profession as far as possible. This study concentrates on the overall status of nurses in Nepal. It focuses on the nursing policy, nursing services, structure of nursing education, as well as current situation of nurses and its scope and problems encountered by the nurses in Nepal. This is a descriptive study using primary and secondary data. Key informant interviews were conducted for the purpose of primary data collection whereas available records and reports were reviewed for secondary data collection. This study recommended that policies should be formulated and must be implemented in order to empower nurses and make them safe accordingly. The nurse-patient ratio has not been met. Similarly, recruiting more nurses in hospitals in order to maintain quality of care is essential which would probably reduce shortage and unemployment problems. Vacant posts of government sectors which are unfulfilled for a long time need to be fulfilled so that fresh nurses get the opportunity. Likewise, in order to strengthen the nursing services in Nepal, the supervision and monitoring of health institutions and hospitals needs to be made effective.

Gjyn O’Toole
The University of Newcastle, Australia
Title: Improving healthcare through culturally capable communication (CCC): A model to guide practice.


Abstract: Cultural diversity is becoming a reality throughout the world. Evidence of this fact is seen daily in health services experiencing this diversity. This creates challenges for all healthcare professionals in these services. Such services experiencing diversity in their clientele typically provide cultural awareness training for staff. However, in the busyness of healthcare provision, trained staff are often unable to provide culturally capable care. Culture, an important consideration in clinical care contributes to creating healthrelated values, beliefs, and behaviours of both the patient/Person and the healthcare professional. Effectively managing the differences in these health-related values, beliefs, and behaviours is essential for exchange of relevant information, building relationships, creation of effective care and ensuring ongoing maintenance of health. Effective management of these differences can be challenging for everyone in the healthcare process. Literature discusses the need for CCC and for clarification of this concept to improve the consistency and quality of such care in practice. This CCC model (published 2016) explores factors affecting each individual from a personal, local-social and national perspective. Presentation and discussion of the model facilitates both awareness of and abilities in the healthcare professional when communicating within culturally diverse healthcare settings.

Ana Rita Cavaco
Ordem dos Enfermeiros (Portuguese Order of Nurses), Portugal
Title: The impact of specialized nursing care in response to the development of health care needs

Biography: Born on 1976/04/21, was given powers as President of Ordem dos Enfermeiros on 2016/01/30. Nursing Graduated at Calouste Gulbenkian Nursing School in Lisbon and D. Ana Guedes Nursing School, in Oporto. She´s a specialist and master in Community and Public Health and has a post-graduation in Management by the Católica Lisbon School. With 21 years of professional experience, she began working at Capuchos’ Hospital, in several health centers where she coordinated teams of continuous care assuming the position of Advisor of the Health Secretary of State in the XV Constitutional Government and currently works at the Autoridade Antidopagem de Portugal.

Abstract: In the face of an aging population with chronic diseases and comorbidities along with technological and organizational changes aimed at promoting primary care intervention and access to health care, is required a redefinition of the human resources management policy (intervention, qualification, number and its distribution), capable of meeting the societal challenges. The Investment in human capital, through the specialization of nurses, is an urgent need, enabling economies of scale and knowledge, productivity growth and better health care, to respond to the challenges. These facts led to the Ordem dos Enfermeiros to develop a study that aimed to evaluate the impact of nursing care specialization and to analyze the budgetary and economic impact of the reintroduction of the career category specialist title within the specialty board. Methodology: there was a quantitative, comparative and prospective approach. The analysis had two distinct phases: in the first, predictions were generated for the evolution of nurses, in a state of invariant policies, creating the base scenario, for comparison; in the second, the specialty board was incorporated, in a prospective view, on the training of the new specialists per year, inferring on the consequent costs arising from the specialization of the nurses. As a starting point there were considered: 15,092 students enrolled in Nursing degree; 43,279 nurses working in the National Health System, of whom 9,954 are specialists and the remaining 33,325 are in general care. Results: The budgetary impact of the creation of a Nursing specialization board is positive, as a result of the expected savings in the number of hospitalizations, whose cost amounts to 1,800 million Euros per year. It is estimated that the budgetary impact of this measure, in a scenario of 2000 available positions for specialist nurses, will generate an average net benefit of about 18M € / year. Value to be achieved, as the specialist nurses are integrated, expecting a saving a minimum of 5% in hospital admissions. Indeed, the projections are based on gains of 5% in the hospitalization indicator, and are therefore very conservative, especially when the empirical evidence indicates that there may be a reduction of up to 23% in hospitalizations, up to 25% in prehospitalization and up to 31% in the time of hospitalization. To secure on the horizon of 15 years, a coverage rate of specialist nurses of 90% in primary health care, 50% in differentiated health care and 30% in long-term integrated care, it is estimated the setting of 3000 positions of boarding, per year. Conclusions: The introduction of improvements in the health system will imply a human capital investment of nurses, aiming at their qualification, facilitating the means that enable the acquisition and / or enhancement of their competencies. According to the report, the technical capacity and clinical competence deriving from specialization are factors of professional valorization, taking into account that "recognizing the role of specialist nurse is also a way to mitigate the negative effects of a discouraged workforce". The specialty boarding is an adequate instrument for the development process and professional appreciation of the Nurse, necessary for the assignment of the Professional Title of Specialist Nurse, allowing to confer, in a protocol form, specialized knowledge and expertise.

Including Families in Nursing Research

Session Introduction